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Retooling for an Aging America: Building the Health Care Workforce
TABLE 2-2 Chronic Disease Prevalence, Cost, and Physician Use Among Medicare Beneficiaries
Number of Chronic Conditions
4 or more
Percent of all Medicare beneficiaries, 1999
Average Medicare expenditures, 1999
Percent that sees more than 10 different physicians per year, 2003
SOURCE: MedPAC, 2006; Wolff et al., 2002.
Medicare spending and 83 percent of Medicaid spending is for the provision of services to individuals with chronic conditions.
In addition, many older adults experience one or more geriatric syndromes, clinical conditions common among older adults that often do not fit into discrete disease categories. Examples include delirium, depression, falls, sensory impairment, incontinence, malnutrition, and osteoporosis. The syndromes tend to be multifactorial and result from an interaction between identifiable patient-specific impairments and situation-specific stressors (Flacker, 2003; Inouye et al., 2007). Geriatric syndromes are prevalent conditions even among community-dwelling older adults and can have a substantial effect on older adults’ quality of life (Cigolle et al., 2007). Estimates of incontinence, for example, range from 17 percent to 55 percent in older women and from 11 percent to 34 percent in older men. Almost half of older men and 34 percent of older women (ages 65 and older) report trouble hearing.
Although estimates vary across surveys, data from the 2002 Health and Retirement Study indicate that 27 percent of community-dwelling adults ages 65 and older (8.7 million people) need assistance with one or more ADLs or IADLs (Johnson and Wiener, 2006). Approximately 6 percent of older adults living in the community (2.0 million people) are severely disabled, reporting difficulty with 3 or more ADLs (Johnson, 2007). This group of older adults requires more intensive care in the home, particularly personal-care services.
Approximately 6.5 percent of older adults live in a long-term care facility. The majority, approximately 1.45 million, live in nursing homes, and approximately 750,000 live in other residential-care settings that provide some long-term care services (Spillman and Black, 2006). Those over age 85 are much more likely to live in a long-term care setting than younger older