Date Source and Date: Age-, sex-, and race-specific estimates of the number of persons with chronic disability from the 1982, 1984, 1989, 1994, and 1999 National Long-Term Care Survey (NLTCS),the use of nursing home beds by elderly persons in the 1985 to 1995 National Nursing Home Surveys (NNHS), and nursing home expenditures from the 1987 to 1996 Medical Expenditures Surveys (MEPS).
Research Methodology: All five NLTCS samples were drawn from Medicare administrative records. This list sample frame maintained near-perfect follow-up of persons across survey years (eliminating bias from loss to follow-up). The sample design for the 1982 NLTCS was drawn, using reduction sets of 5,000 persons, from 55,000 names drawn from Medicare lists. A reduction set was the predefined number of cases screened until a sufficient number of sets had been processed to identify 6,000 chronically disabled persons to receive detailed community interviews. Chronic disability rates were calculated by using as denominators estimates of the size of the population aged 65+ at risk made from sample-weighted counts of persons in each cell. In 1994 and 1999 NLTCS samples were supplemented three ways. First, an over-sample of persons age 95+ was drawn in 1994 (n = 540) and 1999 (n = 600) to improve the precision of estimates for this extreme elderly population. Second, to improve estimates made of the traits of nondisabled persons the sample receiving a detailed community interview was augmented in 1994 by 1,762 persons designated to receive a community interview even though they would not otherwise have received one based on their screen interview (sample component H).
Findings: Dramatic reductions in disability and nursing home use occurred for all age groups above 65, and were largest for persons older than 85.
Observation #1: The decline in disability rates is increasing at an accelerating pace.
| Time Period | Decline in Disability Rates Per Annum |
| 1982-1999 | 1.7% |
| 1982-1989 | 1.0% |
| 1989-1994 | 1.0% |
| 1994-1999 | 2.7% |
| 1982 | 1984 | 1989 | 1994 | 1999 | |
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| Distribution by disability, % | |||||
| Nondisabled | 73.8 | 73.8 | 75.6 | 77.5 | 80.3 |
| IADL only | 5.7 | 6.2 | 4.8 | 4.4 | 3.2 |
| 1 or 2 ADLs | 6.9 | 7.0 | 6.7 | 6.1 | 6.0 |
| 3 or 4 ADLs | 3.0 | 3.1 | 3.7 | 3.4 | 3.5 |
| 5 or 6 ADLs | 3.7 | 3.4 | 3.0 | 3.0 | 2.9 |
| Institutional | 6.8 | 6.6 | 6.1 | 5.7 | 4.2 |
Distribution by housing, % |
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| Housing units | 91.9 | 92.2 | 93.1 | 93.3 | 92.6 |
| Assisted-living community* | 0.0 | 0.0 | 0.0 | 0.0 | 2.3 |
| Nursing home | **6.2 | 5.9 | 5.8 | 5.4 | 3.4 |
| Others | 2.0 | 1.9 | 1.1 | 1.3 | 1.8 |
| Total disabled, % | 26.2 | 26.2 | 24.4 | 22.5 | 19.7 |
| Year | 82-89 | 89-94 | 94-99 | ||
| Standardized decline rate, % per year | 0.26 | 0.38 | 0.56 | ||
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| * Over 50% report no disability. | |||||
| ** Estimated by 1984 nursing home ratio (only community interviews were conducted in 1982). | |||||