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Americans are not only living longer, but they are living more robust lives, according to a new study that tracked chronic disability rates from 1982 to 1999.

Even as the elderly population has grown, the number of seniors needing help with routine activities such as bathing and eating fell sharply in the past decade, according to a report published today in the Proceedings of the National Academy of Sciences.

"This is very good news for a change -- for personal reasons as well as social reasons," said David Cutler, a health economist at Harvard University. "Given that we're going to live longer, it's better to live healthier than not."
Technological advances, healthier lifestyles and education are identified as likely explanations for the trend, a phenomenon that could mean dramatically lower costs for the government's Medicare and Social Security programs, the researchers said.

"People who are chronically impaired have high Medicare expenditures such as nursing homes," said Kenneth Manton, a Duke University researcher and co-author of the study.

In 1982, the study found, 6.2 percent of the nation's elderly were in nursing homes, compared to 3.4 percent in 1999. That decline of 400,000 nursing home residents translated into savings of $18.9 billion alone.

Chronic disability, defined in the study as impairments for three months or longer that impede daily activities, has been slowly falling since 1982. But the pace quickened in the 1990s.

Reviewing data in the National Long-Term Care Survey, the report's authors found that eight in 10 people over age 65 said they were able to care for themselves in 1999, the last year for which data is available. That figure represents an increase of nearly 8 percent from 1982.
The drop is disability was particularly striking among African Americans. 

Chronic disability among blacks increased throughout the 1980s and only began to drop after 1989. From 1982 to 1994, chronic disability fell 4.7 percent for black Americans. From 1994 to 1999, that rate dropped almost 6 percent.

Some of the reasons are straightforward: better diet, fewer smokers and widely available treatments for arthritis and cataracts, two of the most common causes of disability in the elderly. Preventive medicine for illnesses such as heart disease and less physically demanding jobs were also credited with keeping Americans healthy longer.

Most striking was the relationship between education and health -- again, most notably among blacks. Manton said there is increasing evidence that additional schooling (or increased brain activity) reduces the risk of Alzheimer's disease, a form of dementia that often renders patients unable to recognize family members or perform simple tasks such as dressing themselves.

From a socioeconomic perspective, Cutler said it makes sense that health would improve with education, noting that higher-paying jobs traditionally have led to better access to care. In addition, the more people learn about caring for themselves the more likely they are to exercise, eat properly and visit their doctor, he said.

Cutler cautioned that while reduced disability will "ameliorate" escalating health costs, the ever-growing elderly population and more expensive forms of care will continue to push total spending up.
"Medicare will still increase in spending," he said. "Clearly it is less costly to have healthier old people."

Armed with the new statistics, advocates for the elderly said it is time for policymakers to shift more resources into preventive care.
"What we are seeing is that health promotion and disease prevention are really cost-effective steps," said Bill Novelli, associate executive director of AARP, the retiree group that advocates a prescription drug benefit for Medicare recipients.

Dan Perry, executive director of the not-for-profit Alliance for Aging Research, said the debate over long-term care needs to be reoriented away from bemoaning the aging of the population to focusing on what keeps people well.

"We might be seeing trends in the right direction here that need to be stepped up a bit," he said.