The risk of chronic and disabling conditions increases with age. As more of the elderly live to the oldest ages, increasing numbers will face chronic, limiting illnesses or conditions. The prevalence of these major chronic conditions among the elderly is five times that observed in younger persons. These conditions result in dependence on others for assistance in performing the activities of daily living (ADL), especially among the older elderly, portending a significant increase in the need for health care and social support services.

A person's health declines in older ages because of age-related chronic conditions and disabilities. The proportion of persons needing assistance in everyday activities increases with age. These facts suggest that a large number of elderly will seek hospitalization for serious acute and chronic conditions and they will seek long-term care as part of a continuum of care from independent living to assisted living to institutional care.

Alzheimer's disease is the leading cause of dementia in old age. The risk of the disease rises sharply with advancing age, from less than 4 percent of noninstitutionalized persons 65 to 74 years old to nearly half of those 85 years and older. It afflicted an estimated 3.8 million noninstitutionalized elderly in 1990 (Evans et al., 1990). It is a major reason for older persons' being institutionalized. If no breakthrough occurs in prevention or cure, the prevalence of Alzheimer's disease will increase substantially in the years ahead as the oldest age groups in the elderly population increase. In 2050, the number of persons 65 and older affected by Alzheimer's disease is estimated to be around 7.5 million. Increases in the oldest age groups will account for most of the projected increases over this period if no treatment has been found (Evans et al., 1990). The number in the 65- to 74-year age group is expected to rise only moderately. In contrast, the number affected by this disease in the age group 85 and older will increase almost sevenfold by 2050. These numbers indicate the magnitude of the problem, today and in the future.

Use of Health Services

The aging of the population affects the demand for all health care services, including hospitals, and long-term care. Older persons use more health services than their younger counterparts because they have more health problems. They are also hospitalized more often and have longer lengths of stay than younger persons. The growth of the elderly population is likely to result in increases in inpatient admissions. (Some signs of that happening are reflected in recent statistics as discussed in Chapter 3.)

Thus, hospitals will have to increase their sensitivity and ability to care for the acutely ill aging population. An increase in the number of elderly patients requiring more assistance in all aspects of their care, including ADLs, will impact on staffing requirements for nursing services in hospitals. Moreover, as the length of stay in hospitals declines in general, the emphasis on discharge planning

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