counter a number of health challenges as they age and, on average, use a relatively large volume of health care services. However, the older adult population is quite heterogeneous, with individual members displaying an array of health statuses and needing a variety of services. Box 2-1 presents some hypothetical examples to illustrate the diversity of the current older population by describing several typical older adult profiles.

The chapter continues with a review of projections of the future health status and utilization patterns of older adults as well as a description of the assumptions and limitations of those projections. Although it is difficult to predict with accuracy the number and types of health services that will be demanded by older adults, it is clear that the total volume of health and long-term care services needed in the future will be much greater than the volume provided today.

The chapter concludes with a brief discussion of the implications of these projections. If current patterns continue, the financial and human resources required to meet the projected demand for services will be strained well beyond today’s supply.

THE HEALTH AND LONG-TERM CARE NEEDS OF OLDER ADULTS

The health status of older Americans has improved over the past several decades (Crimmins, 2004). Older adults today have greater longevity and less chronic disability than did those of previous generations (Federal Interagency Forum on Aging Related Statistics, 2006; Manton et al., 1997, 2007). While these improvements appear to be related in part to declines in smoking rates and better control of blood pressure (Cutler et al., 2007), the causation has not been conclusively proven. Studies also show improvements in the reported physical functioning of older adults, such as the ability to lift, carry, walk, and stoop (Freedman et al., 2002), as well as declines in limitations in instrumental activities of daily living (IADLs), such as shopping for groceries, preparing hot meals, using the telephone, taking medications, and managing money. The evidence for declines in limitations in activities of daily living (ADLs), such as eating, bathing, dressing, using the toilet, transferring (such as from bed to chair), and walking across the room is less strong (Freedman et al., 2004a). Finally, the percentage of older adults who self-report their health as “fair” or “poor” has declined (Martin et al., 2007). Despite these improvements, however, older adults still do have high rates of chronic disease and disability, particularly as compared to younger adults (Table 2-1), and disease prevalence has risen as longevity has increased (Crimmins, 2004).

It is important to note that if one looks just at aggregate data, such as those on disease prevalence (Table 2-1), it obscures important differences in



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