Working Paper: NBER ID: w14811
Authors: Gabriel Aranovich; Jay Bhattacharya; Alan M. Garber; Thomas E. Macurdy
Abstract: It is well known that disability rates among the American elderly have declined over the past decades. The cause of this decline is less well established. In this paper, we test one important possible explanation--that the decline in disability occurred because of chronic disease prevention efforts among the elderly. For this purpose we analyze data from the National Long Term Care Survey and from the National Health and Interview Survey. Our findings suggest that primary prevention, as reflected in decreased disease prevalence, was not responsible for advances made in elderly functioning between 1980 and 2000. We found a broad decline in less severe forms of disability that is unlikely to have resulted from improved disease management. Instead, these measured improvements in functioning may reflect environmental, technological, and/or socioeconomic changes. Improvements in the more severe forms of disability were modest and were restricted to those suffering from particular illnesses, which make improved and/or more aggressive management a plausible explanation and one that might increase costs should the trend persist.
Keywords: Chronic Disease; Disability; Elderly; Health Policy
JEL Codes: I10; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| decline in disability rates among the elderly (J14) | not due to primary prevention efforts related to chronic diseases (I12) |
| decline in disability rates among the elderly (J14) | reflects broader environmental, technological, and socioeconomic changes (F69) |
| improvements in functioning among the elderly (J14) | attributed to advances in disease management (I15) |
| decreased disease prevalence (I12) | not responsible for advancements in elderly functioning (J14) |
| chronic diseases like arthritis and heart disease (I12) | changes in disability rates (J14) |
| arthritis-related functional impairment (J14) | dropping by 19% during the 1990s (F66) |
| heart disease-related impairment (I12) | dropping by 24% during the 1990s (F66) |
| less severe forms of disability (I12) | improved significantly (O52) |
| more severe disabilities (ADLs) (I12) | improvements were modest (O49) |