of every dollar spent on prescriptions (Families USA, 2000). According to physician office records and hospital outpatient records, the most common medications used by older adults in 2004-2005 included anti-hypertensives (133.3 drugs per every 100 older adults), cholesterol control drugs (128.1), non-narcotic analgesics for pain relief (104.7), and diuretics for high blood pressure and heart disease (95.4) (NCHS, 2007). In 2002, prior to the implementation of Medicare Part D, the average Medicare enrollee aged 65 and older filled 32 prescriptions (including refills), but that number rose dramatically for individuals with greater numbers of chronic conditions. On average, enrollees with three or four chronic conditions filled an average of 44 prescriptions per year, and those with five or more filled 60 prescriptions per year (Federal Interagency Forum on Aging Related Statistics, 2006).

Besides the traditional forms of health care discussed so far, surveys on the use of complementary and alternative medicine (CAM) estimate that anywhere from 30 percent to 88 percent of older adults use some form of CAM. Studies often vary in terms of which forms of CAM are examined. According to data from the National Health Interview Survey, prayer for health is among the most common forms of CAM practiced among older adults (Barnes et al., 2004). Data from the Health and Retirement Study, which did not examine prayer, found that the most common forms of CAM used by older adults included dietary supplements (65 percent) and chiropractic services (46 percent), though personal practice (breathing exercises and meditation), massage therapy, and herbal supplements were also commonly used (Ness et al., 2005).

There are also a number of different types of providers, such as nurse practitioners, social workers, psychologists, dentists, and pharmacists, for which utilization data have not been discussed in this section. Visits to these providers are typically not captured by national surveys of older adults, but the numbers are likely to be considerable.

DIFFERENCES BY DEMOGRAPHIC CHARACTERISTICS

The data presented above mask important differences in the health status of and the health care service use by older adults in various demographic categories, including sex, race, and socioeconomic status. For example, women and men face different challenges in maintaining their health and have different patterns of service utilization. Men have higher rates of heart disease, cancer, diabetes, and emphysema and have more inpatient hospital stays than women (Robinson, 2007). On the other hand, women have higher rates of osteoporosis, arthritis, asthma, chronic bronchitis, and hypertension, and women are more likely to report depressive symptoms (Federal Interagency Forum on Aging Related Statistics, 2006). Because women have longer life expectancy than men and greater age-adjusted dis-



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