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or engagement may facilitate a more refined understanding of the shifts in population-level disability trends. Sorting out the roles of factors earlier in life may require panel surveys that start earlier in life. Inclusion of a standardized core set of disability measures that apply across all ages, as well as life course-specific measures, also may prove useful.

Looking forward, there is debate about the implications of these trends for public and private expenditures18,47-49. Some researchers are optimistic that the declines in rates of late-life disability will ultimately lead to (all else being equal) lower medical costs; others are dubious about whether declines will ultimately lead to savings. Whether declines in late-life disability will continue into the future is unclear, given, for example, the impending increases in rates of obesity50 and related chronic conditions and the slowing increases in educational attainment30.

Indeed, the impending growth of the older population suggests that it will be important to continue to achieve declines in rates of late-life disability. Projections of the size of the older population with disabilities, which depend upon assumptions about mortality and disability rates into the future, suggest that declines in disability rates will need to continue at the rates observed during the 1990s (on average, 1 to 2 percent per year) for this group to remain stable51. Projections that assume much lower rates of decline portend large increases in the number of older people with a disability, from 6 million today to 10 million in 205052. How these population shifts will influence the composition of the population of people with disabilities is unclear and merits further study.

REFERENCES

1. Fries J. Aging, natural death, and the compression of morbidity. New England Journal of Medicine 1980;303(3):130–135.

2. Gruenberg EM. Failures of success. Milbank Memorial Fund Quarterly 1977;55(1):3–24.

3. Manton KG. Changing concepts of morbidity and mortality in the elderly population. Milbank Memorial Fund Quarterly 1982;60(2):183–244.

4. Freedman VA, Martin LG, Schoeni RF. Recent trends in disability and functioning among older adults in the United States: a systematic review. Journal of the American Medical Association 2002;288(24):3137–3146.

5. Crimmins E. Trends in the health of the elderly. Annual Review of Public Health 2004; 25(1):79.

6. Schoeni R, Freedman V, Martin L. Socioeconomic and demographic disparities in trends in old-age disability. University of Michigan Center for Demography of Aging Trends Network Working Paper Series 05-01. Ann Arbor: University of Michigan Center for Demography of Aging Trends Network; 2004.

7. Schoeni R, Martin L, Andreski P, Freedman V. Persistent and Growing Socioeconomic Disparities in Disability Among the Elderly: 1982-2002. American Journal of Public Health, 2005;95(11):2065-2070.



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