OLDER
AMERICANS
2010
Key Indicators of Well-Being
            FEDERAL
            ' INTERAGENCY
            FORUM ON
            RELATED
            STATISTICS

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The Federal Interagency Forum  on Aging-Related Statistics
The Federal Interagency Forum on Aging-Related Statistics (Forum) was founded in 1986 to foster
collaboration among federal agencies that produce or use statistical data on the older population. Forum
agencies as of July 2010 are listed below.
Department of Commerce
U.S. Census Bureau
http://www.census.gov

Department of Health and Human Services
Administration on Aging
http://www.aoa.gov

Agency for Healthcare Research and Quality
http: //www.ahrq .gov

Centers for Medicare and Medicaid Services
http ://www. cms .hhs .gov

National Center for Health Statistics
http: //www.cdc .gov/nchs

National Institute on Aging
http://www.nia.nih.gov

Office of the Assistant Secretary for Planning and
Evaluation
http: //www.aspe .hhs .gov

Substance Abuse and Mental Health Services
Administration
http://www.samhsa.gov

Department of Housing and Urban
Development
http://www.hud.gov
Department of Labor
Bureau of Labor Statistics
http://www.bls.gov

Employee Benefits Security Adminstration
http ://www.dol .gov/ebsa

Department of Veterans Affairs
http://www.va.gov

Environmental Protection Agency
http://www.epa.gov

Office of Management and Budget
Office of Statistical and Science Policy
http://www.whitehouse.gov/omb/inforeg/statpolicy.
html

Social Security Administration
Office of Research, Evaluation, and Statistics
http://www.ssa.gov
Copyright information: All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation
as to source, however, is appreciated. Recommended citation: Federal Interagency Forum on Aging-Related Statistics. Older Americans 2010: Key
Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office. July 2010.
Report availability:  Single copies of this report are available at no charge through the National Center for Health Statistics while supplies last.
Requests may be sent to the Information Dissemination Staff, National Center for Health Statistics, 3311 Toledo Road, Room 5412, Hyattsville,
MD 20782. Copies may also be ordered by calling 1-866^141-NCHS (6247) or by e-mailing nchsquciy@cdc.gov. This report is also available on
the World Wide Web at http://www.agingstats.gov.

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OLDER
AMERICANS
2010

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Foreword

Americans age 65  and over  are  an important
and growing segment of our population. Many
federal agencies provide data on aspects of older
Americans' lives,  but it can be difficult to fit the
pieces together. Thus, it has become increasingly
important for policymakers and the general public
to have an accessible, easy-to-understand portrait
that shows how older Americans are faring.

Older Americans  2010: Key Indicators of Weil-
Being  (Older  Americans   2010)  provides  a
comprehensive  picture of our older population's
health and well-being.  It is the fifth chartbook
prepared by the Federal Interagency  Forum on
Aging-Related  Statistics  (Forum),  which  now
has 15 participating federal agencies.  As  with
the  earlier volumes, readers will  find here an
accessible compendium of indicators drawn from
the most reliable official statistics.  The indicators
are  again categorized  into  five broad groups:
population, economics, health status, health risks
and behaviors, and health care.

Many of the estimates reported in Older Americans
2010 were collected in 2007 and 2008, the years
straddling the large-scale financial downturn that
began in December 2007.   Thus,  although this
was an economically challenging  time, the data
reported in Older Americans 2010 do not in all
cases  reflect this crisis. The Forum did produce
a short report, Data Sources on the Impact of the
2008  Financial Crisis on  the Economic Well-
being of Older Americans at the end of 2009 that
provides information about data sources that may
shed light on the effects of the economic downturn
on the well-being of older Americans.

While  federal  agencies  currently  collect and
report substantial  information on the population
age 65  and over,  there  remain  gaps in  our
knowledge.  Two  years ago, in Older Americans
2008, the Forum  identified six data need areas:
caregiving, elder abuse, functioning and disability,
mental health, pension measures, and  residential
care. In Older Americans 2010, we provide updated
information  on the status of data availability for
those  specific areas and add a new call for data
on end-of-life issues. We continue to  appreciate
users' requests for greater detail for many existing
indicators of well-being. The Forum encourages
extending age reporting categories,  oversampling
older racial and ethnic populations, collecting data
at lower levels of geography, and including the
institutionalized  population in national surveys.
By displaying what we know and do not know,
this report  challenges federal statistical agencies
to do even better.

The  Older Americans reports reflect the Forum's
commitment to advancing our understanding of
where older Americans stand today and what they
may face tomorrow.  I  congratulate the Forum
agencies for joining together to enhance their work
and present the American people with a valuable
tool. Last,  but not least, none of this work would
be possible without the  continued cooperation
of millions of American citizens who willingly
provide the data that are summarized and analyzed
by staff in the federal agencies.

We invite you to  suggest ways in which we can
enhance this biennial portrait of older Americans.
Please  send  comments  to  us  at the  Forum's
website (http://www.agingstats.gov). I hope that
our compendium will continue to be useful in
your work.

Katherine  K. Wallman
Chief Statistician
Office of Management and Budget

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Acknowledgments

Older Americans 2010: Key Indicators of We II-
Being is a report of the Federal Interagency Forum
on Aging-Related Statistics (Forum). This report
was prepared by the Forum's planning committee
and reviewed by the Forum's principal members,
which include Edwin L. Walker, Administration
on Aging (AoA);  Steven  B.  Cohen, Agency
for Healthcare Research and Quality (AHRQ);
Thomas Nardone, Bureau  of  Labor Statistics
(BLS); Howard Hogan, U.S.  Census Bureau;
Thomas  Reilly,  Centers  for   Medicare and
Medicaid Services (CMS); Raphael W.  Bostic,
Department of Housing and Urban Development
(HUD); Joseph Piacentini,  Employee  Benefits
Security Administration (EBSA); Peter Grevatt,
Environmental Protection Agency (EPA); Edward
Sondik, National  Center  for Health Statistics
(NCHS);  Richard Suzman, National Institute on
Aging (NIA); Ruth Katz, Office of the Assistant
Secretary for  Planning and Evaluation (ASPE),
Department  of Health and  Human  Services;
Katherine K.  Wallman, Office  of  Management
and  Budget  (OMB);  Daryl Kade,  Substance
Abuse and Mental Health Services Administration
(SAMHSA); Manuel de la Puente, Social Security
Administration (SSA); and Dat Tran, Department
of Veterans Affairs (VA).

The following members of the  Forum agencies
reviewed the  chartbook and provided valuable
guidance  and assistance: Nancy Gordon, U.S.
Census Bureau; Jennifer Madans, NCHS; William
Marton, ASPE; John Haaga, NIA; Anja Decressin,
EBSA, and Susan Grad, SSA.

The  Forum's  planning committee  members
include Saadia Greenberg, AoA; David Kashihara
and D.E.B. Potter, AHRQ; Emy  Sok, BLS; Amy
Symens Smith and Wan He, U.S. Census Bureau;
Gerald Riley, CMS; Meena Bavan and Cheryl
Levine, HUD; Miranda Moore and Daniel Puskin,
EBSA; Kathy Sykes, EPA; Ellen Kramarow and
Julie Dawson Weeks, NCHS; Elizabeth Hamilton,
NIA; He lenZayac Lament, ASPE; Roche lie Wilkie
Martinez, OMB; Ingrid Goldstrom,  Beth Han,
and Jennifer Solomon,  SAMHSA; Howard lams,
SSA; Dorothy Glasgow and Cathy Tomczak, VA;
and the Forum's Staff Director, Elena M. Fazio.
to contribute to this report.  The Forum greatly
appreciates the efforts of Patricia Guenther, Hazel
Hiza, and Kellie O'Connell, Center for Nutrition
Policy  and  Promotion,  USDA,  in  providing
valuable information from their agency.

Other staff members of federal agencies  who
provided data and  assistance include  Jennifer
Klocinski, AoA; Rachel Krantz-Kent and Geoffrey
Paulin, BLS;  Jean Bradley and Marcella Jones-
Puthoff, U.S.  Census  Bureau; Rick Andrews,
Franklin Eppig, Deborah Kidd, Chris McCormick,
Maggie Murgolo, and Joseph Regan, CMS; Ellen
Baldridge, EPA;  Carolyn  Lynch, HUD; Robert
Anderson, Amy  Bernstein,   Mary Ann Bush,
Liming Cai, Robin Cohen, Nazik Elgaddal, Ginny
Freid, Lauren Harris-Kojetin, Melonie Heron, and
Rhonda Robinson, NCHS; Vicky Cahan, NIA;
Anne DeCesaro and Lynn Fisher, SSA; and Peter
Ahn, Linda Bergofsky, and Jin Kim, VA.

The Forum is  also indebted to the people outside
the federal government who contributed to this
chartbook: Cathy Liebowitz, Mohammed Kabeto,
Kate McGonagle, Robert Schoeni, Frank Stafford,
and David Weir, University of Michigan.

Member   agencies  of  the  Forum   provided
funds and valuable staff  time  to  produce this
report.     NCHS  and  its  contractor,  NOVA
Research Company, facilitated the production,
printing,  and  dissemination   of  this   report.
Zorica  Tomic-Whalen,  NOVA, designed  the
layout and supervised the overall presentation of
the report;  Zorica Tomic-Whalen and Ode 11  D.
Eldridge, NOVA,  designed and produced the data
tables. RichardDevens, FirstXVCommunications,
provided  consultation  and  editing  services;
Demarius  V.  Miller, CDC,  provided  editorial
oversight and review. Patricia L. Wilson, CDC,
managed the printing of the report.
In addition to the 15 agencies of the Forum, the
Department of Agriculture (USDA) was invited

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About this Report

Introduction

Older Americans 2010:  Key Indicators of Well-
Being  (Older Americans 2010)  is the fifth  in
a  series  of reports  produced  by the Federal
Interagency Forum  on Aging-Related Statistics
(Forum) that describe the overall status  of the
U.S. population age 65 and over. Once again, this
report uses data from over a dozen national data
sources to construct broad indicators of well-being
for the older population and to monitor changes
in these indicators over time. By following these
data trends, more accessible information will be
available to target efforts to improve the lives  of
older Americans.

With the exception  of the indicator on nursing
home utilization,  for  which new data are not
available at this time,  all  indicators  from the
last  edition reappear in Older Americans 2010.
The  Forum hopes that this  report will stimulate
discussions  by policymakers  and  the  public,
encourage  exchanges  between  the  data  and
policy  communities, and  foster  improvements
in federal  data collection on older Americans.
By  examining  a  broad  range of  indicators,
researchers, policymakers, service providers, and
the federal  government can better understand the
areas of well-being that are improving for older
Americans  and the areas of well-being that require
more attention and effort.

Structure of the Report

Older Americans 2010 is  designed  to  present
data in  a nontechnical, user-friendly  format;
it  complements  other  more   technical  and
comprehensive reports produced by the individual
Forum agencies. The report includes 37 indicators
that  are grouped into five sections:  Population,
Economics, Health Status,  Health  Risks  and
Behaviors, and Health Care. A list of the indicators
included in this report is located in the Table  of
Contents on page IX.
Each indicator includes the following:

0 An introductory paragraph that describes the
   relevance of the indicator to the well-being of
   the older population.

V One or more charts that graphically display
   analyses of the data.

V Bulleted highlights of salient findings from the
   data and other sources. The data used to develop
   the indicators and their accompanying bullets are
   presented in table format in Appendix A. Data
   source descriptions are provided in Appendix
   B. A glossary is supplied in Appendix C.

Selection Criteria for Indicators

Older Americans 2010 presents 37 key indicators
that measure  critical aspects of older  people's
lives.  The Forum chose these indicators because
they meet the following criteria:

V Easy  to  understand  by a  wide  range  of
   audiences.

0 Based on  reliable, nationwide data (sponsored,
   collected,  or disseminated  by  the federal
   government).

V Objectively  based on  substantial  research
   that connects them to the well-being of older
   Americans.

0 Balanced  so that no single area dominates the
   report. Measured periodically (not necessarily
   annually)   so  that they  can be  updated as
   appropriate and show trends over time.

0 Representative of large segments of the aging
   population, rather than one particular group.

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Considerations When Examining
the Indicators

Older  Americans  2010  generally  addresses the
U.S.  population age  65  and  over.  Mutually
exclusive age groups (e.g., age 65-74, 75-84, and
85 and over) are reported whenever possible.

Data  availability and  analytical relevance  may
affect the specific age groups that are included for
an indicator. For example, because of small sample
sizes  in  some surveys, statistically reliable data
for the population age 85 and over often are not
available. Conversely, data from the population
youngerthan age 65 sometimes are included if they
are relevant to the interpretation of the indicator.
For example,  in "Indicator 11: Participation in
the Labor Force," a comparison with a younger
population enhances the interpretation of the labor
force trends among people age 65 and over.
To standardize the age distribution of the 65 and
over population across years, some estimates have
been age adjusted by multiplying age-specific rates
by age-specific weights.  If an indicator has been
age adjusted,  it will be stated in the note  under
the chart(s) as well as under the corresponding  Survey Years
table(s) in Appendix A.
However, some indicators  show  data  only for
the  civilian   noninstitutionalized  population.
Because the older population residing in nursing
homes  (and  other  long-term care  institutional
settings) is excluded from samples based on the
noninstitutionalized population, caution  should
be exercised when  attempting to  generalize the
findings from these data sources to the entire
population age 65 and over. This is  especially true
for the  older age groups. For example  in 2008,
only 86 percent of the population age 85 and over
was  included in the civilian noninstitutionalized
population as defined by the U.S. Census Bureau.
  Civilian noninstitutionalized population as a percentage of the total
  resident population by age July 1, 2008
  Percent
  100
  90
Because the older population is becoming more
diverse,  analyses  often are presented by sex,
race and Hispanic  origin,  income, and  other
characteristics.

Updated indicators in Older Americans 2010 are
not always comparable to indicators  in  Older
Americans 2000, 2004,  Update 2006,  or  Older
Americans  2008.  The  replication  of certain
indicators with updated data is sometimes difficult
because  of changes  in data sources, definitions,
questionnaires,  and/or  reporting  categories.  A
comparability table is available on  the Forum's
website  at http://www.agingstats.gov  to  help
readers understand the  changes that have  taken
place.

The reference population  (the base population
sampled at the time of data  collection) for each
indicator is clearly labeled under each chart and
table  and  defined in the  glossary. Whenever
possible, the indicators include data on the U.S.
resident  population  (i.e.,  people  living  in the
community and  people living  in  institutions).
In the charts, tick marks along the x-axis indicate
years for which  data are  available.  The range
of years presented in each chart varies because
data availability is  not uniform across the  data
sources.  To standardize the time  frames  across
the indicators, a timeline has been placed at the
bottom of each indicator that reports data for more
than one year.

1900 1910   1920  1930  1940  1950  1960 1970 1980   1990 2000  2010

Accuracy of the  Estimates

Most estimates in this report are based on a sample
of  the  population  and  are,  therefore, subject
to sampling error.  Standard tests  of statistical
significance have been used to determine whether
the  differences  between populations  exist  at
generally accepted levels of confidence or whether
they occurred by chance. Unless otherwise noted,
only differences that are statistically significant at
the 0.05 level are discussed in the text. To indicate
the reliability of the estimates,  standard errors for

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selected estimates in the chartbook can be found
on the Forum's website at http://www.agingstats.
gov.

Finally, the data in some indicators may not sum
to totals because of rounding.

Sources of Data

The data used to create the charts are provided in
tables in the back of the report (Appendix A). The
tables also contain data that are described in the
bullets below each chart. The source  of the data
for each indicator is noted below the chart.

Descriptions of the data sources can be found in
Appendix B.  Additional information about these
data sources is available on the Forum's  website
at http://www.agingstats.gov.

Occasionally, data from another publication are
included to give a more complete explanation of
the indicator. The citations  for these sources are
included in the "References" section (page 66).
For those who wish to access the survey data used
in this chartbook, contact information is given for
each of the data sources in Appendix B.

Data Needs

Because Older Americans 2010 is a collaborative
effort of many federal agencies, a comprehensive
array of data  was available for inclusion  in
this report. However,  even with all of the data
available, there are still areas where scant data
exist. Although the indicators that were chosen
cover a broad range of components that affect
well-being, there are other issues that the Forum
would like to address in the future. These issues
are  identified  in  the  "Data  Needs"  section
(page 63).

Mission
The Forum's mission is to encourage cooperation
and  collaboration among  federal agencies  to
improve  the quality  and utility  of data  on the
aging population.  To accomplish  this mission,
the Forum provides  agencies with a venue  to
discuss data issues and concerns that cut across
agency boundaries, facilitates the development of
new  databases, improves mechanisms currently
used to disseminate information on aging-related
data, invites researchers to report on cutting-edge
analyses  of data,  and encourages international
collaboration.

The specific goals of the Forum are  to improve
both the  quality and use  of data  on the  aging
population by:

0 Widening access to information on the  aging
  population through periodic publications and
  other means.

V Promoting   communication   among   data
  producers,  researchers,  and  public  policy-
  makers.

V Coordinating  the  development and  use  of
  statistical databases among federal agencies.

V Identifying   information  gaps  and   data
  inconsistencies.

0 Investigating questions of data quality.

0 Encouraging cross-national research and data
  collection on the aging population.

V Addressing  concerns  regarding  collection,
  access, and dissemination of data.

Financial Support

The Forum members provide funds and valuable
staff time to support the activities of the Forum.

More Information
If you would like more information about Older
Americans  2010  or other  Forum  activities,
contact:

Elena M. Fazio, Ph.D.
Staff Director
Federal Interagency Forum on Aging-Related
Statistics
3311 Toledo Road, Room 6321
Hyattsville, MD 20782
Phone:(301)458-4460
Fax:(301)458-4038
E-mail:
Website: http ://www.agingstats .gov

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Older Americans on the Internet

Supporting material for this report can be found
at http://www.agingstats.gov. The website
contains the following:

V Data  for  all  of  the indicators  in Excel
  spreadsheets  (with  standard  errors, when
  available).

V Data source descriptions.

0 PowerPoint slides of the charts.

V A comparability table explaining the  changes
  to the indicators that have taken place between
  Older Americans 2000, 2004, Update 2006,
  Older Americans 2008, and Older Americans
  2010.

The Forum's website also provides:

V Ongoing federal data resources relevant to the
  study of the aging.

V Links  to  aging-related statistical information
  on Forum member websites.

V Other  Forum  publications (including  Data
  Sources on Older Americans 2009).

V Workshop presentations, papers, and reports.

V Agency contacts.

V Subject area contact list for federal statistics.

0 Information about the Forum.

Additional Online Resources

Administration on Aging
Statistics on the Aging Population
http://www.aoa.gov/AoARoot/Aging_Statistics/
index.aspx

A Profile of Older Americans
http://www.aoa.gov/AoARoot/Aging_Statistics/
Profile/index.aspx

Online Statistical Data on the Aging
http://www.aoa.gov/AoARoot/Aging_Statistics/
Census_Population/census 1990/Introduction.
aspx
Agency for Healthcare Research and Quality
AHRQ Data and Surveys
http: //www. ahrq. go v/data

Bureau of Labor Statistics
Bureau of Labor Statistics Data
http ://www. stats .bis .gov/data

U.S. Census Bureau
Statistical Abstract of the United States
http: //www. census .gov/compendia/statab

Age Data
http: //www. census .gov/population/www/
socdemo/age .html

Longitudinal Employer-Household Dynamics
http://lehd.did.census.gov/led/

Centers for Medicare and Medicaid Services
CMS Data and Statistics
http: //www. cms .hhs .gov/home/rsds. asp

Department of Housing and Urban
Development
Policy Development and Research Information
Services
http://www.huduser.org/

Department of Veterans Affairs
Veteran Data and Information
http://wwwl .va.gov/vetdata

Employee Benefit Security Administration
EBSA's Research
http://www.dol.gov/ebsa/publications/research.
html

Environmental Protection Agency
Aging Initiative
http: //www. epa.gov/aging

Information Resources
http://www.epa.gov/aging/resources/index.htm

National Center for Health Statistics
Health Data Interactive
http: //www. cdc.gov/nchs/hdi .htm

Longitudinal Studies of Aging
http: //www. cdc.gov/nchs/lsoa.htm

Health, United States
http: //www. cdc.gov/nchs/hus .htm

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National Institute on Aging
NIA Centers on the Demography of Aging
http://www.agingcenters.org/

National Archive of Computerized Data on Aging
http://www.icpsr.umich.edu/NACDA

Publicly Available Datasets for Aging-Related
Secondary Analysis
http://www.nia.nih.gov/researchinformation/
scientificresources

Office of the Assistant Secretary for Planning
and Evaluation, HHS
Office of Disability, Aging, and Long-Term Care
Policy http://www.aspe.hhs.gov/_/office_specific/
daltcp.cfm

Office of Management and Budget
Federal  Committee on Statistical Methodology
http://www.fcsm.gov

Social Security Administration
Social Security Administration Statistical
Information
http://www.ssa.gov/policy

Substance Abuse and Mental Health Services
Administration
Office of Applied Studies
http://www.oas.samhsa.gov

Center for Mental Health Services
http: //www.mentalhealth. samhsa.gov/cmhs/
MentalHealthStatistics

Other Resources
FedStats.gov
http://www.fedstats.gov

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Table of Contents
Foreword
Acknowledgments
About This Report
List of Tables
Highlights
.11
.m
.IV
.X
.XIV
                                                  Indicator 34: Sources of Payment for
                                                  Health Care Services	
                                                  Indicator 35: Veterans' Health Care	
                                                  Indicator 36: Residential Services	
                                                  Indicator 37: Personal Assistance
                                                  and Equipment	
                                                Data Needs
Population                              i    References
  Indicator 1: Number of Older Americans	2    Appendix A: Detailed Tables.
  Indicator 2: Racial and Ethnic Composition	4
  Indicator 3: Marital Status	5    Appendix  B: Data
  Indicator 4: Educational Attainment	6    Source Descriptions	
  Indicator 5: Living Arrangements	8    Appendix  Cl Glossary	
  Indicator6: Older Veterans	9      rr                    J

Economics                              n
  Indicator?: Poverty	12
  Indicator 8: Income	13
  Indicator 9: Sources  of Income	14
  Indicator 10:  Net Worth	16
  Indicator 11:  Participation in the Labor Force	18
  Indicator 12:  Total Expenditures	20
  Indicator 13:  Housing Problems	21

Health Status                           23
  Indicator 14:  Life Expectancy	24
  Indicator 15:  Mortality	26
  Indicator 16:  Chronic Health Conditions	27
  Indicator 17:  Sensory Impairments
  and Oral Health	28
  Indicator 18:  Respondent-
  Assessed Health Status	29
  Indicator 19:  Depressive Symptoms	30
  Indicator 20:  Functional Limitations	32

Health Risks and Behaviors          35
  Indicator 21:  Vaccinations	36
  Indicator 22:  Mammography	37
  Indicator 23:  Diet Quality	38
  Indicator 24:  Physical Activity	39
  Indicator 25:  Obesity	40
  Indicator 26:  Cigarette Smoking	41
  Indicator 27:  Air Quality	42
  Indicator 28:  Use of Time	44

Health Care                            47
  Indicator 29:  Use of Health Care Services	48
  Indicator 30:  Health Care Expenditures	50
  Indicator 31:  Prescription Drugs	52
  Indicator 32:  Sources of Health Insurance	54
  Indicator 33:  Out-of-Pocket
  Health Care Expenditures	55
.56
.57
.58
..60
.63

.66

.71


.135

.145

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List of Tables


Population

Indicator 1: Number of Older Americans

Table la. Number of people  age 65 and over
and 85 and over, selected years  1900-2008 and
projected 2010-2050	72

Table Ib. Percentage of the population age 65 and
over and 85 and over,  selected years 1900-2008
and projected 2010-2050	73

Table Ic. Population of countries or areas with
at least 10 percent of their population age 65 and
over, 2008	74

Table Id. Percentage of the population age 65 and
over, by state, July 1, 2008	75

Table le. Percentage of the population age 65 and
over, by county, 2008	76
Indicator 6: Older Veterans

Table 6a. Percentage of people age 65 and over
who are veterans, by sex and age group, United
States and Puerto Rico, 2000 and projected 2010
and 2020	79

Table 6b. Estimated  and projected  number of
veterans age 65 and over, by sex and age group,
United States and Puerto Rico, 2000 and projected
2010 and 2020	80

Economics

Indicator 7: Poverty

Table 7a. Percentage of the population living in
poverty, by age group, 2007	81

Table 7b.  Percentage of the  population age 65
and  over   living in  poverty,   by  selected
characteristics, 2007	82

Indicators: Income
Table If Number and percentage of people age 65   Table 8a. Income distribution of the population
and over and 85 and over, by sex, 2008	76   age 65 and over, 1974-2007	83

Indicator 2: Racial and Ethnic Composition      Table 8b. Median income of householders age 65
                                              and over, in current and 2007 dollars, 1974-2007
Table 2. Population age 65 and over, by race and                                           34
Hispanic origin, 2008 and projected 2050	76
                                              Indicator 9: Sources of Income
Indicator 3: Marital Status
                                              Table  9a.  Distribution  of sources of income
Table 3. Marital status of the population age 65   for age units  (married couples  and nonmarried
and over,  by age group and sex, 2008	77   persons) 65 or oide]; selected years, 1962-2008
                                                                                      85
Indicator 4: Educational Attainment

Table  4a.   Educational   attainment  of  the   Table 9b. Sources of income for married couples
population   age   65   and   over,   selected   and nonmarned peopb who are age 65 and over,
years 1965-2008	77   ^ income ^intile' 2ฐฐ8	85

Table  4b.   Educational   attainment  of  the   Table 9C. Percentage of people age 55 and over
     , ,.       rr    ,      ,         ,  o-        with family income from specified sources, by age
population age 65 and over, by race and  Hispanic           -f              F                 
  •  •  onno                             -70   group, 2008	86
origin, 2008	78   ฐ   ^
T  ,.  .   r  T . .    ป           *                Indicator 10: Net Worth
Indicator 5: Living Arrangements
rr 1.1  e   i  • •                 r^-i       i  +•      Table 10. Median household net worth of head
Table 5a. Living arrangements of the population    „,     , ,, ,     ,    , ,       ...
    ,-f   ,      .          i        JTT--OI household, by selected characteristics, in 2005
age 65 and over, by sex and race and  Hispanic   , „      ,     ,                          „„
  .  .  9nnfi                             7Q   dollars, selected years 1984-2007	87
origin, ZUUo	 /o
„,,.,„,.        re   i     i      i       Indicator 11: Participation in the Labor Force
lable 5b.  Population age 65 and over living alone,                     r
by age group and sex,  selected years 1970-2008   Table  n Labor force partlclpation of persons
	 '9   age  55  and over, by age group  and sex, annual
                                              averages, 1963-2008	88

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Indicator 12: Total Expenditures

Table 12. Percentage of total household annual
expenditures   by  age   of  reference  person,
2008	89

Indicator 13: Housing Problems

Table 13a. Percentage of households with residents
age 65 and over that report housing problems, by
type of problems, selected years 1985-2007... 89

Table 13b. Percentage of all U.S. households that
report housing problems, by  type of problem,
selected years 1985-2007	91

Health Status

Indicator 14: Life Expectancy

Table 14a. Life expectancy, by age and sex, selected
years 1900-2006	93

Table  14b. Life  expectancy,  by  age  and  sex,
2006	93

Table 14c. Average life expectancy at age 65, by
sex and selected countries or areas, selected years
1980-2005	94

Indicator 15: Mortality

Table  15a.  Death rates  for selected leading
causes of death among people age 65  and over,
1981-2006	95

Table 15b. Leading causes of death among people
age 65 and over, by sex and race and Hispanic
origin, 2006	96

Table 15c. Leading causes of death among people
age 85 and over, by sex and race and Hispanic
origin, 2006	98

Indicator 16: Chronic Health Conditions

Table  16a. Percentage  of people age 65  and
over  who reported  having  selected chronic
health   conditions,   by    sex,   2007-2008
	100

Table 16b. Percentage of people age 65 and over
who  reported  having selected   chronic  health
conditions, 1997-2008	100
Indicator 17: Sensory Impairments and Oral
Health

Table 17a. Percentage of people age 65 and over who
reported having any trouble hearing, trouble seeing,
or no natural teeth, by selected  characteristics,
2008	101

Table 17b. Percentage of people age  65 and over
who reported ever having worn a  hearing aid,
2008	101

Indicator  18:   Respondent-Assessed   Health
Status

Table 18. Respondent-assessed health status among
people age 65 and over, by selected  characteristics,
2006-2008	102

Indicator 19: Depressive Symptoms

Table 19a. Percentage of people age  65 and over
with clinically relevant depressive  symptoms, by
sex, selected years 1998-2006	103

Table 19b. Percentage of people age  65 and over
with clinically relevant depressive  symptoms, by
age group and sex, 2006	103

Indicator 20: Functional Limitations

Table 20a. Percentage of Medicare enrollees age 65
and over who have limitations in activities of daily
living (ADLs) or instrumental  activities of daily
living (lADLs), or who are in a facility,  selected
years 1992-2007	104

Table 20b. Percentage of Medicare enrollees age 65
and over who have limitations in activities of daily
living (ADLs) or instrumental  activities of daily
living (lADLs), or who are  in  a facility,  by sex,
2007	104

Table    20c:    Percentage    of    Medicare
enrollees age 65 and  over who  are unable  to
perform certain physical functions, by sex, 1991
and 2007	105

Table 20d: Percentage  of Medicare enrollees  age
65 and over who are unable to perform any one of
five physical functions,  by selected  characteristics,
2007	105

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Health Risks and Behaviors

Indicator 21: Vaccinations

Table 2 la. Percentage of people age 65 and over
who  reported having  been  vaccinated  against
influenza   and   pneumococcal   disease,   by
race  and   Hispanic   origin,   selected  years
1989-2008	106

Table 21b. Percentage of people age 65 and over
who  reported having  been  vaccinated  against
influenza and pneumococcal disease, by selected
characteristics, 2008	106

Indicator 22: Mammography

Table   22.    Percentage    of   women   who
reported  having  had  a   mammogram   within
the past 2  years,   by  selected  characteristics,
selected years 1987-2008	107

Indicator 23: Diet Quality

Table 23. Average dietary component scores as a
percent of federal diet quality standards, population
age 65 and older, by age group, 2003-2004.... 108

Indicator 24: Physical Activity

Table  24a.   Percentage  of  people  age   45
and  over who   reported   engaging in  regular
leisure time  physical  activity,  by  age   group,
1997-2008	109

Table 24b. Percentage of people age 65 and over
who reported  engaging in regular leisure time
physical  activity, by  selected  characteristics,
2007-2008	109

Indicator 25: Obesity

Table 25. Body  weight status  among  persons
65 years  of age and  over, by sex and age group,
selected years 1976-2008	110

Indicator 26: Cigarette Smoking

Table  26a.  Percentage of men  age  45  and
over  who   are   current   cigarette  smokers,
by   selected   characteristics,   selected   years
1965-2008	Ill

Table  26b.   Percentage  of  women  age   45
and  over who  are  current  cigarette  smokers,
by   selected   characteristics,   selected   years
1965-2008	112
Table 26c. Cigarette smoking status of people age
18 and over, by sex and age group, 2008	113

Indicator 27: Air Quality

Table 27a.  Percentage  of people  age  65  and
over living  in counties with "poor air  quality"
2000-2008	113

Table 27b. Counties with "poor air quality," for any
standard in 2008	114

Indicator 28: Use of Time

Table 28a. Percentage of day that people age 55 and
over spent doing selected activities on an average
day, by age group, 2008	118

Table 28b. Percentage of total  leisure time  that
people age  55  and over spent  doing  selected
leisure activities  on an average day, by age group,
2008	118

Health Care

Indicator 29: Use of Health Care Services

Table 29a.  Use of Medicare-covered health care
services by Medicare enrollees age 65 and over,
1992-2007	119

Table  29b.   Use  of  Medicare-covered  home
health and skilled  nursing  facility services  by
Medicare enrollees age 65 and over, by age group,
2007	119

Indicator 30: Health Care Expenditures

Table 30a. Average annual health  care  costs  for
Medicare enrollees age 65 and over, in 2006 dollars,
by age group, 1992-2006	120

Table 3Ob. Major components of health care costs
among Medicare enrollees age 65  and over, 1992
and 2006	120

Table 30c. Average annual health care costs among
Medicare enrollees age 65 and  over, by selected
characteristics, 2006	121

Table 30d. Major components of health care costs
among Medicare enrollees age  65 and over,  by
age group, 2006	121

Table  30e.   Percentage  of noninstitutionalized
Medicare enrollees age 65 and older who reported
problems with access to  health care, 1992-2005
	122

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Indicator 31: Prescription Drugs

Table 3 la. Average  prescription  drug costs  and
sources of  payment  among noninstitutionalized
Medicare    enrollees   age    65   and   over,
1992-2004	122

Table  31b.  Distribution of  annual prescription
drug costs among noninstitutionalized  Medicare
enrollees age 65 and over, 2004	122

Table 31c. Number of Medicare enrollees age 65
and over who enrolled in Part D prescription drug
plans or who were covered by retiree drug subsidy
payments, June 2006 and December 2009	123

Table 3 Id. Average prescription drug costs among
noninstitutionalized Medicare enrollees age 65 and
over, by selected characteristics, 2000, 2002,  and
2004	123

Indicator 32: Sources of Health Insurance

Table  32a.  Percentage of  noninstitutionalized
Medicare  enrollees   age  65  and  over  with
supplemental health insurance, by type of insurance,
1991-2007	124

Table 32b. Percentage of people  age 55-64 with
health insurance coverage, by type  of insurance and
poverty status, 2008	124

Indicator  33:   Out-of-Pocket  Health  Care
Expenditures

Table 33a. Percentage of people age 55 and over
with out-of-pocket expenditures  for health care
service use, by age group, 1977,  1987, 1996, 2000-
2006	125

Table    33b.     Out-of-pocket    health    care
expenditures   as   a   percentage   of   household
income,  among  people age  55  and  over  by
selected   characteristics,   1977,    1987,   1996,
2000-2006	125

Table 33c. Distribution of total out-of-pocket health
care expenditures among people age 55 and over by
type of health  care services and age group, 2000-
2006	127

Indicator 34: Sources  of Payment for Health
Care Services

Table 34a. Sources  of  payment  for health care
services for Medicare enrollees age 65 and over, by
type of service, 2006	129
Table 34b. Sources of payment for health  care
services for Medicare enrollees age 65 and over,
by income, 2006	129

Indicator 35: Veterans' Health Care

Table 35. Total number of veterans age 65 and
over who  are  enrolled in  or receiving  health
care from the  Veterans  Health Administration,
1990-2008	130

Indicator 36: Residential Services

Table 36a. Percentage of Medicare enrollees age 65
and over residing in selected residential settings,
by age group, 2007	131

Table 36b. Percentage of Medicare enrollees age 65
and over with functional limitations, by residential
setting, 2007	131

Table  36c.  Availability  of  specific  services
among  Medicare  enrollees  age   65 and  over
residing  in  community housing  with  services,
2007	131

Table  36d.  Annual  income  distribution  of
Medicare enrollees age 65 and over, by residential
setting, 2007	132

Table 36e. Characteristics  of services available
to  Medicare  enrollees   age  65   and   over
residing  in  community housing  with  services,
2007	132

Indicator   37:   Personal   Assistance   and
Equipment

Table 37a.  Distribution  of noninstitutionalized
Medicare   enrollees  age   65  and  over  who
have  limitations  in  activities of daily  living
(ADLs),  by types of assistance,  selected years
1992-2007	133

Table 37b.  Percentage  of noninstitutionalized
Medicare  enrollees  age 65  and over who have
limitations in instrumental activities of daily living
(lADLs)  and who receive personal assistance, by
age group, selected years 1992-2007	133

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Highlights
Older Americans 2010: Key Indicators of Well-
Being is one in a series of periodic reports to the
Nation on the condition of older adults in the
United States. The indicators assembled in this
chartbook show the results of decades of progress.
Older Americans are living longer and enjoying
greater prosperity than any previous generation.
Despite these advances, inequalities  between
the sexes and among income groups and racial
and  ethnic groups continue to  exist.   As  the
baby boomers continue  to age  and America's
older population grows larger and more diverse,
community leaders, policymakers, and researchers
will have an even greater need to monitor the health
and economic well-being of older Americans. In
this  report, 37 indicators depict the  well-being
of older Americans in the areas of demographic
characteristics, economic circumstances, overall
health status,  health risks and behaviors, and cost
and use of health care services. Selected highlights
from each section of the report follow.
Population
The  demographics of aging continue to change
dramatically.  The  older population is  growing
rapidly, and the aging of the baby boomers, born
between 1946 and 1964 (and who begin turning
age 65 in 2011), will accelerate this growth. This
larger population of older Americans will be more
racially diverse and better educated than previous
generations.  Another  significant trend is  the
increase in the proportion of men age 85 and over
who are veterans.

V In 2008, there  were an estimated 39 million
   people age 65 and over in the United States,
   accounting for just  over  13  percent of the
   total population. The older population in 2030
   is expected to  be twice  as large as  in 2000,
   growing from  35 million  to 72  million  and
   representing nearly 20 percent of the total U.S.
   population. (See "Indicator 1: Number of Older
   Americans.")

0 In 1965, 24 percent of the older population had
   graduated from high school, and only 5 percent
   had at least a bachelor's  degree. By 2008, 77
   percent were high school graduates  or more,
   and 21 percent had a bachelor's degree or more.
   (See "Indicator 4: Educational Attainment.")
v The number of men age 85 and over who are
   veterans is projected to increase from 400,000
   in 2000 to  almost  1.2 million by 2010. The
   proportion of men  age 85  and over who are
   veterans is projected to increase from 33 percent
   in 2000 to 66  percent in 2010. (See "Indicator
   6: Older Veterans.")

Economics

Most older people are  enjoying greater prosperity
than any  previous generation.  There has been
an  increase in the  proportion  of older people
in the high-income group and a decrease in the
proportion of older people living in poverty, as well
as a decrease in the proportion of older people in
the low-income group just above the poverty line.
Among older Americans, the  share of aggregate
income coming from earnings has increased since
the mid-1980s, partly because  more older people,
especially  women, continue  to  work past age
55. Finally, on average, net worth has increased
almost 80 percent for older Americans over the
past 20 years.  Yet major inequalities continue to
exist with older  blacks and people without high
school diplomas reporting smaller economic gains
and fewer financial resources overall.

0 Between 1974 and 2007, there was a decrease
   in the proportion of older people with income
   below poverty from 15 percent to 10 percent
   and with low income from 35 percent to 26
   percent;  and an increase in the proportion of
   people with high income from 18 percent to 31
   percent.  (See "Indicator 8: Income.")

V In 2007, the median net worth of households
   headed  by  white  people  age 65  and  over
   ($280,000)  was six times that of older  black
   households  ($46,000).  This difference is less
   than in 2003  when the median net worth of
   households  headed  by older white people was
   eight times higher than that of  households
   headed by older black people.  (See "Indicator
   10: Net Worth.")   The large  increase in net
   worth in past  years may not continue into the
   future due to recent declines in housing values.

v Labor force participation rates have risen among
   all women age 55 and over during the past four
   decades. As new cohorts of baby boom women
   approach older ages they are  participating in
   the labor force at higher rates than previous

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   generations.  Labor  force  participation rates
   among men  age  55  and over have gradually
   begun to increase after a steady decline from the
   early 1960s to the mid-1990s. (See "Indicator
   11: Participation in the Labor Force.")

Health Status

Americans are living longer than ever before, yet
their life expectancies lag behind those of other
developed nations. Older age is often accompanied
by increased risk of certain diseases and disorders.
Large  proportions  of  older  Americans  report
a  variety of chronic health conditions such  as
hypertension and  arthritis.  Despite  these and
other conditions, the rate of functional limitations
among older people has declined in recent years.

0 Life expectancy at age 65 in the United States
   is lower than that of many other industrialized
   nations. In 2005, women age 65 in Japan could
   expect to live on average 3.7 years longer than
   women in the United States. Among men, the
   difference  was 1.3 years. (See  "Indicator  14:
   Life Expectancy.")

0 The prevalence  of certain  chronic conditions
   differs by  sex. Women report higher levels of
   arthritis  (55  percent versus 42 percent) than
   men. Men report higher levels of heart disease
   (38 percent versus 27 percent) and cancer (24
   percent versus 21 percent).  (See "Indicator 16:
   Chronic Health Conditions.")

v Between 1992  and 2007,  the age-adjusted
   proportion of people age 65  and over with a
   functional limitation declined from 49 percent
   to 42 percent. (See "Indicator 20:  Functional
   Limitations.")

Health Risks and  Behaviors

Social  and lifestyle factors can affect the health
and well-being of older Americans. These factors
include  preventive behaviors  such  as cancer
screenings  and  vaccinations  along  with diet,
physical activity, obesity, and cigarette smoking.
Health  and well-being are  also affected by  the
quality of the air where people live and by the time
they spend socializing  and communicating with
others. Many of these health risks and behaviors
have shown long-term improvements, even though
recent estimates indicate no significant changes.
V There  was  no  significant  change  in  the
   percentage of people age 65 and over reporting
   physical activity between 1997 and 2008. (See
   "Indicator 24: Physical Activity.")

0 As with other  age  groups, the percentage of
   people  age 65 and  over who are obese  has
   increased since 1988-1994. In 2007-2008, 32
   percent of people age 65 and over were obese,
   compared  with  22 percent in  1988-1994.
   However, over the past several years, the trend
   has leveled off, with no  statistically significant
   change in obesity  for older men or  women
   between  1999-2000 and  2007-2008. (See
   "Indicator 25: Obesity.")

v The percentage of people age 65 and over living
   in counties that experienced poor air quality for
   any air pollutant decreased from 52 percent in
   2000 to 36 percent in 2008. (See "Indicator 27:
   Air Quality.")

V The   proportion   of  leisure   time   that
   older   Americans   spent   socializing   and
   communicating—such as  visiting friends  or
   attending or hosting social  events—declined
   with age. For Americans age 55-64, 13 percent
   of  leisure time  was  spent  socializing  and
   communicating compared with 8 percent for
   those age 75 and over. (See "Indicator  28: Use
   of Time.")

Health Care

Overall, health care  costs have risen dramatically
for older Americans.  In addition, between 1992 and
2006, the percentage of health care costs going to
prescription drugs almost doubled from 8 percent
to 16 percent, with prescription drugs accounting
for a large percentage of out-of-pocket health care
spending. To help ease the burden of prescription
drug costs,  Medicare  Part D  prescription drug
costs, began in January 2006.

V After adjustment for inflation, health care costs
   increased significantly among older Americans
   from $9,224 in 1992 to  $15,081 in 2006. (See
   "Indicator 30: Health Care Expenditures.")

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V From 1977 to 2006, the percentage of household
   income that people age 65 and over allocated to
   out-of-pocket spending for health care services
   increased among those  in the poor/near poor
   income category from 12 percent to 28 percent.
   (See "Indicator 33: Out-of-Pocket Health Care
   Expenditures.")

V The number of Medicare beneficiaries enrolled
   in  Part D prescription  drug plans increased
   from  18.2 million (51 percent of beneficiaries)
   in  June 2006 to  22.2 million (57 percent of
   beneficiaries) in December 2009. In December
   2009,61 percent of plan enrollees were in stand-
   alone plans and 39 percent were in Medicare
   Advantage plans. In addition,  approximately
   6.2 million  beneficiaries  were  covered by
   the Retiree Drug Subsidy (See "Indicator 31:
   Prescription Drugs.")

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Population
         Indicator 1:
         Indicator 2:
         Indicators:
         Indicator 4:
         Indicator 5:
         Indicator 6:
Number of Older Americans
Racial and Ethnic Composition
Marital Status
Educational Attainment
Living Arrangements
Older Veterans

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  INDICATOR 1
Number of Older Americans
The  growth of the  population age 65 and over affects  many  aspects of our society,  challenging
policymakers, families, businesses, and health care providers, among others, to meet the needs of aging
individuals.
   Population age 65 and over and age 85 and over, selected years
   1900-2008 and projected 2010-2050
   Millions
   100
    1900  1910  1920  1930  1940  1950  1960  1970  1980  1990  2000  |2010  2020  2030  2040 2050
                                                            20081	I
                                                                       Projected
   NOTE: Data for 2010-2050 are projections of the population.
   Reference population: These data refer to the resident population.
   SOURCE: U.S. Census Bureau, Decennial Census, Population Estimates and Projections.
V In 2008,39 million people age 65 and overlived
   in the United States, accounting for 13 percent
   of the total population.  The older population
   grew from 3 million in 1900 to 39 million in
   2008.  The oldest-old population (those age 85
   and over) grew from just over 100,000 in 1900
   to 5.7 million in 2008.

V The baby boomers  (those born between 1946
   and 1964) will  start turning 65 in 2011, and
   the  number  of older  people  will  increase
   dramatically during the 2010-2030 period. The
   older population in 2030 is projected to be twice
   as large as their counterparts in 2000, growing
   from 35 million to 72 million and representing
   nearly 20 percent of the total U.S. population.
V The growth  rate of the older population is
   projected to slow after 2030, when the last baby
   boomers enter the ranks of the older population.
   From 2030 onward, the proportion age 65 and
   over will be relatively stable, at around 20
   percent,  even though the absolute number of
   people age 65 and over is projected to continue
   to grow.  The oldest-old population, however, is
   projected to grow rapidly after 2030, when the
   baby boomers move into this age group.

0 The U.S.  Census Bureau projects that  the
   population age 85 and over could grow from 5.7
   million in 2008 to 19 million by 2050.   Some
   researchers predict that death rates at older ages
   will decline more rapidly than is reflected in the
   U.S. Census Bureau's projections, which could
   lead to faster growth of this population.1"3
 1900   1910   1920   1930   1940   1950   1960   1970   1980   1990  2000
                                                               2010
                                                                                      2050

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  INDICATOR
Number of Older Americans continued
                     Percentage of the population age 65
                     and over, by county and State, 2008
                  o
                           Percentage by county
                             B 20.0 to 36.2
                             |  | 16.0 to 19.9
                             |  | 12.8 to 15.9
                             |  | 10.0 to 12.7
                             |  | 2.6 to 9.9

                             U.S. tofa//s 12.8percent.
   Reference population: These data refer to the resident population.
   SOURCE: U.S. Census Bureau, July 1, 2008 Population Estimates.
V The proportion of the population age 65 and
   over varies by state. This proportion is partly
   affected by the state fertility and mortality levels
   and partly by the number of older and younger
   people who migrate to and from the state.  In
   2008,  Florida had  the  highest proportion  of
   people age 65  and over, 17 percent.  Maine,
   Pennsylvania, and West Virginia also had high
   proportions, over 15 percent.

V The proportion of the population age 65 and
   over varies even more by county.  In 2008,  36
   percent of Mclntosh County, North  Dakota,
   was age 65 and over, the highest proportion in
   the  country.  In several Florida counties, the
   proportion was over 30 percent. At the other
   end of the spectrum was Chattahoochee County,
   Georgia, with only  3 percent of its population
   age 65 and over.
V Older women outnumbered older men in the
   United States, and the proportion that is female
   increased with age.  In 2008, women accounted
   for 58 percent of the population age 65  and
   over  and for 67 percent of the population 85
   and over.

0 The United Statesisfairlyyoungforadeveloped
   country,  with 13 percent of its population aged
   65 and over in 2008.  Japan had the highest
   percent  of 65 and  over (22 percent) among
   countries with at least 100,000 population. The
   older population made up more than  15 percent
   of the population in most European countries,
   20 percent in Germany and Italy.

Data for this  indicator's charts and bullets
can be found in Tables la, Ib, Ic, Id, le, and
If on pages 72-76.

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  INDICATOR 2
Racial and Ethnic  Composition
As the older population grows larger, it will also grow more diverse, reflecting the demographic changes
in the U.S. population as a whole over the last several decades. By 2050, programs and services for
older people will require greater flexibility to meet the needs of a more diverse population.
   Population age 65 and over, by race and Hispanic origin, 2008 and
   projected 2050
   Percent
   100 _
    90

    80

    70

    60

    50

    40

    30

    20

    10
I 2008
2050 (projected)
       Non-Hispanic white alone    Black alone
                                                Asian alone
                All other races alone
                 or in combination
                                           20
                             Hispanic
                           (of any race)
   NOTE: The term "non-Hispanic white alone " is used to refer to people who reported being white and no other race and who are not Hispanic. The term
   "black alone" is used to refer to people who reported being black or African American and no other race, and the term "Asian alone" is used to refer to people
   who reported only Asian as their race. The use of single-race populations in this report does not imply that this is the preferred method of presenting or
   analyzing data. The U.S. Census Bureau uses a variety of approaches. The race group "All other races alone or in combination" includes American Indian
   and Alaska Native alone; Native Hawaiian and Other Pacific Islander alone; and all people who reported two or more races.
   Reference population: These data refer to the resident population.
   SOURCE: U.S. Census Bureau, Population Estimates and Projections. 2008.
V In 2008, non-Hispanic whites accounted for 80
   percent of the U.S. older population.  Blacks
   made up 9 percent, Asians made up 3 percent,
   and Hispanics (of any  race) accounted for 7
   percent of the older population.

0 Projections   indicate   that   by  2050  the
   composition of the older population will be
   59  percent non-Hispanic white, 20 percent
   Hispanic,  12  percent  black,  and  9 percent
   Asian.
    v The older  population  among  all  racial and
       ethnic groups will grow;  however, the older
       Hispanic population is projected to grow the
       fastest, from just under 3 million in 2008 to 17.5
       million in 2050, and to be larger than the older
       black population.  The older Asian population
       is also projected to experience a large increase.
       In 2008, just  over 1 million older Asians lived
       in the United  States; by 2050 this population is
       projected to be almost  7.5 million.

    Data  for this  indicator's  charts  and bullets
    can be found in Table 2 on page 76.
 1900   1910   1920   1930   1940   1950   1960   1970   1980   1990  2000
                                                                     2010
                                                                                              2050

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  INDICATOR 3
Marital Status

Marital status can strongly affect one's emotional and economic well-being.  Among other factors, it
influences living arrangements and the availability of caregivers for older Americans with an illness or
disability.
   Marital status of the population age 65 and over, by age group and sex, percent
   distribution, 2008           65-74    175-84   • 85 and over
  Percent
  100

   90

   80

   70

   60

   50

   40

   30

   20

   10

    0
                           Percent
                           100
Men
                                             Women
                                                            57
        Never
        married
                 Divorced   Widowed
                                    Married
                                Never
                                married
                                         Divorced   Widowed
                                                            Married
  NOTE: Married includes married, spouse present; married, spouse absent; and separated.
  Reference population: These data refer to the civilian noninstitutionalized population.
  SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008.
V In 2008, older men were much more likely than
   olderwomento be married. Over three-quarters
   of  men age  65-74 were married,  compared
   with over one-half (57 percent) of women in
   the same age group. The  proportion married is
   lower at older ages: 37 percent of women age
   75-84 and 15 percent of women age 85 and over
   were married. For men, the proportion married
   also is lower at older ages but not as  low as for
   older women. Even among the oldest old, the
   majority of men were married (55 percent).

V Widowhood  is more common among  older
   women than older men.  Women age 65 and
   over were three times as likely as men of the
   same age to be widowed, 42 percent compared
   with 14 percent.  In 2008, 76 percent of women
   age 85 and over were widowed, compared with
   38 percent of men.
                           0 Relatively small proportions of older men (8
                             percent) and women (10 percent) were divorced
                             in 2008. A smaller proportion (4 percent) of the
                             older population had never married.
                           All comparisons presented for this indicator
                           are significant at 0.10 confidence level. Data
                           for this indicator's charts and bullets can be
                           found in Table 3 on page 77.

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  INDICATOR 4
Educational Attainment
Educational attainment influences socioeconomic status, which in turn plays a role in well-being at
older ages. Higher levels of education are usually associated with higher incomes, higher standards of
living, and above-average health.
   Educational attainment of the population age 65 and over, selected years
   1965-2008
   Percent
   100
                                                                 High school graduate or more
                           Bachelor's degree or more
     1965
               1970
                         1975
                                    1980
                                              1985
                                                         1990
                                                                   1995 2000
                                                                                 2005   2008
    NOTE: A single question which asks for the highest grade or degree completed is now used to determine educational attainment.
    Prior to 1995, educational attainment was measured using data on years of school completed.
    Reference population: These data refer to the civilian noninstitutionalized population.
    SOURCE: U.S.Census Bureau,Current Population Survey, Annual Social and Economic Supplement, 1966-2008.
V In 1965, 24 percent of the older population had   v In 2008, about 78 percent of older men and
   graduated from high school, and only 5 percent     77 percent of older women had at least a high
   had at least a Bachelor's degree.  By 2008, 77     school diploma. Older men attained at least a
   percent were high school graduates ormore, and     Bachelor's degree more often than older women
   21 percent had a Bachelor's degree or more.        (27 percent compared with 16 percent).
 1900  1910   1920   1930   1940   1950   1960   1970   1980   1990   2000  2010

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  INDICATOR 4
Educational Attainment continued
   Educational attainment of the population age 65 and over, by race and
   Hispanic origin,  2008
   Percent
   100
    90

    80

    70

    60

    50

    40

    30

    20

    10
-    77
                   High school graduate or more

                      82
                                                         Bachelor's degree or more
                                                         74
               Total
                             Non-Hispanic
                             white alone
                                               Black alone
                                                                Asian alone
                                                                            Hispanic
                                                                          (of any race)
   NOTE: The term "non-Hispanic white alone" is used to refer to people who reported being white and no other race and who are not
   Hispanic. The term "black alone" is used to refer to people who reported being black or African American and no other race, and the
   term "Asian alone" is used to refer to people who reported only Asian as their race. The use of single-race populations in this report
   does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social  and Economic Supplement, 2008.
  Despite the  overall  increase  in educational
  attainment among older Americans, substantial
  educational differences exist among racial and
  ethnic  groups.   In  2008, 82 percent of non-
  Hispanic whites age 65 and over had completed
  high school.   Older  Asians also had a high
  proportion with at least a high school education
  (74 percent).  In contrast, 60 percent of older
  blacks  and 46 percent of older Hispanics had
  completed high school.
                                           0 In 2008, older Asians had the highest proportion
                                              with at least a Bachelor's degree (32 percent).
                                              About 22 percent of older non-Hispanic whites
                                              had this level of education.   The proportions
                                              were 12 percent and 9 percent, respectively, for
                                              older blacks and Hispanics.
                                                  All comparisons presented for this indicator
                                                  are significant at 0.10 confidence level. Data
                                                  for this indicator's charts and bullets can be
                                                  found in Tables 4a and 4b on pages 77-78.

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  INDICATOR 5
Living Arrangements
The living arrangements of America's older population are linked to income, health status, and the
availability of caregivers. Older people who live alone are more likely than older people who live with
their spouses to be in poverty.
   Living arrangements of the population age 65 and over, by sex and race
   and  Hispanic origin, percent distribution, 2008
                   • With spouse    • With other relatives     • With nonrelatives      Alone
    Percent
    100
     90

     80

     70

     60

     50

     40

     30

     20

     10

      0
                          Men
  Percent
  100
                                                                       Women
         Total Non-Hispanic Black
               white alone  alone
       Total Non-Hispanic Black
             white alone  alone
Asian   Hispanic
alone (of any race)
                              Asian  Hispanic
                              alone (of any race)
NOTE: Living with other relatives indicates no spouse present. Living with nonrelatives indicates no spouse or other relatives present. The term
"non-Hispanic white alone" is used to refer to people who reported being white and no other race and who are not Hispanic. The term "black
alone" is used to refer to people who reported being black or African American and no other race, and the term "Asian alone" is used to refer to
people who reported only Asian as their race. The use of single-race populations in this report does not imply that this is the preferred method
of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches.
Reference population: These data do not include the noninstitutionalized group quarters population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008.
V In 2008, 72  percent  of older men lived with
   their spouse  while less than half (42 percent)
   of older women did.  In contrast, older women
   were more than twice  as likely  as older men
   to live alone  (40 percent  and 19  percent,
   respectively).

V Older black,  Asian, and Hispanic women were
   more  likely  than  non-Hispanic white women
   to live with relatives  other than  a spouse.
   Older  non-Hispanic white women and black
   women were more likely than women of other
   races to live  alone (41 percent and 42 percent,
   respectively,  compared with about 22 percent
   for older Asian  women and  27 percent  for
   older  Hispanic women).  The percentages of
   non-Hispanic white and black women  living
   alone  are not statistically different.  Also, the
   percentages of older Asian and older Hispanic
   women  living  alone   are  not statistically
   different. Older black men lived alone about
   three times as often as older Asian men (30
   percent compared  with  11  percent).   Older
   black men lived alone more often than older
   non-Hispanic white men  (18 percent).   The
   percentages of older Asian and older Hispanic
   men living alone (11 percent and 13 percent,
   respectively) are not statistically different.

V Older  Hispanic  men were  more likely  (15
   percent) than non-Hispanic  white   men (6
   percent) to live with  relatives  other than a
   spouse. The percentages of black, Asian, and
   Hispanic men (11 percent, 10 percent and 15
   percent, respectively) living with relatives other
   than a spouse are not statistically different.

All comparisons presented for this indicator
are significant at 0.10 confidence level. Data
for this indicator's charts and bullets can be
found in Tables 5a and 5b on pages 78-79.

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  INDICATOR 6
Older Veterans

Veteran status of America's older population is associated with higher median family income, lower
percentage of uninsured or coverage by Medicaid,  higher percentage of functional limitations  in
activities of daily living or instrumental activities of daily living, greater likelihood of having any
disability, and less likelihood of rating their general health status as good or better.4 The large increase
in the oldest segment of the veteran population will continue to have significant ramifications on the
demand for health care services, particularly  in the area of long-term care.5
  Percentage of population age 65 and over who are veterans, by sex and
  age group, United States and Puerto Rico, 2000 with projections for
  2010 and 2020
                               2000
          2020 (projected)
                                                                    Women
                                                  2  1  2
              1   1  2
                                                                          1   1
       65 and over   65-74     75-84   85 and over     65 and over    65-74
  Reference population: These data refer to the resident population of the United States and Puerto Rico.
  SOURCE: U.S. Census Bureau, Decennial Census and Population Projections; Department of Veterans Affairs, VetPop2007.
                         75-84
                                  85 and over
v According to Census 2000, there were  9.7
   million veterans age 65 and over in the United
   States and Puerto Rico. Two of three men  age
   65 and over were veterans.

0 More  than 95  percent  of  veterans  age  65
   and over are male. As World War II veterans
   continue to die and Vietnam veterans continue
   to age, the number of veterans age 65 and over
   will gradually decline from 9.4 million in 2000
   to a projected 8.1 million in 2020.
0 The increase in the proportion of men age 85 and
   over who are veterans is striking.  The number
   of men age 85 and over who are veterans is
   projected to increase from 400,000 in 2000 to
   almost  1.2 million by 2010.   The proportion
   of men age 85 and over who are veterans is
   projected to increase from 33 percent in 2000
   to 66 percent in 2010.

v Between 2000 and 2010, the number of female
   veterans age 85 and over is projected to increase
   from about 30,000 to 98,000 but is projected to
   decrease back to 50,000 by 2020.

Data for this indicator's chart and bullets
can be found in Tables 6a and 6b on pages
79-80.
                     i_
                   1900   1910   1920  1930   1940   1950  1960   1970   1980   1990   2000
                                                                                  2010
                                                                                       2020

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Economics
         Indicator?: Poverty
         Indicator 8: Income
         Indicator 9: Sources of Income
         Indicator 10: Net Worth
         Indicator 11: Participation in the Labor Force
         Indicator 12: Total Expenditures
         Indicator 13: Housing Problems

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   INDICATOR 7
Poverty
Poverty rates are one way to evaluate economic well-being. The official poverty definition is based on
annual money income before taxes and does not include capital gains, earned income tax credits, or
noncash benefits. To determine who is poor, the U.S. Census Bureau compares family income (or an
unrelated individual's income) with a set of poverty thresholds that vary by family size and composition
and are updated annually for inflation. People identified as living in poverty are  at risk  of having
inadequate resources for food, housing, health care, and other needs.
   Poverty rate of the population, by age group, 1959-2007
   Percent
  100

   90

   80

   70

   60

   50

   40

   30

   20

   10
65 and over
                    Under 18
                                      18 to 64
                         Under 18
    1959
                      i9  9
    1974
1979
:9 4
19 9
!994
1999
?004 5007
   • • • • Data not available.
   NOTE: The poverty level is based on money income and does not include noncash benefits such as food stamps. Poverty thresholds reflect family size
   and composition and are adjusted each year using the annual average Consumer Price Index. For more detail, see U.S. Census Bureau, Series P-60,
   No.222. Poverty status in the Current Population Survey is based on prior year income.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 1960-2008.
V In  1959, older people had the highest poverty
   rate (35 percent), followed  by children (27
   percent) and those in the working  ages (17
   percent).  By 2007, the proportions of the older
   population and those of working age living in
   poverty were about 10 percent and 11 percent,
   respectively, while 18 percent of children lived
   in poverty.

V Older women (12 percent) were more likely
   than older men (7 percent) to live in poverty in
   2007.  People age 65-74 had a poverty rate of 9
   percent, compared with 11 percent of those age
   75 and over.

V Race and ethnicity are related to poverty among
   older men.  In 2007, older non-Hispanic white
   men were less likely than older  black  men,
   older  Hispanic men, and  older Asian men to
                        live in poverty—about 5  percent  compared
                        with 17 percent of older black men, 13 percent
                        of older Hispanic men, and 10 percent of older,
                        Asian  men. However, the percentage of older
                        Hispanic men is not significantly different than
                        older black men or older Asian men.

                      V Older  non-Hispanic white women (9 percent)
                        and older Asian women (12 percent)  were less
                        likely  than older black women (27 percent)
                        and older Hispanic  women  (20 percent)  to
                        live in poverty. However, older non-Hispanic
                        white  women in poverty were not statistically
                        different from Asian women in poverty.

                      All comparisons presented for this  indicator
                      are significant at 0.10 confidence level. Data
                      for this indicator's charts and bullets can  be
                      found in Tables  7a and 7b on pages 81-82.
 1900   1910
             1920  1930   1940   1950   1960   1970
                                                1980
                                                      1990   2000  2010

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   INDICATOR 8
Income
The percentage of people living below the poverty line does not give a complete picture of the economic
situation of older Americans. Examining the income distribution of the population age 65 and over and
their median income provides additional insights into their economic well-being.
   Income distribution of the population age 65 and over, 1974-2007
    1974  1976 1978 1980 1982  1984  1986  1988  1990 1992 1994  1996  1998  2000 2002 2004
                                                                                         2007
   NOTE: The income categories are derived from the ratio of the family's income (or an unrelated individual's income) to the corresponding poverty threshold.
   Being in poverty is measured as income less than 100 percent of the poverty threshold. Low income is between 100 percent and 199 percent of the poverty
   threshold. Middle income is between 200 percent and 399 percent of the poverty threshold. High income is 400 percent or more of the poverty threshold.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 1975-2008.
                                                    older population also has been positive. In 1974,
                                                    the median household income for householders
                                                    age 65 and over was $20,838 when expressed in
                                                    2007 dollars. By 2007, the  median household
                                                    income had increased to $29,393.
v Since 1974,  the  proportion of older people   v The trend in median household income of the
   living in poverty and in the  low income group
   has generally declined so that, by 2007,  10
   percent of the older population lived in poverty
   and 26 percent of the older population were in
   the low income group.

V In 2007, people in the middle income group
   made up the  largest share of older people by
   income category (33 percent). The proportion
   with a high income has increased over time.
   The proportion of the older population having a
   high income rose from  18 percent in 1974 to 31
   percent in 2007.                                All comparisons presented for this indicator
                                                 are significant at 0.10 confidence level. Data
                                                 for this indicator's charts and bullets can be
                                                 found in Tables 8a and 8b on pages 83-84.
                          1900   1910   1920   1930   1940   1950   1960   1970   1980   1990   2000   2010

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   INDICATOR 9
Sources  of Income
Most older Americans are retired from full-time work.  Social Security was developed as a floor of
protection for their incomes, to be supplemented by other pension income, income from assets, and to
some extent, continued earnings. Overtime, Social Security has taken on a greater importance to many
older Americans.
   Sources of income for married couples and nonmarried people who are
   age 65 and over, percent distribution, selected years 1962-2008
   Percent
   100
    90

    80

    70

    60

    50

    40

    30

    20

    10
Percent
100
           1962
                     1967
                                                   Other
                                                   Earnings
                                                   Pensions
                                                   Asset income
                                                   Social Security
                                1976 1980
                  1990
2000
2008
  NOTE: A married couple is age 65 and over if the husband is age 65 and over or the husband is younger than age 55 and the wife is age 65 and over. The definition
  of "other" includes, but is not limited to, public assistance, unemployment compensation, workers compensation, alimony, child support, and personal contributions.
  Reference population: These data refer to the civilian noninstitutionalized population.
  SOURCE: Social Security Administration, 1963 Survey of the Aged, and 1968 Survey of Demographic and Economic Characteristics of the Aged; U.S. Census
  Bureau, Current Population Survey, Annual Social and Economic Supplement, 1977-2009.
V Since the early 1960s,  Social  Security  has
   provided the largest share of aggregate income
   for older Americans. The share of income from
   pensions increased  rapidly in the 1960s  and
   1970s to apeak in 1992 and has fluctuated since
   then. The share of income from assets peaked
   in the mid-1980s and has generally declined
   since then. The share from earnings has  had
   the opposite pattern—declining until the mid-
   1980s and generally increasing since then.

V In 2008, aggregate income for the population
   aged 65 and  over came largely from four
   sources.  Social Security provided 37 percent,
   earnings   provided  30  percent,   pensions
   provided  19  percent,   and  asset  income
   accounted for  13 percent.  About 89 percent
   of people age 65 and over live in families with
                     income from Social Security. About three-fifths
                     (59 percent) are in families with income  from
                     assets, and two-fifths (44 percent) with income
                     from pensions.  About two-fifths (38  percent)
                     are in families with earnings. About 1  in 20 (5
                     percent) are in families receiving  cash public
                     assistance.

                  V Among   married  couples  and   nonmarried
                     people age 65 and over in the lowest fifth of the
                     income  distribution, Social Security accounts
                     for 83 percent of aggregate  income, and cash
                     public assistance for another 8 percent.   For
                     those  whose income is  in the highest income
                     category, Social Security,  pensions, and  asset
                     income  each  account for almost a  fifth of
                     aggregate income, and  earnings accounts for
                     the remaining two-fifths.
 1900   1910
             1920   1930   1940   1950   1960   1970   1980   1990   2000   2010

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   INDICATOR 9
Sources of Income continued
   Sources of income for married couples and nonmarried people who are
   age 65 and over, by income quintile, percent distribution, 2008
   Percent
   100
                                                                                Other

                                                                                Public assistance


                                                                                Earnings
                                                                                Pensions
                                                                                Asset Income
                                                                                Social Security
           Lowest fifth
                         Second fifth
                                        Third fifth
                                       Income Level
                                                       Fourth fifth
                   Highest fifth
   NOTE: A married couple is age 65 and over if the husband is age 65 and over or the husband is younger than age 55 and the wire is age 65 and over. The
   definition of "other" includes, but is not limited to, public assistance, unemployment compensation, worker's compensation, alimony, child support, and personal
   contributions. Quintile limits are $12,082, $19,877, $31,303, and $55,889 for all units; $23,637, $35,794, $53,180, and $86,988 for married couples; and $9,929,
   $14,265, $20,187, and $32,937 for nonmarried persons.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2009.
V For the population age 80 and over, a larger
   percentage  lived   in  families  with  Social
   Security income  (92 percent) and  a smaller
   percentage had earnings (22 percent) compared
   to the population age 65-69 (83 percent and 55
   percent, respectively).

V The financial situation of 2008 was the worst
   economic downturn since the Great Depression
   of the   1930s.   This  downturn  could affect
   income received in 2008 by the population age
   55 and  over. People aged 50-64 may have been
   most affected by the downturn and people age
   65 and over may have been least affected by
   the downturn.6 Between the peak of October 9,
   2007, and through January 2009, the Wilshire
   5000 index of broad stock holdings  decreased
   by 47  percent.7 Retirement accounts of those
   50 and over lost 18 percent of their value  over
   the 12  months8 and by May 2009, retirement
   accounts lost $2.7 trillion or 31 percent since
   September 2007.9 The economic downturn also
   resulted in rising unemployment,  decreasing
   spending,  and falling  housing  prices with
   threats of foreclosure.10  There is likely to be a
   negative impact on the economic well-being of
   current and future retirees although it is unclear
   the extent of the negative impact.7
Data for  this indicator's charts and bullets
can be found in Tables 9 a, 9b, and9c on pages
85-86.

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   INDICATOR 10
Net Worth
Net worth (the value of real estate, stocks, bonds, and other assets minus outstanding debts) is an
important indicator of economic security and well-being. Greater net worth allows a family to maintain
its standard of living when income falls because of job  loss, health problems, or family changes such
as divorce or widowhood.
    Median household net worth in 2005 dollars, by race of head of
    household age 65 and over, selected years 1984-2007
    Dollars, in thousands
    500

    450

    400

    350

    300

    250

    200

    150

    100

     50
White
              Black
      0
      1984
                       1989
                                         1994
                                                           1999
                                                                  2001
                                                                         2003
                                                                                2005
                                                                                       2007
    NOTE: Net worth data do not include pension wealth. This excludes private defined-contribution and defined-benefit plans as well as rights to Social Security
    wealth. Data for 1984-2003 have been inflation adjusted to 2007 dollars. See Appendix B for the definition of race and Hispanic origin in the Panel Study of
    Income Dynamics.
    Reference population: These data refer to the civilian noninstitutionalized population.
    SOURCE: Panel Study of Income Dynamics.
V Between 1984 and 2007, the median net worth   V In 2007, the median net worth of households
   of households headed by white people aged     headed by married people  age  65 and older
   65 and over  increased by  125  percent, from     ($385,000) was more  than  2.5  times that of
   $125,000 to $280,000.  The median net worth     households headed by unmarried people in the
   of households headed by black people age 65     same age group ($152,000).
   and over increased 63 percent from $28,200 to
   $46,000.

V In 1984, the median net worth of households
   headed by white people age 65 and over was
   4 times that  of households headed by black
   people over 65.  In 2007, the median net worth
   of older white households was 6 times that of
   older black households. This difference is less
   than it was in  2003, when the median net worth
   of white older households was 8 times higher
   than older black households.
 1900  1910   1920   1930   1940   1950   1960   1970   1980   1990   2000  2010

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   INDICATOR 10
Net Worth continued
   Median household net worth in 2005 dollars, by educational attainment
   of head of household, age 65 and over, selected years 1984-2007
   Dollars, in thousands
   500
   450
     1984
                      1989
                                        1994
                                                         1999    2001
                                                                       2003    2005
                                                                                     2007
   NOTE: Net worth data do not include pension wealth. This excludes private defined-contribution and defined-benefit plans as well as rights to Social Security
   wealth. Data for 1984-2003 have been inflation adjusted to 2007 dollars.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: Panel Study of Income Dynamics.
   Overall, between 1984 and 2007, the median
   net worth of households headed by people age
   65 and older increased by 117 percent  (from
   $109,000 to $237,000).  The increase over the
   last two years, from 2005, was 20 percent (from
   $196,000 to $237,000).

   In 2007, households headed by people age 65
   and over with at least some college reported a
   median household net worth ($434,400) more
   than five times that  of households headed by
   older people without a high school diploma
   ($78,000).
Between 1984 and 2007, the median net worth
of households headed by people aged 65 and
over without a high school diploma increased by
28 percent. Almost all of this increase occurred
between  2005 and 2007;  between 1984 and
2005, the median net worth in these households
remained approximately the same. By contrast,
between 1984 and 2007, the median net worth
of older households headed by those with some
college or more increased by 82 percent.
                                               Data for this indicator's charts and bullets
                                               can be found in Table 10 on page 87.
                         1900   1910   1920  1930   1940   1950  1960   1970   1980  1990   2000   2010

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   INDICATOR 11
Participation in the Labor Force
The labor force participation rate is the percentage of a group that is in the labor force—that is, either
working (employed) or actively looking for work (unemployed). Some older Americans work out of
economic necessity. Others may be attracted by the social contact, intellectual challenges, or sense of
value that work often provides.
   Labor force participation rates of men age 55 and over, by age group,
   annual averages, 1963-2008
   Percent
   100
    90

    80

    70

    60

    50

    40

    30

    20

    10
             55-61
     1963
              1968
                       1973
                                1978
                                         1983
                                                  1988
                                                           1993
                                                                    1998
                                                                             2003
                                                                                      2008
   NOTE: Data for 1994 and later years are not strictly comparable with data for 1993 and earlier years due to a redesign of the survey and
   methodology of the Current Population Survey. Beginning in 2000, data incorporate population controls from Census 2000.
   Reference population:These data refer to the civilian noninstitutionalized population.
   SOURCE: Bureau of Labor Statistics, Current Population Survey.
0 In 2008, the labor force participation rate for
   men age 55-61 was 76 percent, far below the
   rate in 1963 (90 percent). The participation rate
   for men age 62-64 declined from 76 percent in
   1963 to a low of 45 percent in  1995, and has
   gradually increased since  then. In 2008,  the
   participation rate  for men age 62-64 was 53
   percent.

V Men age 65-69 also have experienced a gradual
   rise in labor force  participation following a
   period of decline in the late 1960s and  1970s.
   The labor force participation rate for men age
   65-69 declined from a high of 43 percent in
   1967 to 24 percent in 1985. Their participation
   rate leveled off from the mid-1980s to the early
   1990s and remained in the 24  to 26 percent
   range. Beginning  in the mid-1990s, the labor
   force participation rate began to increase and
   reached 36 percent in 2008.

V The participation rate for men age 70 and over
   showed a similar pattern  from 1963 to 2008.
   In  1993, the labor force participation rate  for
   men age  70 and over reached a low of 10
   percent after declining from 21 percent in 1963.
   Since reaching the lows of the mid-1990s,  the
   participation rate for men age 70 and over has
   trended higher and reached 15 percent in 2008.
 1900  1910   1920   1930   1940   1950  1960   1970   1980   1990   2000  2010

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   INDICATOR 11
Participation in the Labor Force continued
  Labor force participation rates of women age 55 and over, by age group,
  annual averages, 1963-2008
  Percent
  100
     1963
              1968
                       1973
                                1978
                                         1983
                                                  1988
                                                           1993
                                                                    1998
                                                                             2003
                                                                                      2008
  NOTE: Data for 1994 and later years are not strictly comparable with data for 1993 and earlier years due to a redesign of the survey and
  methodology of the Current Population Survey. Beginning in 2000, data incorporate population controls from Census 2000.
  Reference population: These data refer to the civilian noninstitutionalized population.
  SOURCE: Bureau of Labor Statistics, Current Population Survey.
0 Among women age 55 and over, the labor force
   participation rate rose over the past 4 decades.
   The increase has been largest among women
   age 55-61, rising from 44 percent in 1963
   to 65 percent  in 2008, with a majority of the
   increase occurring after 1985.  For women age
   62-64,  65-69, and 70 years and over, most of
   the increase in labor force participation began
   in the mid-1990s.

V The labor force participation  rate for older
   women reflects changes in the work experience
   of successive generations  of women. Many
   women now in their 60s and 70s did not work
   outside the home when they were younger, or
   they moved in and out of the labor force. As
   new cohorts of baby boom women approach
   older ages, they are  participating in the labor
   force at higher rates than previous generations.
   As a result, in 2008,  65 percent of women age
   55-61 were in the labor force, compared with
   44 percent of women age 55-61 in 1963. Over
   the same  period, the labor force participation
   rate for women age 62-64 increased from 29 to
   42 percent, while the rate for women age 65-69
   increased from 17  percent to 26 percent.

0 The difference between labor force participation
   rates  for men and women has narrowed  over
   time. Among people age 55-61, for example,
   the gap between men's  and women's  rates in
   2008 was 11 percentage  points, compared with
   46 percentage points in 1963.
Data for this indicator's charts and bullets
can be found in Table 11 on page 88.
                         1900   1910   1920  1930   1940   1950   1960   1970   1980   1990   2000   2010

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   INDICATOR 12
Total Expenditures
Expenditures are another indicator of economic well-being that show how the older population allocates
resources to food, housing, health  care, and other needs. Expenditures may change with changes in
work status, health status, or income.
   Household annual expenditures by expenditure category, by age of
   reference person, percent distribution, 2008
                                                                   Other


                                                                   Food




                                                                   Housing




                                                                   Transportation


                                                                   Health care

                                                                   Personal insurance and pensions
             55-64
                          65 and over
                                           65-74
                                                        75 and over
  NOTE: Other expenditures include apparel, personal care, entertainment, reading, education, alcohol, tobacco, cash contributions, and
  miscellaneous expenditures. Data from the Consumer Expenditure Survey by age group represent average annual expenditures for
  consumer units by the age of reference person, who is the person listed as the owner or renter of the home. For example, the data on
  people age 65 and over reflect consumer units with a reference person age 65 or older. The Consumer Expenditure Survey collects and
  publishes information from consumer units, which are generally defined as a person or group of people who live in the same household
  and are related by blood, marriage, or other legal arrangement (i.e., a family), or people who live in the same household but who are
  unrelated and financially independent from one another (e.g., roommates sharing an apartment). A household usually refers to a physical
  dwelling, and may contain more than one consumer unit.  However, for convenience the term "household" is substituted for "consumer
  unit" in this text.
  Reference population: These data refer to the resident noninstitutionalized population.
  SOURCE: Bureau of Labor Statistics, Consumer Expenditure Survey.
   Housing accounts for the largest share of total
   expenditures—one-third or more on average for
   all groups of households with reference person
   (i.e., a selected household owner or renter) age
   55 or older.  The share is largest (38 percent) for
   households  with reference  person age 75  and
   older, even though this group is the most likely
   to own without a mortgage.

   As a share  of total expenditures, health care
   expenditures increase dramatically  with age.
   For  the  75 and  older  group, the  share  (14
   percent)  is twice as high as it  is for the 55-64
   year old group (7 percent), and is equal to the
   share the older group allocates to transportation
   (14 percent). For the  75  and  older group,
   vehicle insurance  accounts for nearly  one-
   fourth of transportation expenditures, and for a
   larger share of total expenditures (3.3 percent)
   than drugs (2.4  percent) and medical supplies
   (0.5 percent) combined.

0 Regardless of age group studied, the share  of
   total  expenditures  allocated to  food  is about
   12 to 13 percent. Food at home accounts for
   7 to  8 percent of total expenditures, and food
   away from home accounts for 4 to 5 percent  of
   expenditures.

Data for this indicator's chart and bullets can
be found in Table 12 on page 89.

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   INDICATOR 13
Housing Problems
Most older people live in adequate, affordable housing. For some, however, costly or physically
inadequate housing  can pose serious  problems to  an older person's  physical or psychological
well-being.
  Percentage of all U.S. households and of households with any resident
  age 65 and over that report housing problems, by type of problem,
  selected years 1985-2007
  Percent
  100,-

   90

   80

   70

   60

   50

   40

   30

   20

   10

    0
    1985           1989                   1995    1997    1999    2001    2003    2005    2007
  (All) All U.S. households; (65+) U.S. households with one or more residents age 65 and over.
  * Although crowded housing is not a common problem for older people (less than 1 percent), it is included as one of three possible housing
  problems under "housing problem(s)." See Tables 13aand13bin Appendix A for more information.
  Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes
  are excluded.
  SOURCE: Department of Housing and Urban Development, American Housing Survey.
  • Housing problem(s), All
   • — — _. f -
              ACost burden, All

Physically inadequate housing, 65 +
                                                    Physically inadequate housing, All
V In 2007, 40 percent of households with people
   age  65  and over had  one  or more  of the
   following types of housing problems: housing
   cost burden, physically inadequate housing,
   and/or crowded housing. This is slightly higher
   than the occurrence  of  such problems  among
   all U.S.  households  which was 39  percent in
   2007.

V The prevalence of  housing  cost  burden,  or
   expenditures on housing  and utilities that
   exceeds  30 percent of household income, has
   increased for all U.S. households but is slightly
   more prevalent among households with people
   age 65 and over in  2007. Between  1985 and
   2007, housing cost burden for households with
   older people increased from 30 percent to  37
   percent.  By comparison, the  prevalence  of
                                        housing cost burden among all U.S. households
                                        increased from 26 percent in 1985 to 35 percent
                                        in 2007.

                                      0 Physically inadequate housing, or housing with
                                        severe or moderate physical problems such as
                                        lacking complete plumbing or having multiple
                                        upkeep problems, has become less common. In
                                        2007, 4 percent of households with people age
                                        65 and over had inadequate housing, compared
                                        with 8 percent in 1985. In contrast, 5 percent
                                        of U.S. households overall reported living in
                                        physically  inadequate  housing  during 2007
                                        compared with 8 percent in 1985.

                                      Data for this indicator's charts and bullets
                                      can be found in Tables 13a and 13b on pages
                                      89-92.
                         1900   1910   1920   1930  1940   1950   1960   1970   1980   1990   2000  2010

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Health Status
         Indicator 14:
         Indicator 15:
         Indicator 16:
         Indicator 17:

         Indicator 18:
         Indicator 19:
         Indicator 20:
Life Expectancy
Mortality
Chronic Health Conditions
Sensory Impairments and Oral
Health
Respondent-Assessed Health Status
Depressive Symptoms
Functional Limitations

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   INDICATOR 14
Life Expectancy
Life expectancy is a summary measure of the overall health of a population. It represents the average
number of years of life remaining to a person at a given age if death rates were to remain constant. In
the United States, improvements in health have resulted in increased life expectancy and contributed to
the growth of the older population over the past century.
   Life expectancy at ages 65 and 85, by sex, selected years 1900-2006
   Years of life
   25.—
   20
   15
   10
           Women, at age 65
                                'Men, at age 65
                                                                            Women, at age 85
                                                                       Men, at age 85
    1900
            1910
                     1920
                             1930
                                      1940
                                              1950
                                                       1960
                                                               1970
                                                                        1980
                                                                                1990
                                                                                         2000 2006
   NOTE: The life expectancies (LEs) for decennial years 1910 to 1990 are based on decennial census data and deaths for a 3-year period around the census year.
   The LEs for decennial year 1900 are based on deaths from 1900 to 1902. LEs for years prior to 1930 are based on the death registration area only. The death
   registration area increased from 10 states and the District of Columbia in 1900 to the coterminous United States in 1933. LEs for 2000-2006 are based on a
   newly revised methodology that uses vital statistics death rates for ages under 66 and modeled probabilities of death for ages 66 to 100 based on blended vital
   statistics and Medicare probabilities of dying and may differ from figures previously published.
   Reference population: These data refer to the resident population.
   SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.
V Americans are living longer than ever before.
   Life expectancies at both age 65 and age 85 have
   increased. Under current mortality conditions,
   people who survive to age 65 can expect to live
   an average of 18.5 more years, about 4 years
   longer than people age 65 in 1960.  The life
   expectancy  of people who survive  to age 85
   today is 6.8 years for women and 5.7 years for
   men.

V Life expectancy varies by race, butthe difference
   decreases with age. In 2006, life expectancy at
   birth was 5  years higher for white people than
   for black people. At  age 65, white people can
   expect to live an average  of 1.5 years longer
   than black people. Among those who survive
   to age 85, however, the life expectancy among
   black people is slightly higher (6.7 years) than
   white people (6.3 years).
V Life expectancy at age 65 in the United States
   is lower than that of many other industrialized
   nations. In 2005, women age 65 in Japan could
   expect to live on average 3.7 years longer than
   women in the United States. Among men,  the
   difference was 1.3 years.
 1900   1910   1920   1930   1940   1950   1960   1970    1980   1990   2000   2010

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  INDICATOR 14
Life Expectancy continued
   Average life expectancy for women at age 65, by selected countries or
   areas, selected years 1980-2005
   Years of life
   25
   20
   15
   10
                                                                     Japan.
            Canada
                      England & Wales
    0
     1980                       1990                       2000                       2005

   SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, Health, United States, 2009."
   Average life expectancy for men at age 65, by selected countries or
   areas, selected years 1980-2005
   Years of life
   25
   20
    15
    10
                                                   United States
        -France
                            ^ England & Wales
    1980                       1990                       2000
   SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, Health, United States, 2009.11
                                                                                   2005
                                           Data for this indicator's charts and bullets can
                                           be found in Tables 14a, 14b,  and 14c on pages
                                           93  94.
                         1900   1910   1920   1930   1940   1950   1960  1970   1980  1990   2000  2010

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   INDICATOR 15
Mortality
Overall, death rates in the U.S. population have declined during the past century. But for some diseases,
death rates among older Americans have increased in recent years.
    Death rates for selected leading causes of death among people age 65
    and over, 1981-2006
    Per 100,000
    3,000

    2,750
                     1985
                                     1990
                                                     1995
                                                                     2000
                                                                                         2006
    NOTE: Death rates for 1981-1998 are based on the 9th revision of the International Classification of Diseases (ICD-9). Starting in 1999, death rates are
    based on ICD-10 and trends in death rates for some causes may be affected by this change.12 For the period 1981-1998, causes were coded using ICD-9
    codes that are most nearly comparable with the 113 cause list for the ICD-10 and may differ from previously published estimates. Rates are age adjusted
    using the 2000 standard population.
    Reference population: These data refer to the resident population.
    SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.
V In 2006, the leading  cause of death  among
   people age 65 and over was diseases of heart
   (heart  disease)  (1,297  deaths per 100,000
   people),  followed  by  malignant  neoplasms
   (cancer) (1,025 per 100,000), cerebrovascular
   diseases (stroke) (297  per 100,000),  chronic
   lower respiratory diseases (279 per 100,000),
   Alzheimer's disease (177 per 100,000), diabetes
   mellitus (137 per 100,000), and influenza and
   pneumonia (124 per 100,000).

0 Between 1981  and 2006, age-adjusted death
   rates for all causes of death among people age
   65 and over declined  by 21  percent.  Death
   rates for heart disease and stroke  declined by
   about 50 percent. Age-adjusted death rates for
   diabetes increased by  29 percent  since 1981,
   and death rates  for chronic lower respiratory
   diseases increased by 50 percent.
v Heart disease and cancer are the top two leading
   causes  of death among all people age 65  and
   over, irrespective  of sex, race, or  Hispanic
   origin.

V Other causes of death vary among older people
   by  sex and race  and Hispanic origin.  For
   example, men have higher suicide rates than do
   women at all ages, with the largest difference
   occurring at age 85 and over (43  deaths per
   100,000 population for men compared with 3
   per 100,000 for women).  Non-Hispanic white
   men age  85 and over have the highest rate of
   suicide overall at 48 deaths per 100,000.13

Data for  this indicator's chart and bullets can
be found in Tables 15a, 15b, and 15c on pages
95 99.
 1900   1910   1920   1930   1940   1950   1960   1970   1980   1990   2000  2010

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   INDICATOR 16
Chronic Health Conditions

Chronic diseases are long-term illnesses that are rarely cured. Chronic diseases such as heart disease,
stroke, cancer, and diabetes are among the most common and costly health conditions.  Chronic health
conditions negatively affect quality of life, contributing to declines in functioning and the inability to
remain in the community.14 Many chronic conditions can be prevented or modified with behavioral
interventions. Six of the seven leading causes of death  among older Americans are chronic diseases.
(See "Indicator 15: Mortality.")
  Chronic health conditions among the population age 65 and over, by sex,
  2007-2008
  Percent
  100
   90

   80

   70

   60

   50

   40

   30

   20

   10
                                  Men
                                           Women
38
          Heart    Hypertension   Stroke
         disease
                               Asthma    Chronic
                                       bronchitis or
                                       Emphysema
Any cancer   Diabetes
                                                                                 Arthritis
  NOTE: Data are based on a 2-year average from 2007-2008. See Appendix B for the definition of race and Hispanic origin in the National Health Interview Survey.
  Reference population: These data refer to the civilian noninstitutionalized population.
  SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
V The prevalence of certain chronic conditions
   differs by sex. Women report higher levels of
   arthritis and hypertension than men. Men report
   higher levels of heart disease and cancer.
                                      V There are differences by race and ethnicity in
                                         the  prevalence of certain  chronic conditions.
                                         In 2007-2008, among people age 65 and over,
                                         non-Hispanic blacks report higher levels  of
                                         hypertension  and diabetes than non-Hispanic
                                         whites (71 percent compared with 54 percent
                                         for hypertension and 30 percent compared with
                                         16 percent for diabetes). Hispanics also report
                                         higher levels of  diabetes than non-Hispanic
                                         whites (27 percent compared with 16 percent),
                                         but  lower  levels of  arthritis  (42  percent
                                         compared with 51 percent).

                                      Data for this indicator's chart and bullets can
                                      be found in Tables 16a and 16b on page 100.

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   INDICATOR 17
Sensory Impairments and Oral Health

Vision and hearing limitations and oral health problems are often thought of as natural signs of aging.
However, early detection and treatment can prevent, or at least postpone, some of the debilitating
physical, social, and emotional effects these impairments can have on the lives of older people. Glasses,
hearing aids, and regular dental care are not covered services under Medicare.
   Limitations in hearing and vision, and no natural teeth, among the
   population 65 and over, by sex, 2008
    Percent
    100

     90

     80

     70

     60

     50

     40

     30

     20

     10

      0
                             Men
                                      Women
42
                                                                    27
               Any trouble hearing
                            Any trouble seeing
                                                                         No natural teeth
   NOTE: Respondents were asked "WITHOUT the use of hearing aids or other listening devices, is your hearing excellent, good, a little trouble hearing,
   moderate trouble, a lot of trouble, or are you deaf?" For the purposes of this indicator, the category "Any trouble hearing" includes: "a little trouble hearing,
   moderate trouble, a lot of trouble, and deaf." This question differs slightly from the question used to calculate the estimates shown in previous editions of
   Older Americans. Regarding their vision, respondents were asked "Do you have any trouble seeing, even when wearing glasses or contact lenses?" and the
   category "Any trouble seeing" includes those who in a subsequent question report themselves as blind. Lastly, respondents were asked in one question,
   "Have you lost all of your upper and lower natural (permanent) teeth?"
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
V In 2008,42 percent of older men and 30 percent
   of older women reported trouble hearing. The
   percentage with trouble hearing was higher for
   people age 85  and over (60 percent) than for
   people age 65-74 (28 percent). Eleven percent
   of all older women and 18 percent of all older
   men reported having ever worn a hearing aid.

V Vision trouble  affects 18 percent of the older
   population, 15  percent of men and  19 percent
   of women. Among people age 85 and over, 28
   percent reported trouble seeing.
                                  V The  prevalence  of  edentulism, having  no
                                     natural teeth, was higher for people age 85 and
                                     over  (34 percent) than for people age 65-74
                                     (20 percent). Socioeconomic differences are
                                     large. Forty-two percent of older people with
                                     family income below the poverty line reported
                                     no natural teeth compared with 23 percent of
                                     people above the poverty threshold.
                                                  Data for this indicator's charts and bullets
                                                  can be found in Tables 17a and 17b on page
                                                  101.

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   INDICATOR 18
Respondent-Assessed Health Status
Asking people to rate their health as excellent,  very good, good, fair, or poor provides a common
indicator of health easily measured in surveys. It represents physical, emotional, and social aspects
of health and well-being. Respondent-assessed health ratings of poor correlate with higher risks of
mortality.15
   Respondent-reported good to excellent health among the population
   65 and older by age group, race, and Hispanic origin, 2006-2008
   Percent
   100,-
Non-Hispanic
white
Non-Hispanic
black
Hispanic
(of any race)
                                                                        68
              65 and over
                                    65-74
                                                         75-84
                                                                           85 and over
  NOTE: Data are based on a 3-year average from 2006-2008. See Appendix B for the definition of race and Hispanic origin in the National Health Interview Survey.
  Reference population: These data refer to the civilian noninstitutionalized population.
  SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
0 During the  period 2006-2008, 75 percent of
   people  age  65  and over rated their health as
   good, very good, or excellent. Older men and
   women report similar levels of health.

0 The proportion of people reporting good to
   excellent health decreases among the oldest
   age groups.  Seventy-eight percent of those  age
   65-74 report good or better health. At age  85
   and over, 66 percent of people report good or
   better ratings. This pattern is also evident within
   race and ethnic groups.
                 V Regardless of age,  older non-Hispanic white
                   men and women  are  more  likely to  report
                   good health than their non-Hispanic black and
                   Hispanic counterparts.  Non-Hispanic blacks
                   and Hispanics are similar to one another in their
                   positive health evaluations.
                                               Data for this indicator's charts and bullets
                                               can be found in Table 18 on page 102

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   INDICATOR 19
Depressive Symptoms
Depressive symptoms are an important indicator of general well-being and mental health among older
adults. People who report many depressive symptoms often experience higher rates of physical illness,
greater functional disability, and higher health care resource utilization.16
   Clinically relevant depressive symptoms among the population age 65 and
   over, by sex, 1998-2006
   Percent                                       Percent
   100,-                                         100,-
    90

    80

    70

    60

    50

    40

    30

    20

    10
                         Men
12
        12
                12
                         11
                                 10
90

80

70

60

50

40

30

20

10
                                                                          Women
                                              19
                                                      19
                                                               18
                                                                       17
                                                                               18
         1998
                 2000
                         2002
                                 2004
                                          2006
                                                       1998
                                                               2000
                                                                       2002
                                                                                2004
                                                                                        2006
   NOTE: The definition of "clinically relevant depressive symptoms" is four or more symptoms out of a list of eight depressive symptoms from an abbreviated
   version of the Center of Epidemiological Studies Depression Scale (CES-D) adapted by the Health and Retirement Study (MRS). The CES-D scale is a
   measure of depressive symptoms and is not to be used as a diagnosis of clinical depression. A detailed explanation concerning the "4 or more symptoms"
   cut-off can be found in the following documentation, http://hrsonline.isr.umich.edu/docs/userg/dr-005.pdf. Proportions are based on weighted data using the
   preliminary respondent weight from MRS 2006.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: Health and Retirement Study.
V Older women are more likely to report clinically
   relevant depressive symptoms than older men.
   In 2006, 18 percent of women age 65 and over
   reported depressive symptoms compared with
   10 percent of men. There has been no significant
   change in this sex difference between 1998 and
   2006.
                                       V The percentage of people reporting clinically
                                          relevant symptoms has remained  relatively
                                          stable over the past few years.  Between 1998
                                          and 2006, the percentage of men who reported
                                          depressive symptoms ranged between 10 and 12
                                          percent. For women, the percentage reporting
                                          these symptoms ranged from 17 to 19 percent.
 1900   1910   1920   1930   1940   1950   1960   1970   1980   1990   2000  2010

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   INDICATOR 19
Depressive Symptoms continued
   Clinically relevant depressive symptoms among the population age 65
   and over, by age group and sex, 1998-2006
   Percent
   100

    90

    80

    70

    60

    50

    40

    30

    20

    10
                                                Total
                                                         Men
IWomen
14
         17
                                                                     19   18   19
              65-69
                               70-74
                                                 75-79
                                                                  80-84
                                                                                 85 and over
   NOTE: The definition of "clinically relevant depressive symptoms" is four or more symptoms out of a list of eight depressive symptoms from anabbreviated
   version of the Center of Epidemiological Studies Depression Scale (CES-D) adapted by the Health and Retirement Study (MRS). The CES-D scale is a
   measure of depressive symptoms and is not to be used as a diagnosis of clinical depression. A detailed explanation concerning the "4 or more symptoms"
   cut-off can be found in the following documentation, http://hrsonline.isr.umich.edu/docs/userg/dr-005.pdf.  Proportions are based on weighted data using the
   preliminary respondent weight from MRS 2006.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: Health and Retirement Study.
V The  prevalence  of depressive  symptoms  is
   related to  age.   In 2006, the proportion  of
   people age 65 and over with clinically relevant
   symptoms  was higher for people age 85 and
   over (19 percent) than for people in any of the
   younger groups (13 to  16 percent).
                                       V In 2006, the percentage of men  85 and over
                                          (almost   18  percent)  reporting   clinically
                                          relevant  depressive symptoms  was  twice  (or
                                          almost twice) that of men in any of the younger
                                          age  groups (8-10  percent).    Prevalence  of
                                          depression among women age 65 and older did
                                          not follow this same pattern; the percentage of
                                          women reporting clinically relevant symptoms
                                          ranges between  17 percent and 20 percent,
                                          with women age 75-79 reporting the highest
                                          prevalence.
                                                  Data for  this indicator's charts and  bullets
                                                  can be found in  Tables 19a and 19b on page
                                                  103.

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   INDICATOR 20
Functional Limitations
Functioning in later years may be diminished if illness, chronic disease, or injury limits physical and/
or mental abilities. Changes in functional limitation rates have  important implications for work and
retirement policies, health and long-term care needs, and the social well-being of the older population.
  Percentage of Medicare enrollees age 65 and over who have limitations in
  activities of daily living (ADLs) or instrumental activities of daily living
  (lADLs), or who are in a facility, selected years 1992-2007
   Percent
   100,-
   90

   80

   70

   60

   50

   40

   30

   20

   10

    0

                                      lADLs only
                                      1 to 2 ADLs
                                      3 to 4 ADLs
                                     I 5 to 6 ADLs
                                      Facilitx
              1992
                              1997
                                               2001
                                                               2005
                                                                                2007
   NOTE: A residence is considered a long-term care facility if it is certified by Medicare or Medicaid; has 3 or more beds and is licensed as a nursing home or
   other long-term care facility and provides at least one personal care service; or provides 24-hour, 7-day-a-week supervision by a caregiver. ADL limitations refer
   to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or
   using the toilet. IADL limitations refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone,
   light housework, heavy housework, meal preparation, shopping, or managing money. Rates are age adjusted using the 2000 standard population. Data for 1992,
   2001, and 2007 do not sum to the totals because of rounding.
   Reference population: These data refer to Medicare enrollees.
   SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
V In 2007, 42 percent of people age 65 and over
   reported  a  functional  limitation.  Fourteen
   percent  had  difficulty  performing  one  or
   more lADLs but  had  no  ADL  limitations.
   Approximately 25 percent had difficulty with at
   least one ADL and 4 percent were in a facility.

V The age-adjusted proportion of people age  65
   and over with a functional limitation declined
   from 49 percent in  1992 to 42 percent in 2007.
   There was a steady  decrease in the percent with
   limitations from 1992 until 1997.  From  1997
   to 2007 the overall levels have not significantly
   changed  although  a smaller  proportion  of
   this population is in a facility compared with
   earlier years.

V Women  have  higher  levels  of  functional
   limitations than men. In 2007, 47  percent of
   female  Medicare  enrollees  age 65 and  over
   had difficulty with ADLs or lADLs, or were
   in a facility, compared with 35 percent of male
   Medicare enrollees.  Overall rates  of decline
   since  1992  are similar for men and women;
   however, a higher proportion of women are in
   facilities compared with men.
 1900   1910   1920   1930   1940    1950  1960  1970   1980   1990   2000   2010

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   INDICATOR 20
Functional Limitations continued

In addition to activities of daily living (ADLs) and instrumental activities of daily living (lADLs),
other measures can be used to assess physical, cognitive, and social functioning. Aspects of physical
functioning such as the ability to lift heavy objects, walk two to three blocks, or reach up over one's
head are more closely linked to physiological capabilities than are ADLs and lADLs, which also may
be influenced by social and cultural role expectations and by changes in technology.
Percentage of Medicare enrollees age 65 and over who are unable to
perform certain physical functions, by sex, 1991 and 2007
Percent Percent
100
90
80
70
60
50
40
30
20
10
0
r 100
90
80
Men
70
60
50
40
30
1919 2ฐ
'8i ^ 2ฑ "l • I10
• 1991 12007
-
.
Women
-
-
.
32 32
. ,,'" jm 18 ,,. II
1 • _ 1 1 1
Stoop/ Reach Write Walk Lift Any of Stoop/ Reach Write Walk Lift Any of
kneel over 2-3 10 Ibs. these knee| over 2-3 10 Ibs. these
head blocks five neacj blocks five
NOTE: Rates for 1991 are age adjusted to the 2007 population.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
V Older women reported more  problems with
   physical functioning than older men.  In 2007,
   32 percent of  women  reported they  were
   unable to perform at least one of five activities,
   compared with 19 percent of men.

V Problems  with  physical  functioning  were
   more frequent at older ages.  Among men aged
   65-74, 13 percent reported they were unable to
   perform at least one of five activities, compared
   with  40 percent of men age 85 and  over.
   Among women,  22 percent of those age 65-74
   were unable to  perform  at least  one activity,
   compared with  56 percent  of those  age  85
   and over.
V Physical functioning was not strongly related
  to race in 2007.  Among men, 19 percent of
  non-Hispanic whites were unable to perform
  at least one activity, compared with 26 percent
  of non-Hispanic blacks.  Among women, there
  were no significant differences  among non-
  Hispanic  whites,  non-Hispanic  blacks,  and
  Hispanics, regarding ability to perform at least
  one activity.

Data for this indicator's charts and bullets
can be found in Tables 20a, 2 Ob, 20c, and 20d
on pages 104 105.
                         1900   1910   1920   1930  1940   1950   1960  1970   1980   1990   2000   2010

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Health Risks and Behaviors
         Indicator 21:
         Indicator 22:
         Indicator 23:
         Indicator 24:
         Indicator 25:
         Indicator 26:
         Indicator 27:
         Indicator 28:
Vaccinations
Mammography
Diet Quality
Physical Activity
Obesity
Cigarette Smoking
Air Quality
Use of Time

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   INDICATOR 21
Vaccinations
Vaccinations against influenza and pneumococcal disease are recommended for older Americans, who
are at increased risk for complications from these diseases compared with younger individuals.17'18
Influenza vaccinations are given annually, and pneumococcal vaccinations are usually given once in a
lifetime. The costs associated with these vaccinations are covered under Medicare Part B.
   Percentage of population age 65 and over vaccinated against influenza
   and pneumococcal disease, by race and Hispanic origin, selected years
   1989-2008
   Percent
   100
    80
    60
    40
    20
                                                         Influenza
                                                  Non-Hispanic whitei
                               Influenza Hispanic
                                 ! Pneumococcal	
                                  Non-Hispanic whitฃป
                Influenza
                Non-Hispanic black
    — -i.
i ^^"Pne
                                     neumococcal disease
                                    Non-Hispanic black
>-           <~
 ^Pneumococcal disease
  Hispanic
     1989
             1991
                      1993 1994 1995
                                        1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
   NOTE: For influenza, the percentage vaccinated consists of people who reported having a flu shot during the past 12 months and does not include receipt
   of nasal spray flu vaccinations. For pneumococcal disease, the percentage refers to people who reported ever having a pneumonia vaccination.
   See Appendix B for the definition of race and Hispanic origin in the National Health  Interview Survey.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
V In 2008, 67 percent of people age 65 and over
   reported receiving a  flu shot in the past 12
   months; however, there are differences by race
   and ethnicity. Seventy percent of non-Hispanic
   whites reported receiving a flu shot compared
   with 50 percent of non-Hispanic blacks and 55
   percent of Hispanics.

V In 2008, 60 percent of people age 65 and over
   had ever received a  pneumonia vaccination.
   Despite recent increases in the rates for all
   groups, non-Hispanic  whites were more likely
   to have received a pneumonia vaccination (64
   percent) compared with non-Hispanic blacks
   (45 percent) or Hispanics (36 percent).
                  V The  percent  of   older   people  receiving
                    vaccinations increases  with  age.   In  2008,
                    79  percent  of persons  age 85 and  older had
                    received a flu shot compared with 73 percent
                    among  persons  age 75-84  and 61  percent
                    among  persons  age 65-74.  For pneumonia
                    vaccinations, 69 percent of persons 75-84 and
                    85  and older had ever  received  a pneumonia
                    vaccination compared with 53 percent among
                    persons 65-74.

                  Data for this indicator's charts and bullets
                  can be found in Tables 2 la and 21b on page
                  106.
 1900   1910   1920  1930   1940   1950   1960   1970   1980   1990   2000  2010

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   INDICATOR 22
Mammography
Health care services and screenings can help prevent disease or detect it at an early, treatable stage.
Mammography has been shown to be effective in reducing breast cancer mortality among women age
50to74.19
   Percentage of women age 50 and over who had a mammogram in the past
   2 years, by age group, selected years 1987-2008
    Percent
   100

    90

    80

    70

    60

    50

    40

    30

    20

    10
            50-64
     1987
                19901991
                            19931994
                                              199819992000
                                                                 2003
                                                                         2005
                                                                                    2008
   NOTE: Questions concerning use of mammography differed slightly on the National Health Interview Survey across the years for which data are
   shown. For details, see Health, United States 2009, Appendix II.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
0 Among women age 65 and over, the percentage
  who had a mammogram within the preceding 2
  years almost tripled from 23 percent in 1987 to
  66 percent in 2008. While there was a significant
  difference in 1987 between the  percentage of
  older non-Hispanic white women (24 percent)
  and the percentage of older non-Hispanic black
  women (14 percent) who reported having had
  a mammogram, in recent years, this difference
  has disappeared.

v Older women who were poor were less likely
  to have had a mammogram in the  preceding 2
  years than older women who were not poor. In
  2008, 49 percent of women age 65 and over
  who lived in families with incomes less than
  100 percent of the poverty threshold reported
  having  had  a mammogram.   Among older
  women living in families with incomes  200
  percent or more of the poverty threshold,  71
  percent reported having had a mammogram.

0 Older women without a high school  diploma
  were less likely to have had a mammogram
  than older women with a high school diploma.
  In 2008, 49 percent of women age 65 and over
  without a high school diploma reported having
  had a mammogram in the preceding  2 years,
  compared with 66 percent of women who had a
  high school diploma and 76 percent of women
  who had at least some college education.
Data for this indicator's charts and bullets
can be found in Table 22 on page 107.
                         1900  1910   1920   1930  1940   1950  1960   1970   1980   1990   2000  2010

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   INDICATOR 23
Diet  Quality
Nutrition plays  a significant  role  in  the  health of older Americans.   A healthful  diet  can reduce
cardiometabolic risk factors, such as hypertension, diabetes, and obesity.  The increase in the size of the
older population is paralleled by an increase in the prevalence of chronic diseases, such as cardiovascular
disease.20  Since diet is a modifiable lifestyle factor, dietary improvement can lead to reduced disease
risk and improved health in older  adults.  The  Healthy Eating Index-2005 (HEI-2005)21'22 measures
how well diets conform to the recommendations of the 2005 Dietary Guidelines for Americans23 and
MyPyramid,24 USDA's food guidance  system (http://www.MyPyramid.gov).
   Average dietary component scores as a percent of federal diet quality
   standards,3  population age 65 and older, by age group, 2003-2004
                                                          100100
                         65-74
                        I 65-74
75 and older
75 and older
           Total   Whole  Total  DGOVb  Total  Whole   Milk   Meat   Oils
           Fruit   Fruit  Vegetables  and   Grains  Grains          and
                              Legumes                      Beans
                               Adequacy components

60
I
64
I

32
I
38
\

51
I
62
I

Saturated Sodium Calories
Fat from
SoFAASc
                         Moderation components
   3Federal diet quality standard is the Healthy Eating Index-2005; "Dark green and orange vegetables; cSolid fats, alcoholic beverages, and added sugars.
   NOTE: The Healthy Eating Index-2005 (HEI-2005) comprises 12 components. Scores are averages across all adults and reflect long-term dietary intakes. The
   scores are expressed here as percentages of recommended dietary intake levels. A score corresponding to 100 percent indicates that the recommendation was
   met or exceeded, on average. A score below 100 percent indicates that average intake does not meet recommendations. Nine components of the HEI-2005
   address nutrient adequacy. The remaining three components assess saturated fat, sodium, and calories from solid fats, alcoholic beverages, and added sugars,
   all of which should be consumed in moderation. For the adequacy components, higher scores reflect higher intakes; for the moderation components, higher
   scores reflect lower intakes because lower intakes are more desirable. For all components, a higher percentage indicates a higher-quality diet.
   Reference population: These data refer to the resident noninstitutionalized population.
   SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, 2003-2004 and
   U.S. Department of Agriculture, Center for Nutrition Policy and Promotion, Healthy Eating Index-2005.
0 In  2003-2004,  the  average  diet  of older
   Americans (age 65 and older) met or exceeded
   the federal  diet  quality standards  for three
   components: whole fruit, total grains, and meat
   and beans; however,  nine dietary components
   fell short.

0 On average, the diets of Americans 75 years
   and older were superior in quality to the diets
   of their younger counterparts, ages 65-74, for
   total fruit, dark green  and orange vegetables
   and  legumes,  whole grains,  milk,  and  oils;
   however, for total vegetables, 65-74-year-olds
   fared better than those  75  and older.  The diet
   quality standards were met or exceeded by both
   age groups for whole  fruit, total grains,  and
   meat and beans.
0 Average intakes of saturated fat, sodium, and
   calories  from  solid  fats, alcoholic beverages,
   and added sugars were too high and failed to
   meet the quality standards in both age groups.

0 To meet  federal guidelines,  older Americans
   would need to reduce  their intake  of foods
   containing solid fats and added sugars,  limit
   alcoholic beverages, and reduce their sodium
   (salt)  intake.  Healthier eating  patterns would
   also  include more  vegetables,  whole  grains,
   oils, and nonfat/lowfat milk products.

Data for this indicator's charts and bullets
can be found in  Table 23 on page 108.

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   INDICATOR 24
Physical Activity
Physical activity is beneficial for the health of people of all ages, including the 65 and overpopulation.
It can reduce the risk of certain chronic diseases, may relieve symptoms of depression, helps to maintain
independent living, and enhance overall quality of life.25'26 Research has shown that even among frail
and very old adults, mobility and functioning can be improved through physical activity.27
  Percentage of population age 45 and over who reported engaging in regular
  leisure time physical activity, by age group, 1997-2008
   Percent
   100,-
    90

    80

    70

    60

    50

    40

    30

    20

    10
     0
,45-64
         T65 and over
                             75-84
                                                          85 and over
  1997-1998
                   1999-2000
                                   2001-2002
                                                   2003-2004
                                                                   2005-2006
                                                                                   2007-2008
  NOTE: Data are based on 2-year averages. "Regular leisure time physical activity" is defined as "engaging in light-moderate leisure time physical activity for
  greater than or equal to 30 minutes at a frequency greater than or equal to five times per week, or engaging in vigorous leisure time physical activity for greater
  than or equal to 20 minutes at a frequency greater than or equal to three times per week."
  Reference population: These data refer to the civilian noninstitutionalized population.
  SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
9 In  2007-2008, 22 percent of people  age 65
   and over reported engaging in regular leisure
   time physical activity. The percentage of older
   people engaging  in  regular physical activity
   was lower at older  ages, ranging from 25
   percent among people age 65-74 to 11 percent
   among people age 85 and over. Although there
   was no  significant change in the percentage
   reporting physical activity between 1997 and
   2008 among all people 65 and over, there were
   small increases among people 75-84.

V Men age  65  and over  are more  likely than
   women  in the  same age group to  report
   engaging  in  regular leisure  time physical
   activity (27 percent and 18 percent, respectively,
   in  2007-2008).  Older  non-Hispanic  white
   people report higher levels of physical activity
                                       than non-Hispanic black people  (23  percent
                                       compared with 13 percent for non-Hispanic
                                       blacks in 2007-2008).

                                     0 Other forms of physical activity also contribute
                                       to overall health and fitness. Strength training
                                       is recommended as part of a comprehensive
                                       physical activity program among  older adults
                                       and may help to improve balance and decrease
                                       risk of falls.28 Fourteen percent of older people
                                       reported engaging  in strengthening exercises in
                                       2007-2008.

                                     Data for this  indicator's charts and bullets
                                     can be found in Tables 24a and 24b on page
                                     109.
                          1900   1910   1920   1930   1940   1950   1960   1970    1980   1990   2000   2010

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   INDICATOR 25
Obesity
Similar to cigarette smoking, obesity is a major cause of preventable disease and premature death.29
Both are associated with increased risk of coronary heart disease; Type 2 diabetes; endometrial, colon,
postmenopausal breast, and other cancers;  asthma and other respiratory problems; osteoarthritis; and
disability.30-31
   Percentage of population age 65 and over who are obese, by sex and age
   group, selected years 1988-2008
   Percent                                        Percent
   100,-
    90

    80

    70

    60

    50

    40

    30

    20

    10
            Men
100

 90

 80

 70

 60
                                                                       I 65-74
                                                                                75 and over
      33
24
                                                            Women
                                                  39     40
                                                              36    37
                                         .  27
        1988- 1999-  2001-  2003-  2005-  2007-
         1994   2000   2002  2004  2006  2008
                                            1988-  1999-  2001-  2003- 2005-  2007-
                                            1994   2000  2002  2004   2006   2008
   NOTE: Data are based on measured height and weight. Height was measured without shoes. Obese is defined by a Body Mass Index (BMI) of 30
   kilograms/meter2 or greater. See Appendix C for the definition of BMI.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey.
V As with other age groups, the percentage of   v Older men followed similar trends; 24 percent
   people  age 65 and over who are obese has     of men age 65-74 and 13 percent of men age 75
   increased since 1988-1994. In 2007-2008, 32     and over were obese in 1988-1994, compared
   percent of people age 65 and over were obese,     with 40 percent of men age 65-74 and  26
   compared with 22 percent in 1988-1994.          percent of men age 75 and over in 2007-2008.

V In 2007-2008, 35 percent of women age 65-74   0 Over the  past 9 years, the trend has leveled
   and 27 percent of women age 75 and over were     off,  with no  statistically  significant change
   obese. This is an  increase from  1988-1994,     in obesity for older men or  women between
   when 27 percent of women age 65-74 and 19     1999-2000 and 2007-2008.
   percent of women age 75 and over were obese.
                                                Data for this indicator's charts and bullets
                                                can be found in Table 25 on page 110.
 1900  1910   1920   1930   1940   1950  1960   1970   1980   1990  2000  2010

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   INDICATOR 26
Cigarette Smoking
Smoking has been linked to an increased likelihood of cancer, cardiovascular disease, chronic obstructive
lung diseases, and other debilitating health conditions. Among older people, the death rate for chronic
lower respiratory diseases (the fourth leading cause of death among people age 65 and over) increased
50 percent between 1981 and 2006. See "Indicator 15:  Mortality." This increase reflects, in part, the
effects of cigarette smoking.32
   Percentage of people age 65 and over who are current cigarette smokers, by
   sex, selected years 1965-2008
   Percent
   100

    90

    80

    70

    60

    50

    40

    30

    20

    10
Men
     1965
                      1974
                                1979
                                        1983
                                                     1990
                                                               1995
                                                              2000
2005  2008
   NOTE: Data starting in 1997 are not strictly comparable with data for earlier years due to the 1997 National Health Interview Survey (NHIS) questionnaire
   redesign. Starting with 1993 data, current cigarette smokers were defined as ever smoking 100 cigarettes in their lifetime and smoking now on every day or
   some days. See Appendix B for the definiton of race and Hispanic origin in the NHIS.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
V The percentage  of older Americans who  are
   current  cigarette smokers declined between
   1965 and 2008. Most of the decrease during this
   period is the result of the declining prevalence
   of cigarette smoking  among men (from  29
   percent  in  1965  to 11  percent in 2008).  For
   the  same period,  the  percentage of women
   who smoke cigarettes has remained relatively
   constant, increasing slightly from 10 percent in
   1965 before declining to 8 percent in 2008.

V Among  older men, blacks have a higher rate
   of smoking than do whites (18 percent and 10
   percent, respectively). The percentage of older
   women  who  smoke is similar among whites
   and African Americans.
                                      v A large percentage of both men and women
                                        age 65 and over are former smokers. In 2008,
                                        55  percent of older  men  previously smoked
                                        cigarettes,  while 31 percent of women age 65
                                        and over were former smokers.
                                                 Data for this indicator's charts and bullets
                                                 can be found in Tables 26a, 26b, and 26c on
                                                 pages 111 113.
                          1900   1910   1920   1930   1940   1950   1960   1970   1980   1990   2000  2010

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   INDICATOR 27
Air Quality
As people age, their bodies are less able to compensate for the effects of environmental hazards.  Air
pollution can aggravate heart and  lung disease, leading to increased medication use, more visits to
health care providers, admissions to emergency rooms and hospitals, and even death.  An important
indicator for environmental health is the percentage of older adults living in areas that have measured
air pollutant concentrations above the  level of the Environmental Protection Agency's (EPA) national
standards. Ozone and particulate matter (PM) (especially smaller, fine particle pollution called PM 2.5)
have the greatest potential to affect the health of older adults.  Fine particle pollution has been linked to
premature death, cardiac arrhythmias and heart attacks, asthma attacks, and the development of chronic
bronchitis.  Ozone, even at low levels, can exacerbate respiratory diseases such as chronic obstructive
pulmonary disease or asthma.33"37
    Percentage of people age 65 and over living in counties with
    air quality," 2000-2008
                                                                                  poor
    Percent
    100
      2000
                 2001
                           2002
                                      2003
                                                 2004
                                                            2005
                                                                       2006
                                                                                  2007
                                                                                             2008
    NOTE: The term 'poor air quality" is defined as air quality concentrations above the level of the National Ambient Air Quality Standards (NAAQS). The term
    "any standard" refers to any NAAQS for ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon monoxide, and lead. In 2008, EPA strengthened the
    national standard for 8-hour ozone to 0.075 ppm and the national standard for lead to 0.15 ug/m3. This figure includes people living in counties that monitored
    ozone and lead concentrations above the new levels. This results in percentages that are not comparable to previous publications.
    Reference population: These data refer to the resident population.
    SOURCE: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S., U.S. Census Bureau, Population
    Projections, 2000-2008.
0 In 2008, 36 percent of people age 65 and over
   lived in counties with poor air quality for ozone
   compared with 52 percent in 2000.

V A comparison  of 2000 and 2008  shows a
   reduction in PM 2.5.  In 2000, 41 percent of
   people age 65 and over lived in a county where
   PM 2.5 concentrations were at times above the
   EPA standards  compared with  11 percent of
   people age 65 and over in 2008.
                                                   0 The percentage of people age 65 and over living
                                                      in counties that experienced poor air quality for
                                                      any air pollutant decreased from 62 percent in
                                                      2000 to 38 percent in 2008.
 1900   1910   1920   1930   1940   1950   1960   1970   1980   1990  2000  2010

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   INDICATOR 27
Air Quality continued

Air quality varies across the United States; thus, where people live can affect their health risk.  Each
state monitors air quality and reports findings to the EPA.  In turn, the EPA determines whether pollutant
measurements meet the standards that have been set to protect human health.
   Counties with "poor air quality" for any standard in 2008
   NOTE: The term "poor air quality" is defined as air quality concentrations above the level of the National Ambient Air Quality Standards (NAAQS).
   The term "any standard" refers to any NAAQS for ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon monoxide, and lead.
   Reference population: These data refer to the resident population.
   SOURCE: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S. Census Bureau, Population
   Projections, 2000-2008.
   In 2008, nearly 42 percent of the population
   lived in a county where measured air pollutants
   reached concentrations above  EPA standards.
   This percentage was fairly consistent across all
   age groups, including people age 65 and over.
Overall, approximately  127  million people
lived in counties where monitored air in 2008
was unhealthy at times because of high levels
of at least one of the six principal air pollutants:
ozone,  particulate matter (PM), nitrogen dio-
xide, sulfur dioxide, carbon monoxide, and lead.
The vast majority of  areas that experienced
unhealthy air did so because of one or both of
two pollutants—ozone and PM.
                                                  Data for  this indicator's charts and  bullets
                                                  can be found in Tables 27a and 27b on pages
                                                  113-117.

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   INDICATOR 28
Use of Time
How  individuals spend their time  reflects their financial and personal  situations, needs, or desires.
Time-use data show that as Americans get older, they spend more of their time in leisure activities.
   Percentage of day that people age 55 and over spent doing selected
   activities on an average day, by age group, 2008
   Percent
   100

    90

    80

    70

    60

    50

    40

    30

    20

    10

     0
               Caring for and helping others
               Sleeping
               Grooming
               Leisure activities
               Work and work-related activities
               Household activities
               Purchasing goods and services
               Eating and drinking
               Other activities
               55-64
                                  65-74
                                                   75 and over
   NOTE: "Other activities''includes activities such as educational activities; organizational.civic,and religious activities; and telephone
   calls. Chart includes people who did not work at all.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: Bureau of Labor Statistics, American Time Use Survey.
   In  2008, older Americans  spent  on average
   more than one-quarter of their time in leisure
   activities. This proportion increased with age:
   Americans  75 and over spent 32  percent of
   their time in leisure compared with 24 percent
   for those age 55-64.
v On an average day, people age 55-64 spent 15
   percent of their time (about 4 hours) working or
   doing work-related activities compared with 5
   percent (about one hour) for people age 65-74
   and 2 percent (less than 30 minutes) for people
   age 75 and over.

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   INDICATOR 28
Use of Time continued

Leisure activities are those done when free from duties such as working, household chores, or caring for
others. During these times, individuals have flexibility in choosing what to do.
  Percentage of total leisure time that people age 55 and over spent doing
  selected leisure activities on an average day, by age group, 2008
  Percent
  100

   90

   80

   70

   60

   50

   40

   30

   20

   10

    0
         Watching TV
         Socializing and communicating

         Reading

         Relaxing and thinking
         Participation in sports, exercise, and recreation
         Other leisure activities (including related travel)
             55-64
                             65-74
                                            75 and over
  Reference population: These data refer to the civilian noninstitutionalized population.
  SOURCE: Bureau of Labor Statistics, American Time Use Survey.
  Watching TV was the activity that occupied the
  most leisure time—slightly more than one-half
  the total—for Americans age 55 and over.

V Americans age  75 and over  spent a higher
  percentage of their  leisure  time reading  (14
  percent versus 9  percent) and relaxing and
  thinking (10 percent versus 5 percent) than did
  Americans age 55-64.
V The   proportion   of   leisure  time   that
   older   Americans   spent   socializing  and
   communicating—such as visiting friends  or
   attending or hosting social events—declined
   with age. For Americans age 55-64, 13 percent
   of  leisure time was  spent socializing and
   communicating compared to 8 percent for those
   age 75 and over.
                                              Data for this indicator's charts and bullets can
                                              be found in Tables 28a and 28b on page 118.

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-------
Health Care
         Indicator 29:
         Indicator 30:
         Indicator 31:
         Indicator 32:
         Indicator 33:

         Indicator 34:

         Indicator 35:
         Indicator 36:
         Indicator 37:
Use of Health Care Services
Health Care Expenditures
Prescription Drugs
Sources of Health Insurance
Out-of-Pocket Health Care
Expenditures
Sources of Payment for Health Care
Services
Veterans' Health Care
Residential Services
Personal Assistance and Equipment

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   INDICATOR 29
Use of Health Care Services

Most older Americans have health insurance through Medicare. Medicare covers a variety of services,
including inpatient hospital care, physician services, hospital outpatient care, home health care, skilled
nursing facility care, hospice services, and (beginning in January 2006) prescription drugs. Utilization
rates  for many services change over time because of changes in physician practice patterns, medical
technology, Medicare payment amounts, and patient demographics.
   Medicare-covered hospital and skilled nursing facility stays per 1,000
   Medicare enrollees age 65 and over in fee-for-service, 1992-2007
   Stays per 1,000
   500

   450

   400

   350

   300

   250

   200

   150

   100

    50
        Hospital stays
           Skilled nursing facility stays
     0
     1992  1993  1994  1995  1996  1997  1998  1999  2000  2001  2002  2003  2004  2005  2006  2007

   NOTE: Beginning in 1994, managed care enrollees were excluded from the denominator of all utilization rates because utilization data are not available for
   them. Prior to 1994, managed care enrollees were included in the denominators; they comprised 7 percent or less of the Medicare population.
   Reference population: These data refer to Medicare enrollees in fee-for-service.
   SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
0 Overall,   between   1992   and   1999,  the
   hospitalization rate increased from 306 hospital
   stays per 1,000 Medicare enrollees to 365 per
   1,000.   The  rate then decreased to 336 per
   1,000 enrollees in 2007. The average length of
   a hospital stay decreased from 8.4 days in 1992
   to 5.6 days in 2007.
0 Skilled   nursing  facility  stays   increased
   significantly  from  28  per  1,000  Medicare
   enrollees in 1992 to 81 per 1,000 in 2007. Much
   of the increase occurred from 1992 to 1997.
 1900   1910   1920   1930  1940    1950  1960   1970   1980   1990   2000   2010

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   INDICATOR 29
Use of Health Care Services continued
    Medicare-covered physician and home health care visits per 1,000
    Medicare enrollees  age 65 and over in fee-for-service, 1992-2007
    Visits per 1,000
    15,000
                           Implementation of the
                           Balanced Budget Act
                 Physician visits
                 and consultations
                                   I
                                                                   Note: The vertical scale used in this chart is
                                                                   not comparable to the vertical scale used in
                                                                   the preceding chart on page 48. Physician
                                                                   visits and consultations and home health
                                                                   care visits are much more common among
                                                                   people age 65 and over than either
                                                                   hospitalizations or skilled nursing facility
                                                                   admissions.
    12,500
10,000
 7,500
     5,000
     2,500
        0

        1992  1993  1994  1995  1996  1997  1998  1999  2000  2001  2002  2003  2004  2005  2006  2007


    • • • •  Data on physician visits and consultations are not available for 1997,1999, 2006, and 2007.
    NOTE: Physician visits and consultations include all settings, such as physician offices, hospitals, emergency rooms, and nursing homes. The definition of
    physician visits and consultations changed beginning in 2003, resulting in a slightly lower rate. Beginning in 1994, managed care enrollees were excluded
    from the denominator of all utilization rates because utilization data are not available for them. Prior to 1994, managed care enrollees were included in the
    denominators; they comprised 7 percent or less of the Medicare population.
    Reference population: These data refer to Medicare enrollees in fee-for-service.
    SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
0 Overall, between 1992 and 2005, the number
   of physician visits and consultations increased.
   There were 11,359 visits and consultations per
   1,000 Medicare enrollees in  1992, compared
   with 13,914 in 2005.

V The  number of home health care visits per
   1,000 Medicare enrollees  increased from 3,822
   in 1992 to 8,376 in 1996.  Home health care
   use increased during this period in part because
   of an expansion in the coverage criteria for the
   Medicare home health care benefit.38  Home
   health care visits declined after 1997 to 2,295
   per  1,000 enrollees  in  2001.   The decline
   coincided with changes in Medicare  payment
   policies for  home health care resulting  from
   implementation  of  the Balanced  Budget Act
   of 1997.  The visit  rate increased thereafter to
   3,409 per 1,000 enrollees  in 2007.
                                                   Use  of  skilled  nursing  facility  and home
                                                   health care increased with age.  In 2007, there
                                                   were 32 skilled nursing facility stays per 1,000
                                                   Medicare enrollees age 65-74, compared with
                                                   227 per 1,000 enrollees age 85 and over. Home
                                                   health  agencies made  1,713  visits per  1,000
                                                   enrollees age 65-74, compared with 7,333 per
                                                   1,000 for those age 85 and over.
                                                    Data for  this indicator's  charts and bullets
                                                    can be found in Tables 29a and 29b on page
                                                    119.
                            1900   1910    1920   1930   1940    1950   1960   1970   1980    1990   2000   2010

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   INDICATOR 30
Health Care  Expenditures
Older Americans use more health care than any other age group. Health care costs are increasing at the
same time the baby boom generation is approaching retirement age.
                               85 and over
                                 ,75-84
Average annual health care costs for Medicare enrollees age 65 and over,
by age group, 1992-2006
Dollars
24,000

22,000

20,000

18,000

16,000

14,000

12,000

10,000

 8;000

 6,000

 4,000

 2,000
     0	
    1992  1993  1994  1995  1996  1997  1998  1999  2000   2001  2002  2003  2004  2005  2006
— — — — Data are not available for 2005.
NOTE: Data include both out-or-pocket costs and costs covered by insurance.
Dollars are inflation-adjusted to 2006 using the Consumer Price Index (Series CPI-U-RS).
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
V After adjusting for inflation, health care costs
   increased significantly among older Americans
   from  1992  to  2006.  Average  costs rose
   substantially with age.

0 Average   health   care  costs   varied   by
   demographic characteristics.   Average  costs
   among non-Hispanic blacks were $18,098  in
   2006, compared with $ 14,144 among Hispanics.
   Low-income individuals incurred higher health
   care costs; those with  less than  $10,000  in
   income averaged $21,033 in health care costs
   whereas those  with more  than  $30,000  in
   income averaged only $12,440.
                                            V Costs also varied by health status. Individuals
                                               with no chronic conditions incurred $5,186 in
                                               health care costs on average.  Those with five
                                               or more conditions incurred $25,132. Average
                                               costs among  residents   of  long-term  care
                                               facilities were $57,022, compared  with only
                                               $12,383 among community residents.

                                            V Access  to  health  care is determined  by  a
                                               variety of factors related to the cost, quality,
                                               and availability of health  care  services.  The
                                               percentage  of older Americans who reported
                                               they  delayed  getting  care  because  of cost
                                               declined from 9.8 percent in  1992 to about 5
                                               percent in 1997 and remained relatively constant
                                               thereafter.   The  percentage  who  reported
                                               difficulty  obtaining  care  varied between  2
                                               percent and 3 percent.
 1900  1910   1920   1930   1940   1950  1960   1970   1980   1990   2000  2010

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   INDICATOR 30
Health Care Expenditures continued

Health care costs can be broken down into different types of goods and services. The amount of money
older Americans spend on health care and the type of health care that they receive provide an indication
of the health status and needs of older Americans in different age and income groups.
   Major components of health care costs among Medicare enrollees age
   65 and over, 1992 and 2006
                                                                          Other

                                                                          Prescription drugs

                                                                          Home health care

                                                                          Long-term care facility
                                                                          Physician/outpatient
                                                                          hospital
                                                                          Inpatient hospital
                      1992
                                                         2006
   NOTE: Data include both out-of-pocket costs and costs covered by insurance. "Other" includes short-term institutions, hospice services, and dental care.
   Reference population: These data refer to Medicare enrollees.
   SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
0 Hospital and physician services are the largest
   components of health care costs.  Long-term
   care facilities accounted for 13 percent of total
   costs in 2006. Prescription drugs accounted for
   16 percent of health care costs.

V The  mix  of health  care  services  changed
   between 1992 and 2006. Inpatient hospital care
   accounted for a lower share of costs  in 2006
   (25 percent compared with 32 percent in 1992).
   Prescription drugs increased in importance from
   8 percent of costs in 1992 to 16 percent in 2006.
   "Other" costs (short-term institutions, hospice
   and dental care) also increased as a percentage
   of all costs (4 percent to 9 percent).
The  mix  of services varied with  age.   The
biggest difference occurred for long-term care
facility services; average costs were $7,182
among  people age  85  and over,  compared
with just $547 among those age 65-74. Costs
of home health care and "other" services also
were higher at older ages. Costs of physician/
outpatient services and  prescription drugs did
not show a strong pattern by age.
                                                Data for  this indicator's charts and bullets
                                                can be found in Tables  30a, 3 Ob, 30c,  30d,
                                                and 30e on pages 120-122.
                          1900   1910   1920   1930  1940    1950   1960   1970   1980   1990   2000  2010

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   INDICATOR 31
Prescription Drugs
Prescription drug costs have increased rapidly in recent years, as more new drugs become available.
Lack of prescription drug coverage has created a financial hardship for many older Americans. Medicare
coverage of prescription drugs began in January 2006, including a low-income subsidy for beneficiaries
with low incomes and assets.
    Average annual prescription drug costs for noninstitutionalized Medicare
    enrollees age 65 and over, by sources of payment, 1992-2004
    Dollars
    2,200

    2,000

    1,800

    1,600

    1,400

    1,200

    1,000

     800

     600

     400

     200

       0
Public programs
       1992   1993   1994   1995    1996   1997   1998   1999   2000   2001    2002    2003   2004

    NOTE: Dollars have been inflation-adjusted to 2004 using the Consumer Price Index (Research Series). Reported costs have been adjusted by a factor of
    1.205 to account for underreporting of prescription drug use. Public programs include Medicare, Medicaid, Department of Veterans Affairs, and other state
    and federal programs. Data for 2005 and 2006 were not available in time to include in this report.
    Reference population: These data refer to Medicare enrollees.
    SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
V Average  prescription  drug  costs  for older   0 Costs varied significantly among individuals.
   Americans have  increased  rapidly in  recent     Approximately 8 percent of older Americans
   years.  Average costs per person were $2,107     incurred no prescription  drug costs  in  2004.
   in 2004.                                         About 24 percent incurred $2,500 or more in
                                                   prescription drug costs that year.
V Average  out-of-pocket  costs  also  increased,
   though not  as  much as  total costs  because
   private and public  insurance  covered more
   of the cost over time.  Older Americans paid
   60 percent of prescription drug costs out of
   pocket in 1992,  compared with 36 percent in
   2004. Private insurance covered 38 percent of
   prescription drug costs in 2004; public programs
   covered 25 percent.
 1900   1910   1920   1930   1940   1950   1960   1970   1980   1990   2000  2010

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   INDICATOR 31
Prescription Drugs continued

Under Medicare Part D, beneficiaries may join a standalone prescription drug plan or a Medicare
Advantage  plan that provides  prescription drug coverage  in addition  to other Medicare-covered
services. In situations where beneficiaries receive drug coverage from a former employer, the former
employer may be eligible to receive a retiree drug subsidy from Medicare to help cover the cost of the
drug benefit.
   Number of Medicare enrollees age 65 and over who enrolled in a Part D
   prescription drug plan or were covered under the Retiree Drug Subsidy,
   June 2006 and December 2009
    Enrollment in millions
    25 i—
    20
    15
    10
 No low-income subsidy
I Low-income subsidy
               Part D plan
Retiree drug subsidy
Part D plan
Retiree drug subsidy
                        June 2006                             December 2009

     Reference population: These data refer to Medicare enrollees.
     SOURCE: Centers for Medicare and Medicaid Services, Management Information Integrated Repository.
V The number of Medicare beneficiaries enrolled
   in  Part D prescription drug plans  increased
   from  18.2 million (51 percent of beneficiaries)
   in  June 2006 to 22.2 million (57 percent of
   beneficiaries) in December 2009.  In December
   2009,61 percent of plan enrollees were in stand-
   alone plans and 39  percent were in  Medicare
   Advantage plans. Approximately 6.2 million
   beneficiaries were covered by the retiree drug
   subsidy.  Beneficiaries who were not in Part D
   plans and not covered by the retiree drug subsidy
   either  had  drug coverage  through another
   source  (e.g.,  TRICARE,  Federal Employees
   Health Benefits plan, Department of Veterans'
   Affairs, current employer) or did not have drug
   coverage.
                 V In December 2009, 6.1 million Part D enrollees
                    were receiving low-income subsidies.  Many of
                    these beneficiaries had drug coverage through
                    the Medicaid program prior to enrollment in
                    Part D.

                 0 Chronic  conditions   are  associated  with
                    high prescription drug costs.  In 2004, older
                    Americans with no chronic conditions incurred
                    average prescription drug costs of $800. Those
                    with five or more chronic conditions incurred
                    $3,862 in prescription drug costs on average.

                 Data for this indicator's charts and bullets
                 can be found in Tables 3 la, 31b, 31c and 3 Id
                 on pages 122-123.
                         1900   1910   1920   1930  1940   1950   1960   1970   1980   1990   2000  2010

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   INDICATOR 32
Sources of Health Insurance

Nearly all older Americans have Medicare as their primary source of health insurance coverage. Medicare
covers mostly acute care services and requires beneficiaries to pay part of the cost, leaving about half of
health spending to be covered by other sources.  Many beneficiaries have supplemental insurance to fill
these gaps  and pay for services not covered by Medicare. Prior to 2006, many beneficiaries received
prescription drug coverage through supplemental insurance. Since January 2006, beneficiaries  have
had the option of receiving prescription drug  coverage under Medicare through stand-alone prescription
drug plans  or through some Medicare Advantage health plans.
    Percentage of noninstitutionalized Medicare enrollees age 65 and over
    with supplemental health insurance, by type of insurance, 1991-2007
    Percent
   100 ,_
    90
    80
    70
    60
            Private (Medigap) '
                                              Private (employer
                                              or union sponsored)
 50

 40

 30

 20

 10

  0
  1991  1992  1993 1994  1995  1996  1997 1998  1999  2000  2001  2002  2003  2004  2005 2006  2007

* Includes people with private supplement of unknown sponsorship.
NOTE: HMO/health plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and privatefee-for-service
plans (PFFSs). Not all types of plans were available in all years. Since 2003 these types of plans have been known collectively as Medicare
Advantage. Estimates are based on enrollees' insurance status in the fall of each year. Categories are not mutually exclusive (i.e., individuals may
have morethan one supplemental policy). Chart excludes enrollees whose primary insurance is not Medicare (approximately 1 to 2 percent of
enrollees). Medicaid coverage was determined from both survey responses and Medicare administrative records.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
V Most  Medicare  enrollees  have  a  private
   insurance  supplement, approximately  equally
   split between employer-sponsored and Medigap
   policies.    The  percentage with  Medicaid
   coverage has increased from  10 percent in 2000
   to 12 percent in 2007. Enrollment in Medicare
   HMOs and other health plans, which are usually
   equivalent to Medicare supplements because
   they offer  extra  benefits,  varied between 6
   percent and  22 percent.  About 13 percent of
   Medicare enrollees  reported having  no health
   insurance supplement in 2007.
                                             V Enrollment in HMOs  and other health plans
                                                increased in the  1990s, decreased from 2000
                                                to 2003  (as many plans withdrew from  the
                                                Medicare program),  then  increased  again,
                                                following  establishment  of  the   Medicare
                                                Advantage program. The percent of Medicare
                                                enrollees without a supplement increased from
                                                10 percent in 2000 to 13 percent in 2007.

                                             Data for this indicator's  charts and bullets
                                             can be found in Tables 32a and 32b on page
                                             124.
 1900   1910   1920   1930  1940   1950   1960   1970   1980   1990   2000  2010

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   INDICATOR 33
Out-of-Pocket Health Care Expenditures
Large out-of-pocket expenditures for health care service use have been shown to encumber access to
care, affect health status and quality of life, and leave insufficient resources for other necessities.39'40
The percentage of household income that is allocated to health care expenditures is a measure of health
care expense burden placed on older people.
   Out-of-pocket health care expenditures as a percentage of household
   income, among noninstitutionalized people age 65 and  over, by age and
   income category, 1977 and 2006
   Percent                                        Percent
   100,_                                        100,_                  1977  12006
    90

    80

    70

    60

    50

    40

    30

    20

    10

     0
       Poor/Near poor
       income category
90

80

70

60

50

40
28
Other income
  category
        65 and over   65-74
                             75-84   85 and over
                                           56       55
                                                    J
                                        65 and over   65-74
   NOTE: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Including expenditures for out-of-pocket premiums
   in the estimates of out-of-pocket spending would increase the percentage of household income spent on health care in all years. People are classified into the
   "poor/near poor" income category if their household income is below 125 percent of the poverty level; otherwise, people are classified into the "other" income
   category. For people with no out-of-pocket expenditures the ratio of out-of pocket spending to income was set to zero. For additional details on how the ratio
   of out-of-pocket spending to income and the poverty level were calculated, see Table 33b in Appendix A.
   Reference population: These data refer to the civilian noninstitutionalized population.
   SOURCE: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), and MEPS predecessor surveys.
0 The percentage of people age 65 and over with
   out-of-pocket spending for health care services
   increased between 1977 and 2006 (83 percent
   to 95 percent, respectively).

V From 1977 to 2006 the percentage of household
   income that people age 65 and over allocated to
   out-of-pocket spending for health care services
   increased among those  in the poor/near  poor
   income category from 12 percent to 28 percent.
   Increases were also observed for those in  poor
   or fair health (from  10 percent to 13 percent)
   as well as for those in excellent, very good, or
   good health (from 6 percent to 8 percent).

V In 2006, as in the 6  previous years, over  one-
   half of out-of-pocket health care spending by
                                       noninstitutionalized  people age  65 and over
                                       was used to purchase prescription drugs. The
                                       percentage  of  out-of-pocket  spending  for
                                       prescription drugs increased from 2000 to 2004
                                       (54 percent to 61 percent, respectively) then
                                       decreased starting in 2005.

                                    V In 2006, people age 85 and over spent a lower
                                       proportion of out-of-pocket dollars than people
                                       age 65-74 on dental services  and office-based
                                       medical provider visits but a higher proportion
                                       on other health care (e.g., home health care).

                                    Data for this indicator's chart and bullets can
                                    be found in Tables 33a,  33b, and33c on pages
                                    125-128.
                            i_
                          1900   1910   1920   1930   1940   1950   1960   1970
                                                                          1980
                                                                                1990   2000   2010

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   INDICATOR 34
Sources of Payment for Health Care Services
Medicare  covers about one-half of the health care costs of Medicare enrollees age  65 and over.
Medicare's payments are focused on acute care services such as hospitals and physicians. Nursing home
care, prescription drugs, and dental care have been primarily financed out-of-pocket or by other payers.
Medicare coverage of prescription drugs began in January 2006, including a low-income subsidy.
   Sources of payment for health care services for Medicare enrollees age
   65 and over, by type of service, 2006
                                                                                   Average
         $239   $3 695   $442    $728   $3,956  $1,290  $2351    $346    $2,034   $15,081  cost Per
   100,— ^^^^_    '            ^^^^_ .                 '      ^^^^_ .            _ enrollee
   90
   80
   70
  260
  CD
  Q_
   50
   40

   30

   20

   10
        Hospice  Inpatient  Home   Short-  Physician/  Out-  Prescription Dental  Long-term   All
                hospital   health    term   Medical  patient   drugs            care
                         care   institution         hospital                  facility
   NOTE: "Other" refers to private insurance, Department of Veterans Affairs, and other public programs.
   Reference population: These data refer to Medicare enrollees.
   SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
                                                                                   Other
                                    Out-of
                                    pocket

                                    Medicaid
                                    Medicare
V Medicare paid for slightly more than half (55
   percent) of the health care costs of Medicare
   enrollees age  65 and over in 2006.  Medicare
   finances most of their hospital and physician
   costs,  as well as  a  majority of short-term
   institutional, home health, and hospice costs.

V Medicaid covered 7 percent of health care costs
   of Medicare enrollees age 65 and over, and other
   payers  (primarily  private  insurers) covered
   another 19 percent. Medicare enrollees age 65
   and over paid 19 percent of their health care
   costs out of pocket, not including insurance
   premiums.

V In 2006, 47 percent of long-term care facility
   costs for Medicare enrollees age 65 and  over
   were covered by Medicaid; another 45 percent of
   these costs were paid out of pocket. Twenty-six
   percent of prescription drug costs for Medicare
   enrollees age 65 and  over  were covered by
   Medicare, 45 percent were  covered by third-
   party payers other than Medicare and Medicaid
   (consisting mostly  of private  insurers), and
   26 percent were paid out of pocket. Seventy-
   seven percent of dental care received by older
   Americans was paid out of pocket.

V Sources  of payment for health care vary by
   income.  Lower-income individuals rely heavily
   on Medicaid; those with higher incomes rely
   more  on  private  insurance.  Lower-income
   individuals pay a lower percent of health care
   costs out of pocket, but have a  higher average
   cost for  services than  individuals with higher
   incomes.

Data for this  indicator's charts and bullets
can be found in Tables  34a and 34b on page
129.

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   INDICATOR 35
Veterans' Health Care

The numbers of veterans age 65 and over who receive health care from the Veterans Health Administration
(VHA), within the Department of Veterans Affairs (VA), has been steadily increasing. This increase may
be because VHA fills important gaps in older veterans' health care needs not currently covered or fully
covered by Medicare, such as mental health services, long-term care (nursing home care and community-
based care), and specialized services for the disabled.  In addition, as the largest integrated health care
system in the country, VHA provides broader geographic access to these important services.
    Veterans age 65 and over enrolled in or receiving care from the Veterans
    Health Administration, 1990-2008
    Millions
    12
    10
              VA health care     VA health care
               reform begins   enrollment begins
                    T             T
Veteran population
 age 65 and over
                                                                                 VAenrollees
                                                                               age 65 and over
             VA patients
            age 65 and over
     0
     1990  1991 1992 1993 1994 1995  1996 1997 1998 1999 2000 2001 2002 2003 2004  2005 2006 2007 2008

    NOTE: Department of Veterans Affairs (VA) enrollees are veterans who have signed up to receive health care from the Veterans Health Administration (VHA).
    VA patients are veterans who have received care each year through VHA. The methods used to calculate VA patients differ from those used in Older
    Americans 2004 and Older Americans Update 2006. Veterans who received care but were not enrolled in VA are now included in patient counts. VHA Vital
    Status files from the Social Security Administration (SSA) are now used to ascertain veteran deaths.
    Reference population: These data refer to the total veteran population, VHA enrollment population, and VHA patient population.
    SOURCE: Department of Veterans Affairs, Veteran Population 2007; Fiscal 2009 Year-end Office of the Assistant Deputy Under Secretary for Health for Policy
    and Planning Enrollment file linked with September 2009 VHA Vital Status data (including data from VHA, VA, Medicare, and SSA).
V In 2008, approximately 2.2  million  veterans
   age 65 and over received health care  from the
   VHA.  An additional 1.2 million older veterans
   were enrolled to receive health  care from the
   VHA but did not use its services in 2008.

V Reforms and initiatives implemented by the VA
   since 1996 have led to an increased demand for
   VHA services among veterans despite the short-
   term decline in the numbers of older veterans
   (see "Indicator 6:  Older Veterans").  Some of
   the changes include: implementing  enrollment
   for VHA health care and opening the system to
   all veterans (1999) and reopening  enrollment
   to Priority 8 veterans with incomes up to 110
   percent of the Geographic Means Test/Veterans
   Means Test Thresholds (2009).
                                   V Older  veterans  continue to turn to VHA for
                                      their health care needs, despite their eligibility
                                      for other sources of health care. VHA estimates
                                      that  approximately  one-third  of its enrollees
                                      age 65 and over are enrolled in Medicare Part
                                      D.  Approximately  22  percent  of enrollees
                                      age 65 and over  have some form of private
                                      insurance. Another  14 percent are enrolled in
                                      TRIG ARE for Life and 12 percent are eligible
                                      for Medicaid.  In contrast, about 4 percent of
                                      VHA enrollees  age  65 and over report having
                                      no other public or private coverage.41

                                   Data for this indicator's chart and bullets can
                                   be found in Table 35  on page 130.
                           1900   1910   1920   1930   1940    1950   1960   1970   1980   1990   2000   2010

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   INDICATOR 36
Residential Services
Some older Americans living in the community have access to various services through their place of
residence.  Such services may include meal preparation, laundry and cleaning services, and help with
medications. Availability of such services through the place of residence may help older Americans
maintain their independence and avoid institutionalization.
   Percentage of Medicare enrollees age 65 and over in selected residential
   settings, by age group, 2007
   Percent
   100

    90

    80

    70

    60

    50

    40

    30

    20

    10
                            Long-term care facilities

                            Community housing
                            with services
                            Traditional community
            65 and over
                                 65-74
                                                   75-84
                                                                   85 and over
   NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior citizen housing,
   continuing care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and other similar situations, AND who
   reported they had access to one or more of the following services through their place of residence: meal preparation; cleaning or housekeeping services; laundry
   services; help with medications. Respondents were asked about access to these services, but not whether they actually used the services. A residence (or unit)
   is considered a long-term care facility if it is certified by Medicare or Medicaid; or has three or more beds and is licensed as a nursing home or other long-term
   care facility and provides at least one personal care service; or provides 24-hour, seven-day-a-week supervision by a non-family, paid caregiver.
   Reference population: These data refer to Medicare enrollees.
   SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
0 In 2007, 2 percent of the Medicare population
   age 65 and over resided in community housing
   with  at least  one  service  available.    Four
   percent resided in long-term care facilities. The
   percentage of  people  residing  in  community
   housing  with  services and in  long-term care
   facilities was higher for the older age groups;
   among  individuals  age 85 and  over, 7  percent
   resided in  community housing  with services,
   and   15  percent  resided  in  long-term  care
   facilities.   Among  individuals  age 65-74,  98
   percent    resided in   traditional   community
   settings.

V Among residents of community housing with
   services,  87  percent reported access  to meal
   preparation   services;   84   percent   reported
   access to housekeeping/cleaning services; 72
   percent reported access  to laundry services;
   and  51 percent  reported access  to  help with
   medications. These numbers reflect percentages
   reporting availability of specific services, but
   not necessarily the number that actually used
   these services.

V Sixty-five percent of residents in community
   housing with services reported that there were
   separate charges for at least some services.

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   INDICATOR 36
Residential Services continued
    Percentage of Medicare enrollees age 65 and over with functional
    limitations, by residential setting, 2007
    Percent
   100

    90

    80

    70

    60

    50

    40

    30

    20

    10
                                             3 or more ADL limitations
                                            1-2 ADL limitations
                                             IADL limitations only

                                             No functional limitations
                Traditional
                community
Community housing
   with services
Long-term
care facility
   NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior citizen housing,
   continuing care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and other similar situations, AND who
   reported they had access to one or more of the following services through their place of residence: meal preparation; cleaning or housekeeping services; laundry
   services; help with medications. Respondents were asked about access to these services, but not whether they actually used the services. A residence (or unit)
   is considered a long-term care facility if it is certified by Medicare or Medicaid; or has three or more beds and is licensed as a nursing home or other long term care
   facility and provides at least one personal care service; or provides 24-hour, seven-day-a-week supervision by a non-family, paid caregiver. Instrumental activities
   of daily living (IADL) limitations refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone;
   light housework; heavy housework; meal preparation; shopping; managing money. Activities of daily living (ADL) limitations refer to difficulty performing (or
   inability to perform for a health reason) the following tasks: bathing; dressing; eating; getting in/out of chairs; walking; using the toilet. Long-term care facility
   residents with no limitations may include individuals with limitations in certain lADLs: doing light or heavy housework or meal preparation. These questions were
   not asked of facility residents.
   Reference population: These data refer to Medicare enrollees.
   SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
V People  living  in  community  housing  with
   services   had  more  functional  limitations
   than   traditional   community  residents,  but
   not as many as those living in long-term care
   facilities.    Forty-six  percent  of individuals
   living  in  community  housing  with services
   had at least one activity of daily living  (ADL)
   limitation   compared  with  25  percent   of
   traditional community  residents.  Among long-
   term  care facility residents, 83 percent had at
   least  one ADL limitation.  Thirty-six percent of
   individuals  living in community housing with
   services had no ADL or instrumental activities
   of daily living (IADL)  limitations.

0 The   availability  of  personal   services   in
   residential settings  may explain  some  of the
   observed decline  in nursing home use.
                   V Residents of community housing with services
                      tended to have similar  incomes to  traditional
                      community residents, and higher incomes than
                      long-term care facility residents.  Thirty-eight
                      percent of long-term care facility residents had
                      incomes  of $10,000 or less in 2007, compared
                      with  13-14 percent of  traditional community
                      residents and residents of community housing
                      with services.

                   V Over one-half (56 percent) of people living
                      in community housing  with services  reported
                      they could continue living there if they needed
                      substantial care.

                   Data for this indicator's  charts and bullets
                   can be found in Tables  36a,  36b,  36c,  36d,
                   and 36e on pages 131-132.

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   INDICATOR 37
Personal Assistance  and  Equipment
As the proportion of the older population residing in long-term care facilities has declined (see "Indicator
20: Functional Limitations"), the use of personal assistance and/or special equipment among those with
limitations has increased. This assistance  helps older people living in the community maintain their
independence.
   Percent distribution of noninstitutionalized Medicare enrollees age 65 and
   over who have limitations in activities of daily living (ADLs), by type of
   assistance, selected years 1992-2007
   Percent
   100 ,-

    90

    80

    70

    60

    50

    40

    30

    20

    10
                             None
                             Personal assistance
                             and equipment

                             Personal assistance
                             only
                             Equipment only
              1992
                            1997
                                         2001
                                                        2005
                                                                      2007
   NOTE: ADL limitations refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating,
   getting in/out of chairs, walking, or using the toilet. Respondents who report difficulty with an activity are subsequently asked about receiving help or
   supervision from another person with the activity and about using special equipment or aids. In this table, personal assistance does not include supervision.
   Reference population: These data refer to noninstitutionalized Medicare enrollees who have limitations with one or more ADLs.
   SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
0 Between 1992 and 2007,  the age-adjusted
   proportion of people age 65 and over who had
   difficulty with  one or more ADLs and who did
   not receive personal assistance or  use special
   equipment with these activities decreased from
   42 percent to 34 percent. More people are using
   equipment  only—the  percentage  increased
   from 28 percent to 38 percent. The percentage
   of people who used personal assistance only
   decreased from 9 percent to 6 percent.

0 In 2007, two-thirds of people who had difficulty
   with  one  or more  ADLs  received personal
   assistance or used special equipment: 6 percent
   received personal assistance  only,  38 percent
   used equipment only, and 22 percent used both
   personal assistance and equipment.

V In  2007, women  and men  with limitations
   in ADLs were equally likely to use special
   equipment only  for help (38 percent).   Men
   were more  likely than women to receive  no
   assistance, and women were more likely than
   men to receive a  combination  of personal
   assistance and equipment.
 1900   1910    1920  1930   1940   1950   1960   1970   1980   1990  2000   2010

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  INDICATOR 37
Personal Assistance and Equipment continued
   Percentage of noninstitutionalized Medicare enrollees age 65 and over who
   have limitations in instrumental activities of daily living (lADLs) and who
   receive personal assistance, by age group,  selected years 1992-2007
   Percent
   100
    90

    80

    70

    60

    50

    40

    30

    20

    10
                                65-74
                                           75-84
                                                     85 and over
        69
    63
59
              1992
                               1997
                                               2001
                                                               2005
                                                                                2007
   NOTE: IADL limitations refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using
   the telephone,  light housework, heavy housework, meal preparation, shopping, or managing money. Respondents who report difficulty
   with an activity are subsequently asked about receiving help from another person with the activity. In this table, personal assistance does
   not include supervision or special equipment.
   Reference population: These data refer to noninstitutionalized Medicare enrollees who have limitations with one or more lADLs.
   SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
  In 2007, two-thirds of people age 65 and over
  who had difficulty with one or  more lADLs
  received personal assistance. The percentage
  of  people receiving  personal assistance was
  higher for people age 85 and over (70 percent)
  than it was for people age 75-84 (66 percent) or
  people age 65-74 (65 percent).
                                       Among  older  people  in  2007  who  had
                                       difficulties  with   lADLs,  there  were  no
                                       significant  differences  in  the   percentage
                                       of women  and men who received  personal
                                       assistance
                                                Data for this indicator's charts and bullets
                                                can be found in Tables 37a and 37b on page
                                                133.
                          1900   1910   1920  1930   1940   1950   1960   1970   1980   1990  2000   2010

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Data Needs
Residential Care
In Older Americans 2008, the Federal Interagency
Forum  on  Aging-Related  Statistics  (Forum)
identified six  areas  where  better  data  were
needed to support research and policy efforts. In
this report, the Forum  updates  those six areas,
identifying new  data sources  when available,
and provides information on one additional topic
area.  These topics have been identified by the
Forum as priority areas for data collection efforts
related  to  older Americans:  caregiving,  elder
abuse, functioning  and  disability,  mental health
and  cognitive  functioning,  pension measures,
residential care, and end-of-life issues.

Caregiving

Informal (unpaid) family caregivers provide the
majority of assistance  that enables  chronically
disabled older  people  to  continue  to  live  in
the community  rather than in  specialized  care
facilities. The annual economic value  of informal
eldercare exceeds national  spending on formal
(paid) care.42 Many of these chronically disabled
older adults have considerable needs, with some
requiring at least 50 hours per week  of personal
assistance with  functional activities.43  Informal
family caregivers of older people with high levels
of personal care needs can face considerable strain
providing such care. In recent years, it has become
clear that data are needed to monitor the amount,
sources,  and outcomes  of  informal  caregiving.
In 2009, a new nationally  representative  data
collection effort,  the National Health and Aging
Trends Study (NHATS), was funded. NHATS, a
representative study of older  adults,  along  with
a  supplemental  survey  of  informal  caregivers,
will provide researchers and policy makers  with
improved national estimates of caregiving and its
impact on care recipients and caregivers.

There remain data gaps across  the spectrum of
care providers.  Recent data are  not available for
nursing homes or their residents  or providers
of home care or  their clients. Data are  also not
available about newly emerging providers and it
is not possible to combine information across all
caregivers or all receivers of care.
A general shift in state Medicaid long-term care
policy and  independent growth in private-pay
residential care has  led to an  increasing set of
alternatives  to home care and traditional skilled
nursing  facilities. Residential  care  outside  of
the  traditional nursing  home  is  provided  in
diverse settings  (e.g., assisted  living facilities,
board  and  care  homes,  personal  care  homes,
and  continuing-care  retirement communities).
A common characteristic is that  these places
provide  both  housing and  supportive services.
Supportive services  typically include protective
oversight and help with  instrumental activities
of daily  living (lADLs) such as transportation,
meal  preparation, and taking medications, and
more basic activities of daily living (ADLs) such
as eating,  dressing,  and bathing. Despite  the
growing role of residential care, there has been little
national data on the number and characteristicsof
facilities and the people living in these settings.

In Older Americans  2008,  the  Forum  reported
that federal  agencies were working to design  a
new survey to obtain these estimates. As of 2010,
the National Survey of Residential Care Facilities
(NSRCF) is  being fielded as the first-ever national
survey of residential  care providers. Residential
care facilities include places  such as:  assisted
living  residences; board  and  care homes; and
personal  care homes that are licensed, registered,
listed, certified, or otherwise regulated by a state.
The NSRCF is designed to produce estimates of
these places and their residents. It will allow for
the  identification  of varied  levels of supportive
care and  assistance by housing arrangement.

The NSRCF will  fill a set of essential data gaps
related  to  residential  care  facilities.   Beyond
residential care facilities, there remains a need
for data to address questions about differences in
health care costs by type of housing arrangement.
For example, data are needed to assess how health
care costs of older  adults living in  congregate
housing  settings  compare to those that live in
other settings.

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Elder Abuse

In 1998, the Institute of Medicine at the National
Academies reported a "paucity of research" on
elder abuse and neglect, with most prior studies
lacking empirical evidence.44 In response to this
report, the Committee on National Statistics and
the Committee  on Law and  Justice convened an
expert panel to  review the risk and prevalence of
elder abuse and neglect. The panel published its
report  in 2003,  finding that there are no reliable
national  estimates of elder abuse,  nor are the
risk factors  clearly understood.45  The need for
a national study  of elder abuse and neglect is
supported by the growing number of older people,
increasing  public awareness  of the  problem,
new legal requirements for reporting abuse, and
advances in questionnaire design.

Following the 2003 report, the National Institute
on  Aging funded  a series of grants to develop
survey methodologies for  abuse  and neglect
surveillance. The CDC (with the assistance of the
member  agencies  of the Elder Justice Working
Group) has  developed preliminary definitions
for elder maltreatment as a first step in designing
recommended  data elements  for  use in  elder
maltreatment surveillance.  Additionally,  a new
indicator is being included in the Healthy People
2020 initiative, increasing the number of states
that collect and  publicly report incidences of elder
maltreatment.

Functioning and Disability

Information on trends in functioning and disability
is critical for monitoring the health and well-being
of the older population. However, the concept of
disability encompasses many different dimensions
of health and functioning and  their multifaceted
interactions with the environment.  Furthermore,
specific definitions of disability are used by some
government agencies to determine eligibility for
benefits. As  a result, disability is often measured
in different ways across surveys, and this has led to
disparate estimates of the prevalence of disability.
To the extent possible, population-based surveys
designed to broadly  measure disability in the
older population should use a common conceptual
framework. Longitudinal data that can be used to
monitor changes in patterns  and in transitions in
functional status also are needed.
There are several current national and international
activities that will  result in greater depth  and
comparability in  information  on functioning
and  disability.   Federal  agencies continue to
work together to find ways  to compare existing
measures  of functioning  and disability across
different surveys and to develop  new ways to
measure  this   complicated,  multidimensional
concept.  For example, the disability questions
developed by an Interagency Workgroup for the
American Community Survey are being adopted
by other federal surveys. Methodological research
on these newly developed disability measures is
being conducted as part of the National Health
Interview  Survey. The  new National Health and
Aging Trends Study (NHATS) includes measures
of disability and functional status that will capture
multiple components of disability, including the
intersection of  environment and  physical  and
cognitive functioning, as well as the relationship
between limitations and overall health and quality
of life.   In response to a request from National
Institute on Aging, the National Academic s recently
convened  a panel to investigate  additional ways
to address these  complex issues.  Their workshop
report describes a number  of innovative ways
to enhance comparability and improve validity
across surveys and in different settings.46

International developments include work from the
Washington Group on Disability Statistics, a UN-
sponsored city group, and the Budapest Initiative
on Health  State, a UNECE-WHO-Eurostat task
force, to develop comparable questions  sets to
measure functioning across a range of domains.
The   Washington  Group  also   is  developing
questions to access the impact of environmental
factors including assistive devices on participation
in society. The  questions developed  by these
groups are undergoing  cognitive and operational
testing  at the U.S.  National Center for Health
Statistics.     In  addition,  a set  of  nationally
representative longitudinal studies of the older
population provides tools to monitor the dynamics
of disability  using  comparable  or harmonized
measures.47

Mental  Health and Cognitive
Functioning

Research  that has  helped  differentiate  mental
disorders from "normal" aging has been one of the

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more important achievements of recent decades in
the field of geriatric health. Depression, anxiety,
schizophrenia, and alcohol and drug misuse and
abuse,  if untreated, can be  severely impairing,
even fatal. Despite interest and increased efforts
to track all of these disorders among older adults,
obtaining national estimates  has proven to be
difficult. International efforts by the Washington
Group  on Disability  Statistics and the Budapest
Initiative on Measuring Health State are underway
to  develop  comparable  short  sets  of  survey
questions to measure cognitive and psychological
functioning  along with  measures of  sensory
functioning,  mobility, upper  body functioning,
pain, fatigue, communication, and learning.

While  there  are  several studies  which report
estimates of the prevalence of Alzheimer's, one of
the major barriers to reliable national estimates of
prevalence is the lack of uniform diagnostic criteria
among the national surveys that attempt to measure
dementia or Alzheimer's. A meeting convened by
the NIA in 2009 to  describe the prevalence  of
Alzheimer's concluded that most of the variation
in prevalence estimates is not driven primarily by
the reliability of the measures or instruments per
se but by systematic differences in the definition
of dementia. Research is underway to address the
challenges in developing consistent indicators  of
cognitive and mental health. Although not intended
to be a platform for the diagnosis of neurological
disorders, the  NIH Toolbox on the Assessment
of Neurological  and Behavioral Functions will
allow different epidemiological studies to collect
harmonized  or comparable measures on many
domains  of  cognitive,  emotional, motor,  and
sensory function.

Pension Measures

As pension plans shift away from defined-benefit
pensions  and  annuities to defined contribution
plans, official  statistical  sources  on income and
poverty fail to measure substantial amounts  of
retirement income formerly provided by defined-
benefit pensions. The common  practice  is  to
transfer retirement plan accumulations to IRAs
and to take the money out of IRAs as irregular
payments. These  payments  are   not  included
as  money  income in the  most  widely used
government surveys.  Improved  measurement  of
withdrawals from retirement investment accounts
(deferred income in IRAs and 40 Iks) would result
in improved measurement of retirement income.

End-of-Life Issues
The  end  of life is recognized as a  uniquely
difficult  time for patients  and their  families.
Many  issues tend to  arise,  including decisions
about  medical  care;  caregiving,  both  formal
and informal; transitions in  living  arrangements
among community, assisted  living, and nursing
homes; financial impacts; whether to use advance
directives and living  wills, etc.  Documented
problem  areas  include  poor  management  of
pain and symptoms; lack of communication by
providers; decision-making  processes regarding
treatment; and insufficient  attention to  patient
preferences.48

The end of life has been the subject of many studies
and reports, including  an Institute of Medicine
(IOM) report in 2003 titled "Describing Death in
America: What We Need to Know."49 The IOM
report  documented many gaps in our knowledge
on how well the needs of individuals near the end
of life are being met. Some questions identified in
the IOM report are:

0 Where are people dying and how much of the
  end of their lives is spent in those settings?

V Who is providing care for them as they die? Do
  institutional settings support family presence at
  the end of life?

0 Are physical  and  psychological symptoms
  being identified and treated (including but not
  limited to pain)?

0 How  many  persons  experience   impaired
  cognitive  function before death?

V How do patients and loved ones perceive their
  quality of life  at various  time points prior to
  death?

V Are loved ones supported through the grieving
  process?

To this end, there is a need  for national data to
monitor the  experiences  of older adults nearing
death as  well as those closely linked to these
individuals.  Information on some of these topics
will be available with the release of Health,  United
States, 2010, which will include a special feature
on death and dying.50

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42. Arno P, Levine C, Memmott MM. The
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-------
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Appendix A: Detailed Tables

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    INDICATOR
Number of Older Americans
Table 1a. Number of people age 65 and over and 85 and over, selected years 1900-2008 and
projected 2010-2050
Year
Estimates
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
2005
2006
2007
2008
Projections
2010
2020
2030
2040
2050
65 and over
In millions
3.1
3.9
4.9
6.6
0.9
12.3
16.2
20.1
25.5
31.2
35.0
36.8
37.3
37.9
38.9

40.2
54.8
72.1
81.2
88.5
85 and over

0.1
0.2
0.2
0.3
0.4
0.6
0.9
1.5
2.2
3.1
4.2
5.1
5.3
5.5
5.7

5.8
6.6
8.7
14.2
19.0
Reference population: These data refer to the resident population.
SOURCE: U.S. Census Bureau, 1900 to 1940, 1970, and 1980, U.S. Census Bureau, 1983, Table 42; 1950, U.S. Census
Bureau, 1953, Table 38; 1960, U.S. Census Bureau, 1964, Table 155; 1990, U.S. Census Bureau, 1991, 1990 Summary Table
File; 2000, U.S. Census Bureau, 2001, Census 2000 Summary File; Table 2: Annual estimates of the resident population by sex
and selected age groups for the U.S.: April 1, 2000 to July 1, 2008 (NC-EST2008-02); Table 2: Projections of the population by
selected age groups and sex for the United States: 2010-2050 (NP2008-t2).

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    INDICATOR 1
Number of Older Americans continued
Table 1b. Percentage of the population age 65 and over and 85 and over, selected years 1900-2008 and projected
2010-2050
Year
Estimates
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
2005
2006
2007
2008
Projections
2010
2020
2030
2040
2050
65 and over
Percent
4.1
4.3
4.7
5.4
6.8
8.1
9.0
9.9
11.3
12.6
12.4
12.4
12.4
12.6
12.8

13.0
16.1
19.3
20.0
20.2
85 and over

0.2
0.2
0.2
0.2
0.3
0.4
0.5
0.7
1.0
1.2
1.5
1.7
1.8
1.8
1.9

1.9
1.9
2.3
3.5
4.3
Reference population: These data refer to the resident population.
SOURCE: U.S. Census Bureau, 1900 to 1940, 1970, and 1980, U.S. Census Bureau, 1983, Table 42; 1950, U.S. Census Bureau, 1953, Table 38; 1960, U.S. Census
Bureau, 1964, Table 155; 1990, U.S. Census Bureau, 1991, 1990 Summary Table File; 2000, U.S. Census Bureau, 2001, Census 2000 Summary File; Table 2:
Annual estimates of the resident population by sex and selected age groups for the U.S.: April 1, 2000 to July 1, 2008 (NC-EST2008-02); Table 2: Projections of the
population by selected age groups and sex for the United States: 2010-2050 (NP2008-t2).

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    INDICATOR
Number of Older Americans continued
Table 1c. Population of countries or areas with at least 10 percent of their population age 65 and over, 2008

Country or Area
Japan
Germany
Italy
Greece
Sweden
Spain
Austria
Estonia
Bulgaria
Belgium
Portugal
Croatia
Latvia
Serbia
Georgia
Finland
France
Slovenia
Ukraine
Lithuania
Switzerland
United Kingdom
Denmark
Hungary
Czech Republic
Norway
Canada
Luxembourg
Bosnia and Herzegovina
Belarus
Romania
Netherlands
Russia
Malta
Montenegro
Puerto Rico
Poland
Australia
Uruguay
Hong Kong S.A.R.
Virgin Islands (U.S.)
United States
New Zealand
Slovakia
Iceland
Ireland
Macedonia
Armenia
Cuba
Moldova
Argentina
South Korea
Taiwan
Aruba
Population
Total
127,288
82,370
58,145
10,723
9,045
40,491
8,206
1,308
7,263
10,404
10,677
4,492
2,245
7,414
4,631
5,245
64,058
2,008
45,994
3,565
7,582
60,944
5,485
9,931
10,221
4,644
33,213
486
4,590
9,686
22,247
1 6,645
1 40,702
404
678
3,954
38,501
21,007
3,478
7,019
110
304,060
4,173
5,455
304
4,156
2,061
2,969
11,424
4,324
40,482
48,379
22,921
102
(number in thousands)
65 and over
27,494
16,515
1 1 ,657
2,048
1,659
7,263
1,455
230
1,276
1,818
1,858
763
380
1,249
768
868
10,428
327
7,399
572
1,213
9,736
862
1,545
1,539
696
4,940
72
676
1,425
3,271
2,433
19,858
56
93
540
5,148
2,794
462
913
14
38,870
526
671
37
491
232
325
1,251
471
4,353
5,087
2,396
11
Percent
65 and over
21.6
20.0
20.0
19.1
18.3
17.9
17.7
17.6
17.6
17.5
17.4
17.0
16.9
16.8
16.6
16.6
16.3
16.3
16.1
16.0
16.0
16.0
15.7
15.6
15.1
15.0
14.9
14.7
14.7
14.7
14.7
14.6
14.1
13.9
13.7
13.7
13.4
13.3
13.3
13.0
12.8
12.8
12.6
12.3
12.0
11.8
11.3
11.0
10.9
10.9
10.8
10.5
10.5
10.4
NOTE: Table excludes countries and areas with less than 100,000 population.
SOURCE: U.S. Census Bureau, International Data Base, accessed on August 24, 2009.

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    INDICATOR  1
Number of Older Americans continued
Table 1d.  Percentage of the population age 65 and over, by state, July 1, 2008
State
(Listed alphabetically)
United States
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Percent
12.8
13.8
7.3
13.3
14.3
11.2
10.3
13.7
13.9
11.9
17.4
10.1
14.8
12.0
12.2
12.8
14.8
13.1
13.3
12.2
15.1
12.1
13.4
13.0
12.5
12.6
13.6
14.2
13.5
11.4
12.9
13.3
13.1
13.4
12.4
14.7
13.7
13.5
13.3
15.3
14.1
13.3
14.4
13.2
10.2
9.0
13.9
12.1
12.0
15.7
13.3
12.3
13.7
State
(Ranked by percentage)
United States
Florida
West Virginia
Pennsylvania
Maine
Iowa
Hawaii
North Dakota
South Dakota
Arkansas
Montana
Rhode Island
Vermont
Delaware
Alabama
Ohio
Connecticut
Missouri
Nebraska
Oklahoma
Massachusetts
New York
Wisconsin
South Carolina
Oregon
Arizona
New Jersey
Kentucky
Tennessee
New Mexico
Kansas
Michigan
New Hampshire
Indiana
Mississippi
Minnesota
North Carolina
Wyoming
Louisiana
Illinois
Virginia
Maryland
Washington
Idaho
District of Columbia
Nevada
California
Colorado
Texas
Georgia
Utah
Alaska
Puerto Rico
Percent
12.8
17.4
15.7
15.3
15.1
14.8
14.8
14.7
14.4
14.3
14.2
14.1
13.9
13.9
13.8
13.7
13.7
13.6
13.5
13.5
13.4
13.4
13.3
13.3
13.3
13.3
13.3
13.3
13.2
13.1
13.1
13.0
12.9
12.8
12.6
12.5
12.4
12.3
12.2
12.2
12.1
12.1
12.0
12.0
11.9
11.4
11.2
10.3
10.2
10.1
9.0
7.3
13.7
Reference population: These data refer to the resident population.
SOURCE: U.S. Census Bureau, Population Division, Table 1. Estimates of the population by selected age groups for the United States and Puerto Rico: July 1, 2008
(SC-EST2008-01).

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    INDICATOR
Number of Older Americans continued
Table 1e. Percentage of the population age 65 and over, by county, 2008
SOURCE: U.S. Census Bureau, July 1, 2008 Population Estimates
Data for this table can be found at http //www.agingstats.gov.

Table 1f. Number and percentage of people age 65 and over and 85 and over, by sex, 2008 (numbers in thousands)
 Selected characteristics
                                                                      Number
                                                                                                     Percent
   65 and over
      Total
      Men
      Women
   85 and over
      Total
      Men
      Women
                                  38,870
                                  16,465
                                  22,405

                                   5,722
                                   1,864
                                   3,858
100.0
 42.4
 57.6

100.0
 32.6
 67.4
Reference population: These data refer to the resident population.
SOURCE: U.S. Census Bureau, Population Division, Table 2. Annual estimates of the resident population by sex and selected age groups for the U.S.: April 1, 2000 to
July 1, 2008 (NC-EST2008-02).
    INDICATOR 2
Racial and Ethnic Composition
Table 2. Population age 65 and over, by race and Hispanic origin, 2008 and projected 2050 (numbers in thousands)
Race and Hispanic origin

Total
Non-Hispanic white alone
Black alone
Asian alone
All other races alone or in combination
Hispanic (of any race)
2008 estimates
Number
38,870
31 ,238
3,315
1,295
522
2,661
Percent
100.0
80.4
8.5
3.3
1.3
6.8
2050 projections
Number
88,547
51 ,772
10,553
7,541
2,397
17,515
Percent
100.0
58.5
11.9
8.5
2.7
19.8
NOTE: The term "non-Hispanic white alone " is used to refer to people who reported being white and no other race and who are not Hispanic. The term "black
alone" is used to refer to people who reported being black or african American and no other race, and the term "Asian alone" is used to refer to people who reported
only Asian as their race. The use of single-race populations in this report does not imply that this is the preferred method of presenting or analyzing data. The U.S.
Census Bureau uses a variety of approaches. The race group "All other races alone or in combination" includes American Indian and Alaska Native alone; Native
Hawaiian and Other Pacific Islander alone; and all people who reported two or more races.
Reference population: These data refer to the resident population.
SOURCE: U.S. Census Bureau, Population Estimates and Projections 2008.

-------
    INDICATOR 3
                     Marital Status
Table 3. Marital status of the population age 65 and over, by age group and sex, 2008
Selected characteristics
Both sexes
Total
Married
Widowed
Divorced
Never married
Men
Total
Married
Widowed
Divorced
Never married
Women
Total
Married
Widowed
Divorced
Never married
65 and over

100.0
57.0
29.8
9.1
4.1

100.0
74.5
13.8
7.5
4.2

100.0
43.9
41.8
10.3
4.0
65-74

100.0
67.0
16.8
11.9
4.3

100.0
79.2
6.9
9.5
4.4

100.0
56.8
25.1
13.9
4.2
75-84
Percent
100.0
51.2
38.6
6.5
3.6

100.0
72.2
18.7
5.6
3.6

100.0
36.6
52.5
7.2
3.7
85 and over

100.0
28.7
62.9
4.1
4.3

100.0
54.8
37.7
2.9
4.7

100.0
14.9
76.2
4.8
4.1
NOTE: Married includes married, spouse present; married, spouse absent; and separated
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008.
    INDICATOR 4
                     Educational Attainment
Table 4a. Educational attainment of the population age 65 and over, selected years 1965-2008
 Educational
  attainment
1965   1970  1975   1980  1985   1990  1995  2000  2001  2002  2003  2004  2005  2006  2007  2008
                                                              Percent
 High school
    graduate   23.5  28.3   37.3  40.7   48.2  55.4   63.8  69.5   70.0   69.9   71.5   73.1   74.0   75.2  76.1   77.4
     or more

  Bachelor's
     degree    5.0   6.3    8.1    8.6    9.4  11.6   13.0  15.6   16.2   16.7   17.4   18.7   18.9   19.5  19.2   20.5
     or more
NOTE: A single question which asks for the highest grade or degree completed is now used to determine educational attainment. Prior to 1995, educational attainment
was measured using data on years of school completed.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008.

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    INDICATOR 4
Educational Attainment continued
Table 4b. Educational attainment of the population age 65 and over, by race and Hispanic origin, 2008
 Race and Hispanic Origin
                   High school graduate or more
Bachelor's degree or more
                                                                                      Percent
   Both sexes
      Non-Hispanic white alone
      Black alone
      Asian alone
      Hispanic (of any race)
   Men
   Women
                               77.4
                               82.3
                               59.8
                               73.8
                               45.9
                               77.9
                               77.1
          20.5
          21.9
          12.3
          31.5
           9.0
          26.7
          15.8
NOTE: The term "non-Hispanic white alone" is used to refer to people who reported being white and no other race and who are not Hispanic. The term "black
alone" is used to refer to people who reported being black or African American and no other race, and the term "Asian alone" is used to refer to people who reported
only Asian as their race. The use of single-race populations in this report does not imply that this is the preferred method of presenting or analyzing data.  The U.S.
Census Bureau uses a variety of approaches.
Reference population: These data refer to the civilian  noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008.
    INDICATOR 5
                                      Living Arrangements
Table 5a. Living arrangements of the population age 65 and over, by sex and race and Hispanic origin, 2008
Selected characteristic
Men
Total
Non-Hispanic white alone
Black alone
Asian alone
Hispanic (of any race)
Women
Total
Non-Hispanic white alone
Black alone
Asian alone
Hispanic (of any race)
With spouse

71.9
73.9
54.2
76.9
67.4

41.7
43.6
24.6
44.6
40.6
With other relatives
Percent
7.0
5.8
11.2
10.3
14.9

17.1
13.4
31.9
32.3
31.4
With nonrelatives

2.5
2.2
4.4
2.2
4.9

1.8
1.8
1.9
0.8
1.3
Alone

18.5
18.2
30.2
10.6
12.8

39.5
41.1
41.7
22.3
26.7
NOTE: Living with other relatives indicates no spouse present. Living with nonrelatives indicates no spouse or other relatives present. The term "non-Hispanic white
alone" is used to refer to people who reported being white and no other race and who are not Hispanic. The term "black alone" is used to refer to people who reported
being black or African American and no other race, and the term "Asian alone" is used to refer to people who reported only Asian as their race. The use of single-race
populations in this report does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches.
Reference population: These data do not include the noninstitutionalized group quarters population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008.

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    INDICATOR 5
Living Arrangements continued
Table 5b. Population age 65 and over living alone, by age group and sex, selected years 1970-2008
Men
Year

1970
1980
1990
2000
2003
2004
2005
2006
2007
2008
65-74

11.3
11.6
13.0
13.8
15.6
15.5
16.1
16.9
16.7
16.3
75 and over
Percent
19.1
21.6
20.9
21.4
22.9
23.2
23.2
22.7
22.0
21.5
Women
65-74

31.7
35.6
33.2
30.6
29.6
29.4
28.9
28.5
28.0
29.1
75 and over

37.0
49.4
54.0
49.5
49.8
49.9
47.8
48.0
48.8
50.1
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008.
    INDICATOR 6
Older Veterans
Table 6a. Percentage of people age 65 and over who are veterans, by sex and age group, United States and Puerto
Rico, 2000 and projected 2010 and 2020
                  65 and over
                                             65-74
                                                                     75-84
    Year
                Men
                         Women
                                        Men
                                                  Women
                                                                Men
                                                                          Women
Reference population: These data refer to the resident population of the United States and Puerto Rico.
SOURCE: U.S. Census Bureau, Decennial Census and Population Projections; Department of Veterans Affairs, VetPop2007.
                                                                                            85 and over
                                                                                          Men
                                                                                                    Women
Percent
Estimates
2000
Projections
2010
2020

64.3

50.3
33.0

1.7

1.3
1.3

65.2

41.8
27.3

1.1

1.0
1.5

70.9

60.3
39.2

2.7

1.1
1.0

32.6

66.5
51.9

1.0

2.5
1.2

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    INDICATOR 6
Older Veterans continued
Table 6b. Estimated and projected number of veterans age 65 and over, by sex and age group, United States and
Puerto Rico, 2000 and projected 2010 and 2020

65 and over
Total
Men
Women
65-74
Total
Men
Women
75-84
Total
Men
Women
85 and over
Total
Men
Women

2000

9,723
9,374
349

5,628
5,516
112

3,667
3,460
207

427
398
30
Estimates
2010
Number in thousands
9,132
8,831
302

4,336
4,214
122

3,421
3,340
82

1,375
1,277
98
Projections
2020

8,555
8,144
411

4,430
4,159
271

2,841
2,750
90

1,285
1,235
50
Reference population: These data refer to the resident population of the United States and Puerto Rico.
SOURCE: Department of Veterans Affairs, VetPop2007.

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    INDICATOR 7
Poverty
Table 7a. Percentage of the population living in poverty, by age group, 2007
Year

1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
65 and over

35.2
na
na
na
na
na
na
28.5
29.5
25.0
25.3
24.6
21.6
18.6
16.3
14.6
15.3
15.0
14.1
14.0
15.2
15.7
15.3
14.6
13.8
12.4
12.6
12.4
12.5
12.0
11.4
12.2
12.4
12.9
12.2
11.7
10.5
10.8
10.5
10.5
9.7
9.9
10.1
10.4
10.2
9.8
10.1
9.4
9.7
Under 18

27.3
26.9
25.6
25.0
23.1
23.0
21.0
17.6
16.6
15.6
14.0
15.1
15.3
15.1
14.4
15.4
17.1
16.0
16.2
15.9
16.4
18.3
20.0
21.9
22.3
21.5
20.7
20.5
20.3
19.5
19.6
20.6
21.8
22.3
22.7
21.8
20.8
20.5
19.9
18.9
17.1
16.2
16.3
16.7
17.6
17.8
17.6
17.4
18.0
18 to 64
Percent
17.0
na
na
na
na
na
na
10.5
10.0
9.0
8.7
9.0
9.3
8.8
8.3
8.3
9.2
9.0
8.8
8.7
8.9
10.1
11.1
12.0
12.4
11.7
11.3
10.8
10.6
10.5
10.2
10.7
11.4
11.9
12.4
11.9
11.4
11.4
10.9
10.5
10.1
9.6
10.1
10.6
10.8
11.3
11.1
10.8
10.9
65-74

na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
12.4
11.9
10.3
10.6
10.3
9.9
10.0
8.8
9.7
10.6
10.6
10.0
10.1
8.6
8.8
9.2
9.1
8.8
8.6
9.2
9.4
9.0
9.4
8.9
8.6
8.8
75-84

na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
17.4
16.7
15.2
15.3
15.3
16.0
14.6
14.6
14.9
14.0
15.2
14.1
12.8
12.3
12.5
11.3
11.6
9.8
10.6
10.4
11.1
11.0
9.7
10.9
10.0
9.8
85 and over

na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
na
21.2
21.3
18.4
18.7
17.6
18.9
17.8
18.4
20.2
18.9
19.9
19.7
18.0
15.7
16.5
15.7
14.2
14.2
14.5
13.9
13.6
13.8
12.6
13.4
11.4
13.0
na: Data not available.
NOTE: The poverty level is based on money income and does not include noncash benefits such as food stamps. Poverty thresholds reflect family size and
composition and are adjusted each year using the annual average Consumer Price Index. For more detail, see U.S. Census Bureau, Series P-60, No. 222. Poverty
status in the current Population Survey is based on prior year income.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008.

-------
    INDICATOR  7
Poverty continued
Table 7b. Percentage of the population age 65 and over living in poverty, by selected characteristics, 2007
 Selected characteristic
                                         65 and over
                     65 and over,
                     living alone
             65 and over,
               married
               couples
                                                                                                 65-74
                                                                                                                75 and over
    Both Sexes
      Total
         Non-Hispanic white alone
         Black alone
         Asian alone
         Hispanic
    Male
      Total
         Non-Hispanic white alone
         Black alone
         Asian alone
         Hispanic
    Female
      Total
         Non-Hispanic white alone
         Black alone
         Asian alone
         Hispanic
         9.7
         7.4
       23.2
       11.3
       17.1

         6.6
         4.7
       16.8
         9.9
       13.3

       12.0
         9.4
       27.3
       12.4
       20.0
17.8
14.4
33.5
31.3
35.7

11.8
 8.9
21.5
26.5
24.1

19.9
16.2
39.0
33.0
39.8
                                                                               Percent
 4.2
 3.1
 9.6
 7.4
10.8

 4.3
 3.1
10.2
 8.2
11.8

 4.1
 3.2
 8.7
 6.4
 9.6
 8.8
 6.1
23.5
 9.4
16.5

 6.5
 4.1
20.3
 8.7
13.1

10.8
 7.8
25.8
10.1
19.2
10.6
 8.8
22.8
14.1
18.0

 6.7
 5.5
11.0
12.0
13.6

13.2
10.9
29.2
15.4
21.2
NOTE: The poverty level is based on money income and does not include noncash benefits such as food stamps.  Poverty thresholds reflect family size and
composition and are adjusted each year using the annual average Consumer Price Index. For more details, see U.S. Census Bureau, Series P-60, No. 222. The
term "non-Hispanic white alone" is used to refer to people who reported being white and no other race and who are not Hispanic.  The term "black alone" is used to
refer to people who reported being black or African American and no other race, and the term "Asian alone" is used to refer to people who reported only Asian as their
race.  The use of single-race populations in this report does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses
a variety of approaches.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2008.

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    INDICATOR 8
Income
Table 8a. Income distribution of the population age 65 and over, 1974-2007
Year

1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Poverty

14.6
15.3
15.0
14.1
14.0
15.2
15.7
15.3
14.6
13.8
12.4
12.6
12.4
12.5
12.0
11.4
12.2
12.4
12.9
12.2
11.7
10.5
10.8
10.5
10.5
9.7
9.9
10.1
10.4
10.2
9.8
10.1
9.4
9.8
Low income

34.6
35.0
34.7
35.9
33.4
33.0
33.5
32.8
31.4
29.7
30.2
29.4
28.4
27.8
28.4
29.1
27.0
28.0
28.6
29.8
29.5
29.1
29.5
28.1
26.8
26.2
27.5
28.1
28.0
28.5
28.1
26.6
26.2
26.3
Middle income
Percent
32.6
32.3
31.8
31.5
34.2
33.6
32.4
33.1
33.3
34.1
33.8
34.6
34.4
35.1
34.5
33.6
35.2
36.3
35.6
35.0
35.6
36.1
34.7
35.3
35.3
36.4
35.5
35.2
35.3
33.8
34.6
35.2
35.7
33.3
High income

18.2
17.4
18.5
18.5
18.5
18.2
18.4
18.9
20.7
22.4
23.6
23.4
24.8
24.7
25.1
25.9
25.6
23.3
22.9
23.0
23.2
24.3
25.1
26.0
27.5
27.7
27.1
26.7
26.2
27.5
27.5
28.1
28.6
30.6
NOTE: The income categories are derived from the ratio of the family's income (or an unrelated individual's income) to the corresponding poverty threshold. Being in
poverty is measured as income less than 100 percent of the poverty threshold. Low income is between 100 percent and 199 percent of the poverty threshold. Middle
income is between 200 percent and 399 percent of the poverty threshold. High income is 400 percent or more of the poverty threshold.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 1975-2008.

-------
    INDICATOR 8
Income continued
Table 8b. Median income of householders age 65 and over, in current and 2007 dollars, 1974-2007
Year
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Number
(in thousands)
14,263
14,802
14,816
15,225
15,795
16,544
16,912
17,312
17,671
17,901
18,155
18,596
18,998
19,412
19,716
20,156
20,527
20,921
20,682
20,806
21,365
21,486
21,408
21,497
21,589
22,478
22,469
22,476
22,659
23,048
23,151
23,459
23,729
24,113
Current dollars
5,292
5,585
5,962
6,347
7,081
7,879
8,781
9,903
11,041
11,718
12,799
13,254
13,845
14,443
14,923
15,771
16,855
16,975
17,135
17,751
18,095
19,096
19,448
20,761
21 ,729
22,797
23,083
23,118
23,152
23,787
24,516
26,036
27,798
28,305
2007 dollars
20,838
20,322
20,513
20,542
21 ,446
21,777
21,845
22,495
23,653
24,076
25,262
25,292
25,950
26,186
26,099
26,441
26,917
26,170
25,764
26,046
25,996
26,789
26,575
27,769
28,664
29,458
28,861
28,115
27,709
27,847
27,945
28,715
29,685
29,393
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 1975-2008.

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    INDICATOR 9
Sources of Income
Table 9a. Distribution of sources of income for age units (married couples and nonmarried persons) 65 or older,
1962-2008
Year Total
1962
1967
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
1999
2000
2001
2002
2003
2004
2005
2006
2008
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
Social Security
31
34
39
38
39
39
38
38
38
36
40
42
40
38
38
38
39
39
39
39
37
37
37
Asset
Income
16
15
18
19
22
25
28
26
25
24
21
18
18
20
19
18
16
14
14
13
13
15
13
NOTE: A married couple is age 65 and over if the husband is age 65 and over or the husband
Reference population: These data refer to the civilian noninstitutionalized population.
Pensions
9
12
16
16
16
15
15
16
17
18
20
19
19
19
19
18
18
19
19
20
19
18
19
Earnings
28
29
23
23
19
18
16
17
17
18
17
18
20
21
21
23
24
25
25
26
28
28
30
Other
16
10
4
4
4
3
3
3
3
4
2
3
3
2
3
3
3
3
2
2
3
3
3























is younger than age 55 and the wife is age 65 and over.
SOURCE: Social Security Administration, 1 963 Survey of the Aged, and 1 968 Survey of Demographic and Economic Characteristics of the Aged; U.S. Census
Bureau, Current Population Survey, Annual Social and Economic Supplement, 1977-2007.
Table 9b. Sources of income
quintile, 2008.
Income Source

Total
Social Security
Asset income
Pensions
Earnings
Public assistance
Other









for married couples and
Lowesf fifth

100.0
83.2
2.1
3.3
1.8
8.5
1.1
nonmarried
Second fifth

100.0
81.8
3.4
7.5
3.9
1.7
1.7
people who are age
Third
fifth
Percent
100.0
64.4
6.5
16.4
9.8
0.5
2.3
65 and over,
Fourth fifth

100.0
43.6
8.4
25.5
19.4
0.1
2.9
by income

Highest fifth

100.
17.
17.
18.
43.
0.
1.

0
,9
,8
,7
7
1
,8
NOTE: A married couple is age 65 and over if the husband is age 65 and over or the husband is younger than age 55 and the wife is age 65 and over. The definition
of "other" includes, but is not limited to, public assistance, unemployment compensation, worker's compensation, alimony, child support, and personal contributions.
Quintile limits are $12,082, $19,877, $31,303, and $55,889 for all units; $23,637, $35,794, $53,180, and $86,988 for married couples; and $9,929, $14,265, $20,187,
and $32,937 for nonmarried persons.
Reference population:  These data refer to the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2009.

-------
    INDICATOR 9
Sources of Income continued
Table 9c. Percentage of people age 55 and over with family income from specified sources, by age group, 2008
Aged 65 or older
Source of family income
Earnings
Wages and salaries
Self-employment
Retirement benefits
Social Security
Benefits other than Social
Security
Other public pensions
Railroad Retirement
Government employee
pensions
Military
Federal
State or local
Private pensions or annuities
Income from assets
Interest
Other income from assets
Dividends
Rent or royalties
Estates or trusts
Veterans' benefits
Unemployment compensation
Workers' compensation
Cash public assistance and
noncash benefits
Cash public assistance
Supplemental Security
Income
Other
Noncash benefits
Food
Energy
Housing
Personal contributions
Number (thousands)
55-61
85.7
82.1
12.6
33.0
20.5
19.8
9.2
0.3
8.9
1.9
2.0
5.3
11.4
59.6
57.7
25.7
21.8
8.5
0.3
3.8
6.7
1.5
10.3
5.8
5.2
0.8
7.0
5.0
2.1
2.4
2.5
25,796
62-64
72.3
68.2
11.3
62.0
51.6
33.8
14.9
0.5
14.3
2.4
3.3
9.4
20.6
60.8
58.3
27.8
23.4
9.2
0.2
4.4
4.9
1.3
10.4
5.4
4.8
0.8
7.1
4.5
2.6
2.5
1.8
8,493
Total
38.2
35.1
5.9
91.3
88.7
44.0
16.1
0.6
15.6
2.2
4.3
9.9
30.9
59.2
57.2
24.8
20.6
7.9
0.2
4.2
2.5
0.6
11.7
4.8
4.5
0.4
9.1
4.5
2.8
4.3
1.4
37,788
65-69
55.2
50.9
9.2
86.6
83.0
43.0
15.7
0.4
15.3
2.0
3.8
10.3
30.0
61.0
59.0
26.8
22.2
8.9
0.2
3.5
3.4
0.9
10.2
4.1
3.8
0.4
8.0
4.6
2.6
3.4
1.7
11,825
70-74
40.5
36.9
6.4
92.9
90.4
44.9
16.8
0.4
16.4
2.7
4.2
10.4
31.2
58.3
57.1
24.5
20.4
7.8
0.2
3.7
2.8
0.6
12.4
5.9
5.6
0.5
9.4
5.1
2.9
4.3
1.4
8,579
75-79
30.0
27.2
4.7
93.4
91.4
45.1
16.2
0.6
15.7
2.5
4.3
10.1
32.1
59.7
57.4
25.4
21.2
7.8
0.2
4.8
2.2
0.7
11.8
4.8
4.5
0.3
9.2
4.4
2.7
4.5
1.1
7,329
80 or older
22.0
20.6
2.5
94.1
91.9
43.8
16.0
1.0
15.1
1.7
5.0
8.9
30.7
57.4
55.0
22.4
18.5
6.8
0.4
5.1
1.4
0.3
12.7
4.6
4.4
0.3
9.9
4.0
3.2
5.3
1.4
10,054
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Suvey, Annual Social and Economic Supplement, 2009.

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   INDICATOR 10
Net Worth
Table 10. Median household net worth of head of household, by selected characteristics, in 2005 dollars, selected
years 1984-2007
Selected characteristic
1984
1989
1994
1999
2001
2003
2005
2007
In dollars
Age of family head

65 and over $109,000
45-54
55-64
65-74
75 and over
Marital status, family head age
Married
Unmarried
Race, family head age 65 and
White
Black
129,700
139,700
128,100
94,000

$118,900
115,400
175,600
148,100
98,400

$131,800
117,300
183,800
152,900
108,900

$177,200
1 04,300
168,800
206,300
150,100

$198,300
107,000
182,000
226,100
158,800

$192,400
107,000
185,700
207,500
169,800

$196,000
108,300
201 ,000
218,500
181,000

$237,000
124,000
200,000
272,000
215,000
65 and over
171,100
77,100
over
125,000
28,200
216,600
72,500

135,500
36,500
242,200
81 ,500

145,000
40,900
276,700
106,200

206,300
32,800
320,900
111,200

226,100
45,200
322,700
110,900

228,200
27,900
328,300
104,000

226,900
37,800
385,000
152,000

280,000
46,000
Education, family head age 65 and over
No high school diploma
High school diploma only
Some college or more
60,900
150,900
238,700
60,300
160,500
275,600
65,900
142,300
296,500
64,500
187,600
352,900
63,200
189,700
397,500
63,200
170,900
399,600
59,500
1 84,000
412,100
78,000
216,200
434,400
NOTE: Net worth data do not include pension wealth. This excludes private defined-contribution and defined-benefit plans as well as rights to Social Security wealth.
Data for 1984-2003 have been inflation adjusted to 2007 dollars. See Appendix B for the definition of race and Hispanic origin in the Panel Study of
Income Dynamics.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Panel Study of Income Dynamics.

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   INDICATOR  11
Participation in the Labor Force
Table 11. Labor force participation of persons ages 55 and over by age group and sex, annual averages, 1963-2008
Men
Year

1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
55-61

89.9
89.5
88.8
88.6
88.5
88.4
88.0
87.7
86.9
85.6
84.0
83.4
81.9
81.1
80.9
80.3
79.5
79.1
78.4
78.5
77.7
76.9
76.6
75.8
76.3
75.8
76.3
76.7
76.1
75.7
74.9
73.8
74.3
74.8
75.4
75.5
75.4
74.3
74.9
75.4
74.9
74.4
74.7
75.2
75.4
75.8
62-64

75.8
74.6
73.2
73.0
72.7
72.6
70.2
69.4
68.4
66.3
62.4
60.8
58.6
56.1
54.6
54.0
54.3
52.6
49.4
48.0
47.7
47.5
46.1
45.8
46.0
45.4
45.3
46.5
45.5
46.2
46.1
45.1
45.0
45.7
46.2
47.3
46.9
47.0
48.2
50.4
49.5
50.8
52.5
52.4
51.7
53.0
65-69

40.9
42.6
43.0
42.7
43.4
43.1
42.3
41.6
39.4
36.8
34.1
32.9
31.7
29.3
29.4
30.1
29.6
28.5
27.8
26.9
26.1
24.6
24.4
25.0
25.8
25.8
26.1
26.0
25.1
26.0
25.4
26.8
27.0
27.5
28.4
28.0
28.5
30.3
30.2
32.2
32.8
32.6
33.6
34.4
34.3
35.6
70 and over
Percent
20.8
19.5
19.1
17.9
17.6
17.9
18.0
17.6
16.9
16.6
15.6
15.5
15.0
14.2
13.9
14.2
13.8
13.1
12.5
12.2
12.2
11.4
10.5
10.4
10.5
10.9
10.9
10.7
10.5
10.7
10.3
11.7
11.6
11.5
11.6
11.1
11.7
12.0
12.1
11.5
12.3
12.8
13.5
13.9
14.0
14.6
55-61

43.7
44.5
45.3
45.5
46.4
46.2
47.3
47.0
47.0
46.4
45.7
45.3
45.6
45.9
45.7
46.2
46.6
46.1
46.6
46.9
46.4
47.1
47.4
48.1
48.9
49.9
51.4
51.7
52.1
53.6
53.8
55.5
55.9
56.4
57.3
57.6
57.9
58.3
58.9
61.1
62.5
62.1
62.7
63.8
63.8
64.6
Women
62-64

28.8
28.5
29.5
31.6
31.5
32.1
31.6
32.3
31.7
30.9
29.2
28.9
28.9
28.3
28.5
28.5
28.8
28.5
27.6
28.5
29.1
28.8
28.7
28.5
27.8
28.5
30.3
30.7
29.3
30.5
31.7
33.1
32.5
31.8
33.6
33.3
33.7
34.1
36.7
37.6
38.6
38.7
40.0
41.5
41.8
24.0
65-69

16.5
17.5
17.4
17.0
17.0
17.0
17.3
17.3
17.0
17.0
15.9
14.4
14.5
14.9
14.5
14.9
15.3
15.1
14.9
14.9
14.7
14.2
13.5
14.3
14.3
15.4
16.4
17.0
17.0
16.2
16.1
17.9
17.5
17.2
17.6
17.8
18.4
19.5
20.0
20.7
22.7
23.3
23.7
24.2
25.7
26.4
70 and over

5.9
6.2
6.1
5.8
5.8
5.8
6.1
5.7
5.6
5.4
5.3
4.8
4.8
4.6
4.6
4.8
4.6
4.5
4.6
4.5
4.5
4.4
4.3
4.1
4.1
4.4
4.6
4.7
4.7
4.8
4.7
5.5
5.3
5.2
5.1
5.2
5.5
5.8
5.9
6.0
6.4
6.7
7.1
7.1
7.7
8.1
NOTE: Data for 1994 and later years are not strictly comparable with data for 1993 and earlier years due to a redesign of the survey and methodology of the Current
Population Survey. Beginning in 2000, data incorporate population controls from Census 2000.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Bureau of Labor Statistics, Current Population Survey.

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   INDICATOR  12
Total Expenditures
Table 12. Percentage of total household annual expenditures by age of reference person, 2008

Personal insurance and pensions
Health care
Transportation
Housing
Food
Other
45-54
12.8
4.8
17.5
32.0
12.6
20.3
55-64
12.7
7.0
17.1
32.1
11.6
19.5
65 and over
5.0
12.5
15.3
35.3
12.7
19.2
65-74
6.3
11.5
16.3
33.4
12.9
19.6
75 and over
3.2
13.9
13.9
38.0
12.4
18.6
NOTE: Other expenditures include apparel, personal care, entertainment, reading, education, alcohol, tobacco, cash contributions, and miscellaneous expenditures.
Data from the Consumer Expenditure Survey by age group represent average annual expenditures for consumer units by the age of reference person, who is the
person listed as the owner or renter of the home.  For example, the data on people age 65 and over reflect consumer units with a reference person age 65 or older.
The Consumer Expenditure Survey collects and publishes information from consumer units, which are generally defined as a person or group of people who live in
the same household and are related by blood, marriage, or other legal arrangement (i.e., a family), or people who live in the same household but who unrelated and
financially independent from one another (e.g., roommates sharing an apartment). A household usually refers to a physical are dwelling, and may contain more than
one consumer unit. However, for convenience the term "household" is substituted for "consumer "unit" in this text.
Reference population: These data refer to the resident noninstitutionalized population.
SOURCE: Bureau of Labor Statistics, Consumer  Expenditure Survey.
   INDICATOR  13
Housing Problems
Table 13a. Percentage of households with any resident age 65 and over that report housing problems, by type of
problems, selected years 1985-2007
House/7 olds
Households with a resident
age 65 and over

Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing

Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing

Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing

Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Numbers in
1,000s

20,912

7,522
6,251
1,737
193

22,017

7,315
6,056
1,706
148

22,791

7,841
6,815
1,402
150

22,975

8,566
7,642
1,321
165
Percent
1985
100

36
30
8
1
1989
100

33
28
8
1
1995
100

34
30
6
1
1997
100

37
33
6
1
People*
Numbers in
1,000s

27,375

9,118
7,498
2,131
238

29,372

8,995
7,394
2,117
180

30,328

9,590
8,290
1,731
199

30,776

10,715
9,539
1,592
224

Percent

100

33
27
8
1

100

31
25
7
1

100

32
27
6
1

100

35
31
5
1
See footnotes at end of table.

-------
   INDICATOR 13
                                     Housing Problems continued
Table 13a. Percentage of households with any resident age 65 and over that report housing problems, by type of
problems, selected years 1985-2007 (continued)
                                                             Households
                                                                                                       People*
            Households with a resident
           	age 65 and over	
Numbers in 1,000s     Percent
Numbers in 1,000s    Percent
                                                                                    1999
   Total                                                23,589            100
      Number and percent with
        One or more of the housing problems              8,534             36
            Housing cost burden  (> 30 percent)           7,635             32
            Physically inadequate housing                 1,337              6
            Crowded housing                              173              1

   Total                                                24,038            100
      Number and percent with
        One or more of the housing problems              9,154             38
            Housing cost burden  (> 30 percent)           8,312             35
            Physically inadequate housing                 1,269              5
            Crowded housing                              222              1

   Total                                                24,140            100
      Number and percent with
        One or more of the housing problems              8,718             36
            Housing cost burden  (> 30 percent)           7,794             32
            Physically inadequate housing                 1,230              5
            Crowded housing                              225              1

   Total                                                24,983            100
      Number and percent with
        One or more of the housing problems            10,153             41
            Housing cost burden  (> 30 percent)           9,400             38
            Physically inadequate housing                 1,188              5
            Crowded housing                              153              1

   Total                                                25,828            100
      Number and percent with
        One or more of the housing problems            10,252             40
            Housing cost burden  (> 30 percent)           9,618             37
            Physically inadequate housing                 1,108              4
            Crowded housing                              164              1
                                 2001
                                 2003
                                 2005
                                 2007
      31,487

      10,750
       9,641
       1,627
         209

      31,935

      11,577
      10,501
       1,567
         288

      32,163

      10,967
       9,808
       1,516
         300

      33,268

      12,649
      11,672
       1,486
         189

      34,306

      12,573
      11,756
       1,362
         199
100

 34
 31
  5
  1

100

 36
 33
  5
  1

100

 34
 30
  5
  1

100

 38
 35
  4
  1

100

 37
 34
  4
  1
* Number of people age 65 and over. The American Housing Survey (AHS) universe is limited to the household population and excludes the population living in
nursing homes, college dormitories, and other group quarters. The AHS is a representative sample of approximately 60,000 households in the U.S. and because it is
a statistical sample, the estimates presented are subject to both sampling and nonsampling errors. Because the AHS is a household survey, its population estimates
are likely to differ from estimates based on a population survey. The estimated number of households with a resident age 65 and over reflects changes in Census
weights: 1985 and 1989 data are consistent with 1980 Census weights; 1995, 1997, 1999 data with 1990 Census weights; and 2001, 2003, 2005, and 2007 with 2000
Census weights.
NOTE: Data are available biennially for odd years. Housing cost burden is defined as expenditures on housing and utilities in excess of 30 percent of reported income.
Physical problem categories include plumbing, heating, electricity, hallways, and upkeep. See definition in Appendix A of the American Housing Survey summary
volume, American Housing Survey for the United States in 2007, Current Housing Reports, H150/07, U.S. Census bureau, 2008. Crowded housing is defined as
housing in which there is more than one person per room in a residence. The subcategories for housing  problems do not add to the total number with housing
problems because a household may have more than one housing problem.
Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group quarters, such as dormitories or
fraternities, are excluded.
SOURCE:  U.S. Census Bureau and the U.S. Department of Housing and Urban Development, American Housing Survey. Tabulated by U.S. Department of Housing
and Urban Development.

-------
  INDICATOR 13
Housing Problems continued
Table 13b. Percentage of all U.S. households that report housing problems, by type of problem, selected
1985-2007
                                                      years
All U.S. households and persons

Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing

Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing

Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing

Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing

Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30 percent)
Physically inadequate housing
Crowded housing
Households
Numbers in 1,000s

88,425

28,709
22,633
7,374
2,496

93,683

28,270
21,690
7,603
2,676

97,694

32,385
26,950
6,370
2,554

99,487

33,402
27,445
6,988
2,806

102,803

33,953
28,204
6,878
2,571

Percent

100

32
26
8
3

100

30
23
8
3

100

33
28
7
3

100

34
28
7
3

100

33
27
7
3
People*
Numbers in 1,000s
1985
234,545

76,447
55,055
20,357
15,071
1989
248,028

75,430
52,449
20,694
16,187
1995
254,160

85,327
65,835
17,432
15,375
1997
257,542

86,559
65,997
18,441
16,860
1999
262,463

86,569
66,945
17,310
15,563

Percent

100

33
23
9
6

100

30
21
8
7

100

34
26
7
6

100

34
26
7
7

100

33
26
7
6
See footnotes at end of table.

-------
   INDICATOR 13
                                     Housing Problems continued
Table 13b. Percentage of all U.S. households that report housing problems, by type of problem, selected years
1985-2007 (continued)
                                                            Households
                                                                                                       People*
 All U.S. households and persons
Numbers in 1,000s     Percent
                 Numbers in 1,000s    Percent
                                                                                     2001
   Total
      Number and percent with
         One or more of the housing problems
            Housing cost burden (> 30 percent)
            Physically inadequate housing
            Crowded housing
   Total
      Number and percent with
         One or more of the housing problems
            Housing cost burden (> 30 percent)
            Physically inadequate housing
            Crowded housing
   Total
      Number and percent with
         One or more of the housing problems
            Housing cost burden (> 30 percent)
            Physically inadequate housing
            Crowded housing
   Total
      Number and percent with
         One or more of the housing problems
            Housing cost burden  (> 30 percent)
            Physically inadequate housing
            Crowded housing
     105,435

      35,937
      30,253
       6,611
       2,631

     105,867

      36,401
      31,044
       6,281
       2,559

     108,901

      40,779
      35,835
       6,199
       2,621

     110,719

      42,837
      38,293
       5,759
       2,529
100

 34
 29
  6
  2

100

 34
 29
  6
  2

100

 37
 33
  6
  2

100

 39
 35
  5
2003
2005
2007
269,102

 91,948
 71,950
 16,709
 16,070

269,508

 92,516
 74,088
 15,364
 15,589

277,085

102,921
 85,542
 14,846
 16,032

278,818

107,940
 91,966
 13,929
 15,433
100

 34
 27
  6
  6

100

 34
 27
  6
  6

100

 37
 31
  5
  6

100

 39
 33
  5
* The American Housing Survey (AHS) universe is limited to the household population and excludes the population living in nursing homes, college dormitories,
and other group quarters. The AHS is a representative sample of approximately 60,000 households in the U.S. and because it is a statistical sample, the estimates
presented are subject to both sampling and nonsampling errors. Because the AHS is a household survey, its population estimates are likely to differ from estimates
based on a population survey. The estimated number of households reflect changes in Census weights: 1985 and 1989 data are consistent with 1980 Census
weights; 1995, 1997, 1999 data with 1990 Census weights; and 2001, 2003, 2005, and 2007 with 2000 Census weights.
NOTE: Data are available biennially for odd years. Housing cost burden is defined as expenditures on housing and utilities are in excess of 30 percent of reported
income. Physical problem categories include plumbing, heating, electricity, hallways, and upkeep. See definition in Appendix A of the American Housing Survey
summary volume, American Housing Survey for the United States in 2007, Current Housing Reports, H150/07, U.S. Census Bureau, 2008. Crowded housing is
defined as housing in which there is more than one person per room in a residence. The subcategories for housing problems do not add to the total number with
housing problems because a household may have more than one housing problem.
Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group quarters, such as dormitories or
fraternities, are excluded..
SOURCE:  U.S. Census Bureau and the U.S. Department of Housing and Urban Development, American Housing Survey. Tabulated by U.S. Department of Housing
and Urban Development.

-------
   INDICATOR 14
                                       Life Expectancy

Table 14a. Life expectancy, by age and sex, selected years 1900-2006
   Age and sex
1900
           1910
                      1920
                                 1930
                                            1940
                                                       1950
                                                                  1960
                                                                             1970
                                                                                        1980
See footnotes at end of table.
Table 14a. Life expectancy, by age and sex, selected years 1900-2006 (continued)
       Age and sex
        2000
                       2001
                                      2002
                                                     2003
                                                                   2004
                                                                                  2005
                                                                                                   1990
Years
Birth
Both sexes
Men
Women
At age 65
Both sexes
Men
Women
At age 85
Both sexes
Men
Women

49.2
47.9
50.7

11.9
11.5
12.2

4.0
3.8
4.1

51.5
49.9
53.2

11.6
11.2
12.0

4.0
3.9
4.1

56.4
55.5
57.4

12.5
12.2
12.7

4.2
4.1
4.3

59.2
57.7
60.9

12.2
11.7
12.8

4.2
4.0
4.3

63.6
61.6
65.9

12.8
12.1
13.6

4.3
4.1
4.5

68.1
65.5
71.0

13.8
12.7
15.0

4.7
4.4
4.9

69.9
66.8
73.2

14.4
13.0
15.8

4.6
4.4
4.7

70.8
67.0
74.6

15.0
13.0
16.8

5.3
4.7
5.6

73.9
70.1
77.6

16.5
14.2
18.4

6.0
5.1
6.4

75.4
71.8
78.8

17.3
15.1
19.0

6.2
5.3
6.7
                                                                                                 2006

Birth
Both sexes
Men
Women
At age 65
Both sexes
Men
Women
At age 85
Both sexes
Men
Women


76.8
74.1
79.3

17.6
16.0
19.0

6.1
5.4
6.5


76.9
74.2
79.4

17.7
16.2
19.0

6.1
5.5
6.5


76.9
74.3
79.5

17.8
16.2
19.1

6.1
5.4
6.5
Years

77.1
74.5
79.6

17.9
16.4
19.2

6.1
5.5
6.5


77.5
74.9
79.9

18.2
16.7
19.5

6.3
5.6
6.7


77.4
74.9
79.9

18.2
16.8
19.5

6.2
5.6
6.6


77.7
75.1
80.2

18.5
17.0
19.7

6.4
5.7
6.8
NOTE: The life expectancies (LEs) for decennial years 1910 to 1990 are based on decennial census data and deaths for a 3-year period around the census year.
The LEs for decennial year 1900 are based on deaths from 1900 to 1902. LEs for years prior to 1930 are based on the death registration area only. The death
registration area increased from 10 states and the District of Columbia in 1900 to the coterminous United States in 1933. LEs for 2000-2006 are based on a newly
revised methodology that uses vital statistics death rates for ages under 66 and modeled probabilities of death for ages 66 to 100 based on blended vital statistics and
Medicare probabilities of dying and may differ from figures previously published.
Reference population: These data refer to the resident population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.


Table 14b. Life expectancy, by age and sex, 2006
                                     Total
                                                                         Men
                                                                                                            Women
   Age
                            White
                                              Black
                                                                White
                                                                                  Black
                                                                                                    White
                                                                                                                     Black
Years
Birth
At age 65
At age 85
78.2
18.6
6.3
73.2
17.1
6.7
75.7
17.1
5.7
69.7
15.1
5.9
80.6
19.8
6.7
76.5
18.6
7.1
NOTE: See Appendix B for the definition of race in the National Vital Statistics System.
Reference population: These data refer to the resident population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

-------
    INDICATOR 14
                                        Life Expectancy continued
Table 14c.  Average life expectancy at age 65, by sex and selected countries or areas, selected years 1980-2005
Men
Years of life remaining
for people who reach age 65
Australia
Austria
Belgium
Bulgaria
Canada
Chile
Costa Rica
Cuba
Czech Republic1
Denmark
England and Wales2
Finland
France
Germany3
Greece
Hong Kong
Hungary
Ireland
Israel
Italy
Japan
Netherlands
New Zealand
Northern Ireland2
Norway
Poland
Portugal
Romania
Russian Federation
Scotland2
Singapore
Slovakia1
Spain
Sweden
Switzerland
United States
Year
1980
13.7
12.9
12.9
12.7
14.5
na
16.1
na
11.2
13.6
12.9
12.5
13.6
13.0
14.6
13.9
11.6
12.6
14.4
13.3
14.6
13.7
13.2
11.9
14.3
12.0
12.9
12.6
11.6
12.3
12.6
12.3
14.8
14.3
14.4
14.1
1990
15.2
14.3
14.3
12.9
15.7
14.6
17.2
na
11.7
14.0
14.1
13.7
15.5
14.0
15.7
15.3
12.0
13.3
15.9
15.1
16.2
14.4
14.7
13.7
14.6
12.7
13.9
13.3
12.1
13.1
14.5
12.2
15.4
15.3
15.3
15.1
2000
16.9
16.0
15.6
12.8
16.8
15.3
17.2
16.7
13.8
15.2
15.8
15.5
16.7
15.7
16.3
17.3
12.7
14.6
16.9
16.5
17.5
15.3
16.7
15.3
16.0
13.6
15.3
13.5
11.1
14.7
15.8
12.9
16.6
16.7
16.9
16.0
2005
18.1
17.0
16.6
na
17.9
15.9
18.1
17.1
14.4
16.1
17.1
16.8
17.7
16.9
17.2
17.8
13.1
16.8
18.2
na
18.1
16.4
17.8
16.6
17.2
14.4
16.1
13.4
11.0
15.8
16.9
13.2
17.3
17.4
18.1
16.8
7980
17.9
16.3
16.9
14.7
18.9
na
18.1
na
14.4
17.6
16.9
16.5
18.2
16.7
16.8
13.9
14.6
15.7
15.8
17.1
17.7
18.0
17.0
15.8
18.0
15.5
16.5
14.2
15.6
16.2
15.4
15.4
17.9
17.9
17.9
18.3
Women
Year
1990
19.0
17.8
18.8
15.4
19.9
17.6
19.5
na
15.3
17.8
17.9
17.7
19.8
17.6
18.0
18.8
15.3
16.9
17.8
18.8
20.0
18.9
18.3
17.5
18.5
16.9
17.0
15.3
15.9
16.7
16.9
15.7
19.0
19.0
19.4
18.9
2000
20.4
19.4
19.7
15.4
20.4
18.6
19.7
19.0
17.3
18.3
19.0
19.3
21.2
19.4
18.3
21.5
16.5
17.8
19.3
20.4
22.4
19.2
20.0
18.5
19.7
17.3
18.7
15.9
15.2
17.8
19.0
16.5
20.4
20.0
20.7
19.2
2005
21.4
20.3
20.2
na
21.1
20.0
20.7
19.6
17.7
19.1
19.9
21.0
22.0
20.1
19.4
22.9
16.9
20.0
20.2
na
23.2
20.0
20.5
19.5
20.9
18.6
19.4
16.2
15.4
18.6
20.4
16.9
21.3
20.6
21.7
19.5
na: Data not available.
1ln 1993, Czechoslovakia was divided into two nations, the Czech Republic and Slovakia. Data for 1980 and 1990 refer to the respective Czech and Slovak regions of
the former Czechoslovakia.
2Different geographic constituents of the United Kingdom may have separate statistical systems. This table includes data for three such areas: England and Wales,
Northern Ireland, and Scotland.
3 Data for 1980 and 1990 refer to the former Federal Republic of Germany (West Germany); from 2000 onwards, data refer to Germany after reunification.
NOTE: Countries or areas in this table have populations of at least one million and death registrations that are at least 90 percent complete. However, this table is not
a comprehensive listing of all countries with these characteristics; for details see Health, United States, 2008. Estimates for the United States for 2000 and 2005 have
been revised and may differ from figures previously published. See Table 14a.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, Health, United States, 2008.

-------
    INDICATOR  15
Mortality
Table 15a. Death rates for selected leading causes of death among people age 65 and over, 1981-2006
Year
Total
Diseases of
heart
Chronic
lower
Malignant Cerebrovascular respiratory Influenza and
neoplasm diseases diseases pneumonia
Diabetes
mellitus
Alzheimer's
disease
Number per 100,000 population
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006


5,713.9
5,609.7
5,685.4
5,644.8
5,693.8
5,628.7
5,577.7
5,625.0
5,456.9
5,352.8
5,290.7
5,205.2
5,348.6
5,269.9
5,264.7
5,221.7
5,178.9
5,168.1
5,220.0
5,137.2
5,044.1
5,000.5
4,907.2
4,698.8
4,676.0
4,518.5

-20.9
2,546.7
2,503.2
2,512.0
2,449.5
2,430.9
2,371.7
2,316.4
2,305.7
2,171.8
2,091.1
2,045.6
1,989.5
2,024.0
1,952.3
1,927.4
1,877.6
1,827.2
1,791.5
1,767.0
1,694.9
1,631.6
1,585.2
1,524.9
1,418.2
1,375.7
1,296.7

-49.1
1 ,055.7
1 ,068.9
1 ,077.5
1,087.1
1,091.2
1,101.2
1,105.5
1,114.1
1,133.0
1,141.8
1,149.5
1,150.6
1,159.2
1,155.3
1,152.5
1,140.8
1,127.3
1,119.2
1,126.1
1,119.2
1,100.2
1 ,090.9
1 ,073.0
1,051.7
1 ,041 .3
1 ,025.4
Percentage
-2.9
623.8
585.2
564.4
546.2
531.0
506.3
495.9
489.4
463.7
447.9
434.7
424.5
434.5
433.7
437.7
433.1
423.8
411.9
433.2
422.7
404.1
393.2
372.8
346.2
320.3
296.8
change between
-52.4
185.8
186.1
204.3
210.8
225.4
227.7
229.7
240.0
240.2
245.0
251.7
252.5
273.6
271.3
271.2
275.5
280.2
268.8
313.0
303.6
300.7
300.6
299.1
284.3
298.8
279.2
1981 and 2006
50.3
207.2
181.2
207.2
214.0
242.9
244.7
237.4
263.1
253.3
258.2
245.1
232.7
247.9
238.1
237.2
233.5
236.3
247.4
167.4
167.2
154.9
160.7
154.8
139.0
141.9
123.7

"-26.1
105.8
102.3
104.4
102.6
103.4
100.8
102.3
104.7
120.4
120.4
120.8
120.8
128.4
132.6
135.9
139.4
140.2
143.4
150.0
149.6
151.1
152.0
150.7
146.0
146.5
136.9

29.4
6.0
9.2
16.3
23.5
31.0
35.0
41.8
44.7
47.3
48.7
48.7
48.8
55.3
59.8
64.9
65.9
67.7
67.0
128.8
139.9
148.3
158.7
167.7
170.6
179.3
176.9

*37.3
*Change calculated from 1999 when ICD-10 was implemented.
NOTE: Death rates for 1981-1998 are based on the 9th revision of the International Classification of Disease (ICD-9). Starting in 1999, death rates are based on
ICD-10. For the period 1981-1998, causes were coded using ICD-9 codes that are most nearly comparable with the 113 cause list for the ICD-10 and may differ from
previously published estimates. Population estimates for July 1, 2000, and July 1, 2001, are postcensal estimates and have been bridged to be consistent with the
race categories used in the 1990 Decennial Census. These estimates were produced by the National Center for Health Statistics under a collaborative arrangement
with the U.S. Census Bureau. Population estimates for 1990-1999 are intercensal estimates, based on the 1990 Decennial Census and bridged estimates for 2000.
These estimates were produced by the Population Estimates Program of the U.S. Census Bureau with support from the National Cancer Institute (NCI). For more
information on the bridged race population estimates for 1990-2001, see http //www.cdc.gov/nchs/nvss/bridged_race.htm. Death rates for 1990-2001 may differ
from those published elsewhere because of the use of the bridged intercensal  and postcensal population estimates. Rates are age adjusted using the 2000 standard
population. Rates are age-adjusted using the 2000 standard population.
Reference population: These data refer to the resident population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics,  National Vital Statistics System.

-------
   INDICATOR 15
Mortality continued
Table 15b.  Leading causes of death among people age 65 and over, by sex and race and Hispanic origin, 2006

All races
White
Black
Asian or Pacific
Islander
American
Indian
Hispanic
Men
1
2
3
4
5
6
7

8
9
10
11
12
13

14
15
Diseases of heart
Malignant
neoplasms
Chronic lower
respiratory
diseases
Cerebrovascular
diseases
Diabetes mellitus
Influenza and
pneumonia
Alzheimer's
disease

Unintentional
injuries
Nephritis
Septicemia
Parkinson's
disease
Pneumonitis
Hypertension

Aortic aneurysm
Benign
neoplasms
Diseases of heart
Malignant
neoplasms
Chronic lower
respiratory
diseases
Cerebrovascular
diseases
Diabetes mellitus
Alzheimer's
disease
Influenza and
pneumonia

Unintentional
injuries
Nephritis
Parkinson's
disease
Septicemia
Pneumonitis
Hypertension

Aortic aneurysm
Benign
neoplasms
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus
Chronic lower
respiratory
diseases
Nephritis
Influenza and
pneumonia

Septicemia
Hypertension
Unintentional
injuries
Alzheimer's
disease
Pneumonitis
1Benign
neoplasms
'Parkinson's
disease

Liver disease
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Chronic lower
respiratory
diseases
Influenza and
pneumonia
Diabetes mellitus
2Benign
neoplasms
Unintentional
injuries

Alzheimer's
disease
Hypertension
Septicemia
Parkinson's
disease
Aortic aneurysm

Pneumonitis
Benign
neoplasms
Diseases of heart
Malignant
neoplasms
Diabetes mellitus
Chronic lower
respiratory
diseases
Cerebrovascular
diseases
Unintentional
injuries
Influenza and
pneumonia

Nephritis
Alzheimer's
disease
Septicemia
Liver disease
Hypertension
Parkinson's
disease

Pneumonitis
Benign
neoplasms
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus
Chronic lower
respiratory
diseases
Influenza and
pneumonia
Nephritis

Unintentional
injuries
Alzheimer's
disease
Liver disease
Septicemia
Parkinson's
disease
Hypertension

Pneumonitis
Benign
neoplasms
'For black men, Benign neoplasms and Parkinson's disease tied for 13th.
2For Asian or Pacific Islander men, Benign neoplasms and Unintentional injuries tied for 7th.
3For American Indian women, Benign neoplasms and Pneumonitis tied for 13th.
NOTE: See Appendix B for the definition of race and Hispanic origin in the National Vital Statistics System.
Reference population: These data refer to the resident population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

-------
   INDICATOR 15
                                     Mortality continued
Table 15b.  Leading causes of death among people age 65 and over, by sex and race and Hispanic origin, 2006
(continued)

All races
White
Black
Asian or Pacific
Islander
American
Indian
Hispanic
Women
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Chronic lower
respiratory
diseases
Alzheimer's
disease
Diabetes mellitus
Influenza and
pneumonia
Nephritis
Unintentional
injuries
Septicemia
Hypertension
Parkinson's
disease
Pneumonitis
Benign
neoplasms
Atherosclerosis
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Chronic lower
respiratory
diseases
Alzheimer's
disease
Influenza and
pneumonia
Diabetes mellitus
Unintentional
injuries
Nephritis
Septicemia
Hypertension
Parkinson's
disease
Pneumonitis
Benign
neoplasms
Atherosclerosis
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus
Nephritis
Alzheimer's
disease
Chronic lower
respiratory
diseases
Septicemia
Influenza and
pneumonia
Hypertension
Unintentional
injuries
Pneumonitis
Benign
neoplasms
Aortic aneurysm
Atherosclerosis
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus
Influenza and
pneumonia
Alzheimer's
disease
Chronic lower
respiratory
diseases
Nephritis
Unintentional
injuries
Hypertension
Septicemia
Parkinson's
disease
Pneumonitis
Benign
neoplasms
Aortic aneurysm
Diseases of heart
Malignant
neoplasms
Diabetes mellitus
Cerebrovascular
diseases
Chronic lower
respiratory
diseases
Alzheimer's
disease
Nephritis
Influenza and
pneumonia
Unintentional
injuries
Liver disease
Septicemia
Hypertension
3Benign
neoplasms
3Pneumonitis

Parkinson's
disease
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus
Alzheimer's
disease
Chronic lower
respiratory
diseases
Influenza and
pneumonia
Nephritis
Unintentional
injuries
Septicemia
Hypertension
Liver disease
Parkinson's
disease
Pneumonitis
Benign
neoplasms
'For black men, Benign neoplasms and Parkinson's disease tied for 13th.
2For Asian or Pacific Islander men, Benign neoplasms and Unintentional injuries tied for 7th.
3For American Indian women, Benign neoplasms and Pneumonitis tied for 13th.
NOTE: See Appendix B for the definition of race and Hispanic origin in the National Vital Statistics System.
Reference population: These data refer to the resident population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

-------
    INDICATOR  15
Mortality continued
Table 15c. Leading causes of death among people age 85 and over, by sex and race and Hispanic origin, 2006

All races
White
Black
Asian or Pacific
Islander
American
Indian
Hispanic
Men
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Chronic lower
respiratory
diseases
Alzheimer's
disease
Influenza and
pneumonia
Nephritis
Unintentional
injuries
Diabetes mellitus
Parkinson's
disease
Pneumonitis
Septicemia
Hypertension
Benign
neoplasms
Aortic aneurysm
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Chronic lower
respiratory
diseases
Alzheimer's
disease
Influenza and
pneumonia
Nephritis
Unintentional
injuries
Diabetes mellitus
Parkinson's
disease
Pneumonitis
Septicemia
Hypertension
Benign
neoplasms
Aortic aneurysm
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Chronic lower
respiratory
diseases
Influenza and
pneumonia
Nephritis
Alzheimer's
disease
Diabetes mellitus
Septicemia
Hypertension
Unintentional
injuries
Pneumonitis
Benign
neoplasms
Atherosclerosis
Parkinson's
disease
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Influenza and
pneumonia
Chronic lower
respiratory
diseases
Alzheimer's
disease
Diabetes mellitus
Nephritis
Unintentional
injuries
Hypertension
Pneumonitis
Parkinson's
disease
Septicemia
Aortic aneurysm
Benign
neoplasms
Diseases of heart
Malignant
neoplasms
Influenza and
pneumonia
Diabetes mellitus
'Alzheimer's
disease
'Chronic lower
respiratory
disease

Cerebrovascular
diseases
Nephritis
'Pneumonitis
'Unintentional
injuries

'Septicemia
'Hypertension

Parkinson's
disease
Benign
neoplasms
Enterocolitis
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Chronic lower
respiratory
diseases
Influenza and
pneumonia
Alzheimer's
disease
Diabetes mellitus
Nephritis
Unintentional
injuries
Parkinson's
disease
Septicemia
Hypertension
Pneumonitis
Benign
neoplasms
Liver disease
'For American Indian men, Alzheimer's disease and Chronic lower respiratory disease tied for 5th; Pneumonitis and Unintentional injuries tied for 9th; and Septicemia
and Hypertension tied for 9th.
2For American Indian women, Nephritis and Unintentional injuries tied for 9th; Septicemia and Parkinson's disease tied for 11th; and Atherosclerosis and Pneumonitis
tied for 14th.
NOTE: See Appendix B for the definition of race and Hispanic origin in the National Vital Statistics System.
Reference population: These data refer to the resident population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

-------
    INDICATOR 15
                                       Mortality continued
Table 15c. Leading causes of death among people age 85 and over, by sex and race and Hispanic origin, 2006
(continued)

All races
White
Black
Asian or Pacific
Islander
American
Indian
Hispanic
Women
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Alzheimer's
disease
Chronic lower
respiratory
diseases
Influenza and
pneumonia
Diabetes mellitus
Nephritis
Unintentional
injuries
Hypertension
Septicemia
Pneumonitis
Parkinson's
disease
Atherosclerosis
Benign
neoplasms
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Alzheimer's
disease
Chronic lower
respiratory
diseases
Influenza and
pneumonia
Unintentional
injuries
Diabetes mellitus
Nephritis
Hypertension
Septicemia
Pneumonitis
Parkinson's
disease
Atherosclerosis
Benign
neoplasms
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Alzheimer's
disease
Diabetes mellitus
Nephritis
Influenza and
pneumonia
Hypertension
Septicemia
Chronic lower
respiratory
diseases
Unintentional
injuries
Pneumonitis
Atherosclerosis
Benign
neoplasms
Aortic aneurysm
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Influenza and
pneumonia
Alzheimer's
disease
Diabetes mellitus
Chronic lower
respiratory
diseases
Hypertension
Nephritis
Unintentional
injuries
Septicemia
Parkinson's
disease
Pneumonitis
Benign
neoplasms
Aortic aneurysm
Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Diabetes mellitus
Alzheimer's
disease
Influenza and
pneumonia
Chronic lower
respiratory
diseases
Hypertension
2Nephritis
Unintentional
injuries

2Septicemia
2Parkinson's
disease

Benign
neoplasms
Atherosclerosis
2Pneumonitis

Diseases of heart
Malignant
neoplasms
Cerebrovascular
diseases
Alzheimer's
disease
Influenza and
pneumonia
Diabetes mellitus
Chronic lower
respiratory
diseases
Nephritis
Hypertension
Unintentional
injuries
Septicemia
Pneumonitis
Parkinson's
disease
Atherosclerosis
Benign
neoplasms
'For American Indian men, Alzheimer's disease and Chronic lower respiratory disease tied for 5th; Pneumonitis and Unintentional injuries tied for 9th; and Septicemia
and Hypertension tied for 9th.
2For American Indian women, Nephritis and Unintentional injuries tied for 9th; Septicemia and Parkinson's disease tied for 11th; and Atherosclerosis and Pneumonitis
tied for 14th.
NOTE: See Appendix B for the definition of race and Hispanic origin in the National Vital Statistics System.
Reference population: These data refer to the resident population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

-------
   INDICATOR 16
Chronic Health Conditions
Table 16a. Percentage of people age 65 and over who reported having selected chronic health conditions, by sex,
2007-2008
dSase Hypertension
Stroke
Asthma
Chronic
bronchitis or
Emphysema
Any
cancer
Diabetes
Arthritis
Percent
Total
Men
Women
Non-Hispanic
White
Non-Hispanic
Black
Hispanic
31.9
38.2
27.1
33.7
27.2
23.8
55.7
53.1
57.6
54.3
71.1
53.1
8.8
8.7
8.9
8.7
10.8
7.7
10.4
8.9
11.5
10.2
11.3
10.9
9.0
8.6
9.2
9.7
5.9
6.2
22.5
23.9
21.4
24.8
13.3
12.4
18.6
19.5
17.9
16.4
29.7
27.3
49.5
42.2
54.9
50.6
52.2
42.1
NOTE: Data are based on a 2-year average from 2007-2008. See Appendix B for the definition of race and Hispanic origin in the National Health Interview Survey.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
Table 16b. Percentage of people age 65 and over who reported having selected chronic health conditions, 1997-2008


1 997-1 998
1 999-2000
2001-2002
2003-2004
2005-2006
2007-2008
dSase

32.3
29.8
31.5
31.8
30.9
31.9
Hypertension

46.5
47.4
50.2
51.9
53.3
55.7
Stroke

8.2
8.2
8.9
9.3
9.3
8.8
Emphysema

5.2
5.2
5.0
5.2
5.7
5.1
Asthma
Percent
7.7
7.4
8.3
8.9
10.6
10.4
Chronic
bronchitis

6.4
6.2
6.1
6.0
6.1
5.4
cancer

18.7
19.9
20.8
20.7
21.1
22.5
Diabetes

13.0
13.7
15.4
16.9
18.0
18.6
Arthritis

na
na
na
50.0
49.5
49.5
na: Comparable data for arthritis not available prior to 2003-2004.
NOTE: Data are based on 2-year averages.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

-------
   INDICATOR  17
Sensory Impairments and Oral Health
Table 17a. Percentage of people age 65 and over who reported having any trouble hearing, trouble seeing, or
no natural teeth, by selected characteristics, 2008
Sex
Age and
poverty status
Any trouble hearing
Any trouble seeing
No natural teeth
Percent
Both sexes





Men



Women



65 and over
65-74
75-84
85 and over
Below poverty
Above poverty
65 and over
65-74
75-84
85 and over
65 and over
65-74
75-84
85 and over
34.8
27.8
36.6
60.1
28.2
35.5
41.5
36.0
43.7
66.7
29.6
20.7
31.7
56.6
17.5
14.3
18.6
28.4
23.8
17.0
14.9
11.3
17.2
28.5
19.4
16.9
19.5
28.4
25.6
20.4
30.7
33.9
41.8
23.4
24.3
19.2
30.7
33.0
26.6
21.4
30.8
34.4
NOTE: Respondents were asked "WITHOUT the use of hearing aids or other listening devices, is your hearing excellent, good, a little trouble hearing,
moderate trouble, a lot of trouble, or are you deaf?"  For the purposes of this indicator, the category "Any trouble hearing" includes: "a little trouble hearing,
moderate trouble, a lot of trouble, and deaf." This question differs slightly from the question used to calculate the estimates shown in previous editions
of Older Americans.  Regarding their vision, respondents were asked "Do you have any trouble seeing, even when wearing glasses or contact lenses?"
and the category "Any trouble seeing" includes those who in a subsequent question report themselves as blind. Lastly, respondents were asked in one
question, "Have you lost all of your upper and lower natural (permanent) teeth?"
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE:  Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
Table 17b. Percentage of people age 65 and over who reported ever having worn a hearing aid, 2008
            Age group
                                          Both sexes
                                                                        Men
                                                                                                 Women
 65 and over
 65-74
 75-84
 85 and over
      13.8
       8.4
      14.9
      34.2
Percent
  17.8
  12.1
  21.0
  40.6
10.7
 5.1
10.7
30.8
NOTE: Respondents were asked "Do you now use a hearing aid(s)?" For those who responded no, they were also asked "Have you ever used
a hearing aid(s) in the past?" Estimates in past editions of Older Americans were based on the answer to a single question of having ever worn
a hearing aid.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

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   INDICATOR 18
Respondent-Assessed Health Status
Table 18. Respondent-assessed health status among people age 65 and over, by selected characteristics, 2006-2008
Not Hispanic or Latino
Selected
characteristic
Fair or poor health
Both sexes
65 and over
65-74
75-84
85 and over
Men
65 and over
65-74
75-84
85 and over
Women
65 and over
65-74
75-84
85 and over
Good to excellent health
Both sexes
65 and over
65-74
75-84
85 and over
Men
65 and over
65-74
75-84
85 and over
Women
65 and over
65-74
75-84
85 and over
Total


25.5
22.4
27.5
33.7

25.3
22.4
27.5
35.1

25.7
22.3
27.6
32.9


74.5
77.6
72.5
66.4

74.8
77.6
72.5
64.9

74.4
77.7
72.5
67.1
White only


23.3
19.9
25.2
32.1

23.6
20.4
25.9
33.7

23.1
19.5
24.7
31.3


76.7
80.1
74.8
67.9

76.4
79.6
74.1
66.3

76.9
80.5
75.3
68.7
Black only
Percent

37.6
34.0
41.5
46.3

34.8
32.5
38.4
42.0

39.3
35.2
43.1
47.9


62.5
66.0
58.5
53.7

65.2
67.5
61.6
58.0

60.7
64.8
56.9
52.1
Hispanic or Latino
(of any race)


36.6
33.7
40.0
46.0

35.3
32.9
37.9
46.9

37.5
34.4
41.3
45.5


63.4
66.3
60.1
54.0

64.8
67.2
62.1
53.1

62.5
65.6
58.7
54.5
NOTE: Data are based on a 3-year average from 2006-2008. See Appendix B for the definition of race and Hispanic origin in the National Health Interview Survey.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

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    INDICATOR  19
Depressive Symptoms
Table 19a. Percentage of people age 65 and over with clinically relevant depressive symptoms, by sex, selected
years 1998-2006
                                            7998
                                                              2000
                                                                                 2002
                                                                                                    2004
                                                                                                                       2006
Both sexes
Men
Women
15.9
11.9
18.6
15.6
11.4
18.5
15.4
11.5
18.0
14.4
11.0
16.8
14.6
10.1
17.9
NOTE: The definition of "clinically relevant depressive symptoms" is four or more symptoms out of a list of eight depressive symptoms from an abbreviated version of
the Center of Epidemiological Studies Depression Scale (CES-D) adapted by the Health and Retirement Study (MRS). The CES-D scale is a measure of depressive
symptoms and is not to be used as a diagnosis of clinical depression. A detailed explanation concerning the "four or more symptoms" cut-off can be found in the
following documentation, http //hrsonline.isr umich.edu/docs/userg/dr-005.pdf. Proportions are based on weighted data using the preliminary respondent weight from
MRS 2006.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Health and Retirement Study.
Table 19b. Percentage of people age 65 and over with clinically relevant depressive symptoms, by age group and
sex, 2006
                                 Both sexes
                                                                         Men
                                                                                                             Women
65 and over
65-69
70-74
75-79
80-84
14.6
13.9
12.9
16.0
14.3
10.1
9.7
8.0
9.7
10.3
17.9
16.7
16.9
20.2
17.0
    85 and over
                                    18.8
                                                                         17.8
                                                                                                             19.2
NOTE: The definition of "clinically relevant depressive symptoms" is four or more symptoms out of a list of eight depressive symptoms from an abbreviated version of
the Center of Epidemiological Studies Depression Scale (CES-D) adapted by the Health and Retirement Study (HRS). The CES-D scale is a measure of depressive
symptoms and is not to be used as a diagnosis of clinical depression. A detailed explanation concerning the "four or more symptoms" cut-off can be found in the
following documentation, http //hrsonline.isr umich.edu/docs/userg/dr-005.pdf. Proportions are based on weighted data using the preliminary respondent weight from
HRS 2006.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Health and Retirement Study.

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    INDICATOR 20
Functional Limitations
Table 20a.  Percentage of Medicare enrollees age 65 and over who have limitations in activities
of daily living (ADLs) or instrumental activities of daily living (lADLs), or who are in a facility,
selected years  1992-2007

lADLsonly
1 to 2 ADLs
3 to 4 ADLs
5 to 6 ADLs
Facility
Total
7992
13.7
19.6
6.1
3.5
5.9
48.8
7997
12.7
16.6
4.9
3.2
5.1
42.5
2007
13.4
17.2
5.3
3.0
4.8
43.7
2005
12.3
18.3
4.7
2.5
4.3
42.1
2007
13.8
17.7
4.5
2.3
3.9
42.2
NOTE:  A residence is considered a long-term care facility if it is certified by Medicare or Medicaid; has three or more beds and is licensed as a nursing home or
other long-term care facility and provides at least one personal care service; or provides 24-hour, seven-day-a-week supervision by a caregiver. ADL limitations refer
to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or
using the toilet. IADL limitations refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light
housework, heavy housework, meal preparation, shopping, or managing money. Rates are age adjusted using the 2000 standard population. Data for 1992, 2001,
and 2007 do not sum to the totals because of rounding.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 20b.  Percentage of Medicare enrollees age 65 and over who have limitations in activities of daily living (ADLs)
or instrumental activities of daily living (lADLs), or who are in a facility, by sex, 2007

lADLsonly
1 to 2 ADLs
3 to 4 ADLs
5 to 6 ADLs
Facility
Total
Both Sexes
13.8
17.7
4.5
2.3
3.9
42.2
Men
10.9
16.3
3.5
2.0
2.5
35.2
Women
16.1
18.8
5.3
2.4
4.7
47.3
NOTE:  A residence is considered a long-term care facility if it is certified by Medicare or Medicaid; has 3 or more beds and is licensed as a nursing home or other
long-term care facility and provides at least one personal care service; or provides 24-hour, seven-day-a-week supervision by a caregiver. ADL limitations refer
to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or
using the toilet. IADL limitations refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light
housework, heavy housework, meal preparation, shopping, or managing money. Rates are age adjusted using the 2000 standard population. Data may not sum to
the totals because of rounding.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.

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   INDICATOR 20
Functional Limitations continued
Table 20c. Percentage of Medicare enrollees age 65 and over who are unable to perform certain physical functions,
by sex, 1991 and 2007
 Function
                                                              1991
                                                                                                 2007
 Men
     Stoop/kneel
     Reach over head
     Write/grasp small objects
     Walk 2-3 blocks
     Lift 10 bs.
     Any of these five
Women
                            7.8
                            3.1
                            2.3
                           14.0
                            9.2
                           18.9
NOTE: Rates for 1991 are age adjusted to the 2007 population.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
                                                                              Percent
10.1
 3.0
 1.3
14.3
 7.0
19.3
Stoop/kneel
Reach over head
Write/grasp small objects
Walk 2-3 blocks
Lift 1 0 bs.
Any of these five
15.3
6.3
2.6
23.2
18.4
32.2
18.7
4.8
2.0
23.4
15.2
32.4
Table 20d. Percentage of Medicare enrollees age 65 and over who are unable to perform any one of five physical
functions, by selected characteristics, 2007
Selected characteristic
Age
65-74
75-84
85 and over
Race
White, not Hispanic or Latino
Black, not Hispanic or Latino
Hispanic or Latino (any race)
Men

13.0
23.1
40.4

18.9
25.6
20.0
Women
Percent
21.8
35.1
55.9

31.9
35.4
33.3
NOTE: The five physical functions include stooping kneeling, reaching over the head, writing/grasping small objects, walking 2-3 blocks, and lifting 10 Ibs.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.

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   INDICATOR 21
Vaccinations
Table 21a. Percentage of people age 65 and over who reported having been vaccinated against influenza and
pneumococcal disease, by race and Hispanic origin, selected years 1989-2008


Influenza
Not Hispanic or Latino
Year
1989
1991
1993
1994
1995
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
White
32.0
42.8
53.1
56.9
60.0
65.8
65.6
67.9
66.6
65.4
68.7
68.6
67.3
63.2
67.3
69.3
69.9
Black
17.7
26.5
31.1
37.7
39.5
44.6
45.9
49.7
47.9
47.9
49.5
47.8
45.7
39.6
47.1
55.7
50.4
Pneumococcal disease
Hispanic or Latino
(of any race)
23.8
33.2
46.2
36.6
49.5
52.7
50.3
55.1
55.7
51.9
48.5
45.4
54.6
41.7
44.9
52.2
54.9
Not Hispanic or Latino Hispa
/_*
White
15.0
21.0
28.7
30.5
34.2
45.6
49.5
53.1
56.8
57.8
60.3
59.6
60.9
60.6
62.0
62.2
64.3
	 iui
Black
6.20
13.2
13.1
13.9
20.5
22.2
26.0
32.3
30.5
33.9
36.9
37.0
38.6
40.4
35.6
44.1
44.5
nic or Latino
any race)
9.80
11.0
12.2
13.7
21.6
23.5
22.8
27.9
30.4
32.9
27.1
31.0
33.7
27.5
33.4
31.8
36.4
NOTE: For influenza, the percentage vaccinated consists of people who reported having a flu shot during the past 12 months and does not include receipt of nasal
spray flu vaccinations. For pneumococcal disease, the percentage refers to people who reported ever having a pneumonia vaccination. See Appendix B for the
definition of race and Hispanic origin in the National Health Interview Survey.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE:  Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
Table 21 b. Percentage of people age 65 and over who reported having been vaccinated against influenza and
pneumococcal disease, by selected characteristics, 2008
Selected characteristic

Both sexes
Men
Women
65-74
75-84
85 and over
High school graduate or less
More than high school
Influenza

67.1
65.8
68.1
60.8
72.7
79.1
66.5
68.0
Pneumococcal disease
Percent
60.0
56.4
62.8
52.5
68.6
69.0
58.1
62.9
NOTE: For influenza, the percentage vaccinated consists of people who reported having a flu shot during the past 12 months and does not include receipt of nasal
spray flu vaccinations. For pneumococcal disease, the percentage refers to people who reported ever having a pneumonia vaccination.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

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   INDICATOR 22
Mammography
Table 22. Percentage of women who reported having had a mammogram within the past 2 years, by selected
characteristics, selected years 1987-2008

Age Groups
40-49
50-64
65 and over
65-74
75 and over
7987

31.9
31.7
22.8
26.6
17.3
7990

55.1
56.0
43.4
48.7
35.8
1991

55.6
60.3
48.1
55.7
37.8
7993

59.9
65.1
54.2
64.2
41.0
Race and Hispanic Origin
White, not
Hispanic or
Latino
Black, not
Hispanic or
Latino
Hispanic or
Latino
Poverty
Poor
Near poor
Nonpoor
Education
No high
school
diploma or
GED
High school
diploma or
GED
Some college
or more

24.0

14.1
*

13.1
19.9
29.7

16.5
25.9
32.3

43.8

39.7
41.1

30.8
38.6
51.5

33.0
47.5
56.7

49.1

41.6
40.9

35.2
41.8
57.8

37.7
54.0
57.9

54.7

56.3
35.7

40.4
47.6
63.5

44.2
57.4
64.8
7994
Women
61.3
66.5
55.0
63.0
44.6
7998
7999
2000
2003
2005
2008
age 40 and over
63.4
73.7
63.8
69.4
57.2
Women 65 and

54.9

61.0
48.0

43.9
48.8
64.0

45.6
59.1
64.3

64.3

60.6
59.0

51.9
57.8
70.1

54.7
66.8
71.3
67.2
76.5
66.8
73.9
58.9
over

66.8

68.1
67.2

57.6
60.2
72.5

56.6
68.4
77.1
64.3
78.7
67.9
74.0
61.3


68.3

65.5
68.3

54.8
60.3
75.0

57.4
71.8
74.1
64.4
76.2
67.7
74.6
60.6


68.1

65.4
69.5

57.0
62.8
72.6

56.9
69.7
75.1
63.5
71.8
63.8
72.5
54.7


64.7

60.5
63.8

52.3
56.1
70.1

50.7
64.3
73.0
61.5
74.2
65.5
72.6
57.9


66.1

66.4
59.0

49.1
59.4
70.5

49.2
65.7
75.6
* Estimates are considered unreliable.
NOTE: Questions concerning use of mammography differed slightly on the National Health Interview Survey across the years for which data are shown. For details,
see Health, United States 2009, Appendix II.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

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    INDICATOR 23
Diet Quality
Table 23. Average dietary component scores as a percent of federal diet quality standards,3 population age 65 and
older, by age group, 2003-2004
Dietary Components

Total Healthy Eating lndex-2005 score
Dietary Adequacy Components"
Total Fruit
Whole Fruit
Total Vegetables
Dark Green and Orange Vegetables
and Legumes
Total Grains
Whole Grains
Milk
Meat and Beans
Oils
Dietary Moderation Components'"
Saturated Fat
Sodium
Extra Calories0

65 and older
65

86
100
82
34
100
32
56
100
76

62
34
55
Age group (Years)
65-74
63

76
100
84
30
100
28
52
100
75

60
32
51

75 and older
67

100
100
80
38
100
34
62
100
77

64
38
62
3Higher scores reflect higher intakes
^Higher scores reflect lower intakes.
cExtra calories from other sources, such as solid fats, added sugars, and alcohol.
NOTE: The Healthy Eating lndex-2005 (HEI-2005) comprises 12 components. Scores are averages across all adults and reflect long-term dietary intakes. The scores are
expressed here as percentages of recommended dietary intake levels. A score corresponding to 100 percent indicates that the recommendation was met or exceeded,
on average. A score below 100 percent indicates that average intake does not meet recommendations. Nine components of the HEI-2005 address nutrient adequacy.
The remaining three components assess saturated fat, sodium,  and calories from solid fats, alcoholic beverages, and added sugars, all of which should be consumed
in moderation. For the adequacy components, higher scores reflect higher intakes; for the moderation components, higher scores reflect lower intakes because lower
intakes are more desirable. For all components, a higher percentage indicates a higher-quality diet.
Reference population: These data refer to the resident noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, 2003-2004 and U.S.
Department of Agriculture, Center for Nutrition Policy and Promotion, Healthy Eating lndex-2005.

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    INDICATOR 24
Physical Activity
Table 24a. Percentage of people age 45 and over who reported engaging in regular leisure time physical activity, by
age group, 1997-2008
                           65 and over
                                                   45-64
                                                                         65-74
                                                                                               75-84
                                                                                                                  85 and over
Percent
1997-1998
1 999-2000
2001-2002
2003-2004
2005-2006
2007-2008
20.7
21.3
21.6
22.5
21.6
22.1
29.1
28.9
30.1
30.5
29.3
30.9
24.9
26.1
26.5
27.5
25.7
25.4
17.0
17.3
17.9
19.4
19.5
20.6
9.0
9.6
8.5
8.4
9.6
11.0
NOTE: Data are based on 2-year averages. "Regular leisure time physical activity" is defined as "engaging in light-moderate leisure time physical activity for greater
than or equal to 30 minutes at a frequency greater than or equal to five times per week, or engaging in vigorous leisure time physical activity for greater than or equal
to 20 minutes at a frequency greater than or equal to three times per week."
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
Table 24b.  Percentage of people age 65 and over who reported engaging in regular leisure time physical activity, by
selected characteristics, 2007-2008
                                               Total
                                                                               Men
                                                                                                              Women
Percent
All
White, not Hispanic or
Latino
Black, not Hispanic or
Latino
Hispanic or Latino
Percent who engage in
strengthening exercises
21.8
22.8
12.5
21.0
14.3
26.9
27.6
17.4
28.3
16.4
18.0
19.1
9.5
15.9
12.8
NOTE: Data are based on a 2-year average from 2007-2008."Regular leisure time physical activity" is defined as "engaging in light-moderate leisure time physical
activity for greater than or equal to 30 minutes at a frequency greater than or equal to 5 times per week, or engaging in vigorous leisure time physical activity for
greater than or equal to 20 minutes at a frequency greater than or equal to three times per week."
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

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   INDICATOR 25
Obesity
Table 25.  Body weight status among persons 65 years of age and over, by sex and age group, selected years
1976-2008
Sex and age group
Overweight
Both sexes
65 and over
65-74
75 and over
Men
65 and over
65-74
75 and over
Women
65 and over
65-74
75 and over
Obese
Both sexes
65 and over
65-74
75 and over
Men
65 and over
65-74
75 and over
Women
65 and over
65-74
75 and over
1976-1980


na
57.2
na

na
54.2
na

na
59.5
na


na
17.9
na

na
13.2
na

na
21.5
na
1988-1994


60.1
64.1
53.9

64.4
68.5
56.5

56.9
60.3
52.3


22.2
25.6
17.0

20.3
24.1
13.2

23.6
26.9
19.2
1999-2000


69.0
73.5
62.3

73.3
77.2
66.4

65.6
70.1
59.6


31.0
36.3
23.2

28.7
33.4
20.4

32.9
38.8
25.1
2001-2002
Percent

69.1
73.1
63.5

73.1
75.4
69.2

66.3
71.3
60.1


29.2
35.9
19.8

25.3
30.8
16.0

32.1
40.1
22.1
2003-2004


70.5
74.0
65.9

72.1
76.6
65.2

69.2
71.7
66.4


29.7
34.6
23.5

28.9
33.0
22.7

30.4
36.1
24.1
2005-2006


68.6
73.8
61.8

73.9
79.5
66.3

64.6
69.4
58.7


30.5
35.0
24.7

29.7
32.9
25.3

31.1
36.7
24.4
2007-2008


71.2
73.7
68.3

77.1
78.8
75.0

66.8
69.8
63.7


32.2
36.9
26.7

33.7
39.9
25.9

31.1
34.6
27.3
na: Data not available.
NOTE: Data are based on measured height and weight. Height was measured without shoes. Overweight is defined as having a body mass index (BMI) greater than
or equal to 25 kilograms/meter2. Obese is defined by a BMI of 30 kilograms/meter2 or greater. The percentage of people who are obese is a subset of the percentage
of those who are overweight. See Appendix C for the definition of BMI.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey.

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   INDICATOR 26
Cigarette Smoking
Table 26a. Percentage of men age 45 and over who are current cigarette smokers, by selected characteristics,
selected years 1965-2008
Total
Year
Men
1965
1974
1979
1983
1985
1987
1988
1990
1991
1992
1993
1994
1995
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
45-64

51.9
42.6
39.3
35.9
33.4
33.5
31.3
29.3
29.3
28.6
29.2
28.3
27.1
27.6
27.7
25.8
26.4
26.4
24.5
23.9
25.0
25.2
24.5
22.6
24.8
65 and over

28.5
24.8
20.9
22.0
19.6
17.2
18.0
14.6
15.1
16.1
13.5
13.2
14.9
12.8
10.4
10.5
10.2
11.5
10.1
10.1
9.8
8.9
12.6
9.3
10.5
45-64

51.3
41.2
38.3
35.0
32.1
32.4
30.0
28.7
28.0
28.1
27.8
26.9
26.3
26.5
27.0
24.5
25.8
25.1
24.4
23.3
24.4
24.5
23.4
22.1
24.0
White
65 and over
Percent
27.7
24.3
20.5
20.6
18.9
16.0
16.9
13.7
14.2
14.9
12.5
11.9
14.1
11.5
10.0
10.0
9.8
10.7
9.3
9.6
9.4
7.9
12.6
8.9
9.9
Black or African American
45-64

57.9
57.8
50.0
44.8
46.1
44.3
43.2
36.7
42.0
35.4
42.4
41.2
33.9
39.4
37.3
35.7
32.2
34.3
29.8
30.1
29.2
32.4
32.6
28.4
33.6
65 and over

36.4
29.7
26.2
38.9
27.7
30.3
29.8
21.5
24.3
28.3
*27.9
25.6
28.5
26.0
16.3
17.3
14.2
21.1
19.4
18.0
14.1
16.8
16.0
14.3
17.5
*Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error of 20-30 percent.
NOTE: Data starting in 1997 are not strictly comparable with data for earlier years due to the 1997 NHIS questionnaire redesign. Starting with 1993 data, current
cigarette smokers were defined as ever smoking 100 cigarettes in their lifetime and smoking now on every day or some days. See Appendix B for the definiton of race
and Hispanic origin in the National Health Interview Survey.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

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    INDICATOR 26
Cigarette Smoking continued
Table 26b. Percentage of women age 45 and over who are current cigarette smokers, by selected characteristics,
selected years 1965-2008
Total
Year
Women
1965
1974
1979
1983
1985
1987
1988
1990
1991
1992
1993
1994
1995
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
45-64

32.0
33.4
30.7
31.0
29.9
28.6
27.7
24.8
24.6
26.1
23.0
22.8
24.0
21.5
22.5
21.0
21.7
21.4
21.1
20.2
19.8
18.8
19.3
20.0
20.5
65 and over

9.6
12.0
13.2
13.1
13.5
13.7
12.8
11.5
12.0
12.4
10.5
11.1
11.5
11.5
11.2
10.7
9.3
T9.1
8.6
8.3
8.1
8.3
8.3
7.6
8.3
White
45-64

32.7
33.0
30.6
30.6
29.7
29.0
27.7
25.4
25.3
25.8
23.4
23.2
24.3
20.9
22.5
21.2
21.4
21.6
21.5
20.1
20.1
18.9
18.8
20.0
20.9
65 and over

9.8
12.3
13.8
13.2
13.3
13.9
12.6
11.5
12.1
12.6
10.5
11.1
11.7
11.7
11.2
10.5
9.1
9.4
8.5
8.4
8.2
8.4
8.4
8.0
8.6
Black or African American
45-64

25.7
38.9
34.2
36.3
33.4
28.4
29.5
22.6
23.4
30.9
21.3
23.5
27.5
28.4
25.4
22.3
25.6
22.6
22.2
23.3
20.9
21.0
25.5
22.6
21.3
65 and over

7.1
*8.9
*8.5
*13.1
14.5
11.7
14.8
11.1
9.6
*11.1
*10.2
13.6
13.3
10.7
11.5
13.5
10.2
9.3
9.4
8.0
6.7
10.0
9.3
6.4
8.1
*Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error of 20-30 percent.
fine value for all women includes other races which have a very low rate of cigarette smoking. Thus, the weighted average for all women is slightly lower than that for
white women.
NOTE: Data starting in 1997 are not strictly comparable with data for earlier years due to the 1997 NHIS questionnaire redesign. Starting with 1993 data, current
cigarette smokers were defined as ever smoking 100 cigarettes in their lifetime and smoking now on every day or some days. See Appendix B for the definiton of race
and Hispanic origin in the National Health Interview Survey.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

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   INDICATOR 26
Cigarette Smoking continued
Table 26c. Cigarette smoking status of people age 18 and over, by sex and age group, 2008
Sex and
age group

Both sexes
Men
18-44
45-64
65 and over
Women
18-44
45-64
65 and over
All current
smokers

20.6

25.6
24.8
10.5

20.6
20.5
8.3
Every day
smokers

16.5

18.9
20.2
8.9

16.8
17.4
6.5
Some day
smokers
Percent
4.2

6.7
4.6
1.6

3.8
3.1
1.8
Former smokers

21.6

13.0
28.5
54.6

11.9
22.4
30.7
Non-smokers

57.8

61.4
46.7
34.9

67.5
57.1
60.9
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.
   INDICATOR 27
Air Quality
Table 27a.  Percentage of people age 65 and over living in counties with "poor air quality," 2000-2008
Pollutant
Measures

Particulate Matter
(PM 2.5)
8-hr Ozone
Any standard
2000

41.0
52.0
62.0
2001

39.0
55.0
62.0
2002

38.0
54.0
60.0
2003
Percent
33.0
54.0
59.0
2004

23.0
35.0
45.0
2005

35.0
52.0
58.0
2006

21.0
50.0
54.0
2007

24.0
48.0
53.0
2008

11.0
36.0
38.0
NOTE: The term "poor air quality" is defined as air quality concentrations above the level of the National Ambient Air Quality Standards (NAAQS). The term "any
standard" refers to any NAAQS for ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon monoxide, and lead. In 2008, EPA strengthened the national
standard for 8-hour ozone to 0 075 ppm and the national standard for lead to 0.15 ug/m3. This figure includes people living in counties that monitored ozone and lead
concentrations above the new levels. This results in percentages that are not comparable to previous publications.
Reference population:  These data refer to the resident population.
SOURCE: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S., U.S. Census Bureau, Population
Projections, 2000-2008.

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   INDICATOR 27
Air Quality continued
Table 27b. Counties with "poor air quality" for any standard in 2008
State
Alabama
Alabama
Alabama
Alabama
Alaska
Arizona
Arizona
Arizona
Arizona
Arizona
Arizona
Arizona
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
County
Jefferson County
Mobile County
P ke County
She by County
Fairbanks North Star
Borough
Cochise County
Gila County
La Paz County
Maricopa County
Final County
Santa Cruz County
Yuma County
Alameda County
Amador County
Butte County
Calaveras County
Contra Costa County
El Dorado County
Fresno County
Imperial County
Inyo County
Kern County
Kings County
Lake County
Los Angeles County
Madera County
Mariposa County
Merced County
Mono County
Nevada County
State
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
Colorado
Colorado
Colorado
Colorado
Colorado
Colorado
Colorado
Connecticut
Connecticut
Connecticut
County
Orange County
Placer County
Plumas County
Riverside County
Sacramento County
San Benito County
San Bernardino County
San Diego County
San Joaquin County
San Luis Obispo County
Shasta County
Solano County
Stanislaus County
Sutler County
Tehama County
Trinity County
Tulare County
Tuolumne County
Ventura County
Yolo County
Adams County
Alamosa County
Boulder County
Douglas County
Jefferson County
Larimer County
Prowers County
Fairfield County
Hartford County
Litchfield County
NOTE: The term "poor air quality" is defined as air quality concentrations above the level of the National Ambient Air Quality Standards (NAAQS). The term "any
standard" refers to any NAAQS for ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon monoxide, and lead.
Reference population: These data refer to the resident population.
SOURCE: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S. Census Bureau, Population Projections,
2000-2008.

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   INDICATOR 27
Air Quality continued
Table 27b. Counties with "poor air quality" for any standard in 2008 (continued)
State
Connecticut
Connecticut
Connecticut
Connecticut
Delaware
Delaware
Delaware
District of Columbia
Florida
Florida
Florida
Florida
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Hawaii
Idaho
Idaho
Illinois
Indiana
Kentucky
Louisiana
Louisiana
Louisiana
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
County
Middlesex County
New Haven County
New London County
Tolland County
Kent County
New Castle County
Sussex County
District of Columbia
Hillsborough County
Pasco County
Santa Rosa County
Sarasota County
B bb County
Clarke County
DeKalb County
Dougherty County
Douglas County
Fayette County
Fulton County
Gwinnett County
Hall County
Henry County
Murray County
Richmond County
Rockdale County
Hawaii County
Power County
Shoshone County
Madison County
Delaware County
Oldham County
Iberville Parish
Pointe Coupee Parish
St. Tammany Parish
Anne Arundel County
Baltimore County
Calvert County
Carroll County
Cecil County
Charles County
Harford County
Kent County
Montgomery County
State
Maryland
Maryland
Massachusetts
Massachusetts
Massachusetts
Massachusetts
Massachusetts
Massachusetts
Massachusetts
Michigan
Minnesota
Minnesota
Minnesota
Mississippi
Mississippi
Missouri
Missouri
Missouri
Missouri
Nevada
Nevada
Nevada
New Hampshire
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Jersey
New Mexico
New Mexico
New York
New York
New York
New York
New York
New York
County
Prince George's County
Baltimore city
Bristol County
Dukes County
Essex County
Hampden County
Hampshire County
Norfolk County
Worcester County
Wayne County
Dakota County
Ramsey County
Washington County
Harrison County
Jackson County
Iron County
Jefferson County
St. Charles County
St. Louis city
Clark County
Nye County
Washoe County
Hillsborough County
Bergen County
Camden County
Cumberland County
Gloucester County
Hudson County
Hunterdon County
Mercer County
Middlesex County
Monmouth County
Morris County
Ocean County
Passaic County
Dona Ana County
Luna County
Albany County
Bronx County
Chautauqua County
Dutchess County
Erie County
Monroe County
NOTE: The term "poor air quality" is defined as air quality concentrations abovi
standard" refers to any NAAQS for ozone, particulate matter, nitrogen dioxide,
Reference population: These data refer to the resident population.
SOURCE: U.S. Environmental Protection Agency, Office of Air Quality Plannin;
2000-2008.
                    •e the level of the National Ambient Air Quality Standards (NAAQS). The term "any
                     sulfur dioxide, carbon monoxide, and lead.

                    g and Standards, Air Quality System; U.S. Census Bureau, Population Projections,

-------
   INDICATOR 27
Air Quality continued
Table 27b. Counties with "poor air quality" for any standard in 2008 (continued)
State
New York
New York
New York
New York
New York
New York
New York
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
North Carolina
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
County
New York County
Orange County
Putnam County
Queens County
Saratoga County
Suffolk County
Westchester County
Alexander County
Caswell County
Davie County
Durham County
Forsyth County
Franklin County
Graham County
Granville County
Guilford County
Haywood County
Johnston County
Lincoln County
Mecklenburg County
New Hanover County
Person County
Pitt County
Rockingham County
Rowan County
Union County
Wake County
Yancey County
Butler County
Clinton County
Cuyahoga County
Franklin County
Fulton County
Geauga County
Hamilton County
Lake County
Lawrence County
Montgomery County
Stark County
Summit County
Trumbull County
State
Ohio
Ohio
Oklahoma
Oklahoma
Oregon
Oregon
Oregon
Oregon
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Rhode Island
Rhode Island
South Carolina
South Carolina
South Carolina
South Carolina
South Carolina
Tennessee
Tennessee
Tennessee
County
Warren County
Washington County
Oklahoma County
Tulsa County
Harney County
Klamath County
Lake County
Lane County
Adams County
Allegheny County
Armstrong County
Beaver County
Berks County
Bucks County
Chester County
Clearfield County
Dauphin County
Delaware County
Indiana County
Lackawanna County
Lancaster County
Lehigh County
Lycoming County
Mercer County
Monroe County
Montgomery County
Northampton County
Perry County
Philadelphia County
Washington County
York County
Providence County
Washington County
Cherokee County
Darlington County
Pickens County
Richland County
Spartanburg County
Blount County
Hamilton County
Knox County
NOTE: The term "poor air quality" is defined as air quality concentrations above the level of the National Ambient Air Quality Standards (NAAQS). The term "any
standard" refers to any NAAQS for ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon monoxide, and lead.
Reference population: These data refer to the resident population.
SOURCE: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S. Census Bureau, Population Projections,
2000-2008.

-------
   INDICATOR 27
                                      Air Quality continued
Table 27b. Counties with "poor air quality" for any standard in 2008 (continued)
State
Tennessee
Tennessee
Tennessee
Tennessee
Tennessee
Tennessee
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Utah
Utah
Utah
Utah
Utah
Utah
County
Loudon County
Sevier County
Shelby County
Sullivan County
Sumner County
Wilson County
Bexar County
Brazoria County
Collin County
Dallas County
Denton County
El Paso County
Harris County
Jefferson County
Johnson County
Parker County
Tarrant County
Webb County
Box Elder County
Cache County
Davis County
Salt Lake County
Utah County
Weber County
State
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Washington
Washington
Washington
West Virginia
West Virginia
West Virginia
Wisconsin
Wyoming
Wyoming


County
Arlington County
Caroline County
Charles City County
Chesterfield County
Fairfax County
Hanover County
Henrico County
Loudoun County
Madison County
Hampton city
Norfolk city
Suffolk city
Virginia Beach city
Pierce County
Stevens County
Yakima County
Brooke County
Hancock County
Kanawha County
Vilas County
Sublette County
Sweetwater County


NOTE: The term "poor air quality" is defined as air quality concentrations above the level of the National Ambient Air Quality Standards (NAAQS). The term "any
standard" refers to any NAAQS for ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon monoxide, and lead.
Reference population: These data refer to the resident population.
SOURCE: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S. Census Bureau, Population Projections,
2000-2008.

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   INDICATOR 28
Use of Time
Table 28a. Percentage of day that people age 55 and over spent doing selected activities on an average day, by age
group, 2008

55-64
65-74
Average P~rr~nf
Selected leisure activities hours nfriav
per day y
Sleeping
Leisure activities
Work and work-related activities
Household activities
Caring for and helping others
Eating and drinking
Purchasing goods and services
Grooming
Other activities
8.3
5.7
3.5
2.1
0.6
1.3
0.9
0.7
1.0
34.4
23.6
14.7
8.7
2.5
5.6
3.6
2.8
4.1
Average
hours
per day
8.8
7.1
1.2
2.3
0.4
1.5
0.9
0.6
1.2
Percent
of day
36.5
29.7
5.1
9.5
1.7
6.1
3.8
2.6
5.0
75 and over
Average
hours
per day
9.1
7.6
0.4
2.3
0.2
1.5
0.8
0.7
1.4
Percent
of day
38.1
31.7
1.5
9.7
0.9
6.3
3.1
2.8
5.6
NOTE: "Other activities" includes activities such as educational activities; organizational, civic and religious activities; and telephone calls.
Table includes people who did not work at all.






Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Bureau of Labor Statistics, American Time Use Survey.
Table 28b. Percentage of total leisure time that
average day, by age group, 2008

Selected leisure activities
Socializing and communicating
Watching TV
Participation in sports, exercise, and
recreation
Relaxing and thinking
Reading
Other leisure activities (including related
travel)


people age 55 and

55-64
Average p
per day '
0.7
3.3
0.2
0.3
0.5
0.6



over spent doing


selected

65-74
'ercent
if day
12.5
57.8
4.1
5.0
9.3
11.3

Average
hours
per day
0.7
4.0
0.3
0.4
0.8
0.8

Percent
of day
10.2
56.3
4.2
6.3
11.0
11.9



leisure activities on an


75 and over
Average
hours
per day
0.6
4.2
0.2
0.7
1.0
0.8

Percent
of day
8.3
55.2
2.3
9.7
13.7
10.9

Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Bureau of Labor Statistics, American Time Use Survey.

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   INDICATOR 29
Use of Health Care  Services
Table 29a. Use of Medicare-covered health care services by Medicare enrollees age 65 and over, 1992-2007
                                            Utilization Measure
y         Hospital stays
                                 Skilled nursing
                                   facility stays
                  Physician visits
                 and consultations
            Home health
             care visits
Average length
of hospital stay
                                        Rate per thousand enrollees
                                                                        Days
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
306
300
331
336
341
351
354
365
361
364
361
359
353
350
343
336
28
33
43
50
59
67
69
67
67
69
72
74
75
79
80
81
1 1 ,359
1 1 ,600
12,045
12,372
12,478
na
13,061
na
13,346
13,685
13,863
13,519
13,776
13,914
na
na
3,822
4,648
6,352
7,608
8,376
8,227
5,058
3,708
2,913
2,295
2,358
2,440
2,594
2,770
3,072
3,409
8.4
8.0
7.5
7.0
6.6
6.3
6.1
6.0
6.0
5.9
5.9
5.8
5.7
5.7
5.6
5.6
na: Data not available.
NOTES: Data are for Medicare enrollees in fee-for-service only. Physician visits and consultations include all settings, such as physician offices, hospitals,
emergency rooms, and nursing homes. The definition of physician visits and consultations changed beginning in 2003, resulting in a slightly lower rate. Beginning in
1994, managed care enrollees were excluded from the denominator of all utilization rates because utilization data are not available for them. Prior to 1994, managed
care enrollees were included in the denominators; they comprised 7% or less of the Medicare population.
Reference population: These data refer to Medicare enrollees.
SOURCE:  Centers for  Medicare and Medicaid Services, Medicare claims and enrollment data.
Table 29b. Use of Medicare-covered home health and skilled nursing facility services by Medicare enrollees age 65
and over, by age group, 2007
                                                                              Age
       Utilization measure
                                              65-74
                                                                              75-84
                                                                                                         85 and over
    Skilled nursing facility stays
    Home health care visits
         32

      1,713
Rate per 1,000 enrollees

          94

        4,156
  227

7,333
NOTE: Data are for Medicare enrollees in fee-for-service only.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.

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   INDICATOR 30
Health Care Expenditures
Table 30a. Average annual health care costs for Medicare enrollees age 65 and over, in 2006 dollars, by age group,
1992-2006
Year

1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006

Total

$9,224
9,886
10,653
11,146
11,273
11,522
11,247
11,562
12,001
12,663
13,588
13,714
13,932
na
15,081
Age
65-74
Dollars
$6,864
7,171
7,871
8,111
8,160
8,140
7,869
8,778
8,937
9,628
10,473
10,385
10,356
na
11,287

75-84

$10,094
11,300
11,800
12,197
12,690
12,800
12,512
12,260
13,082
14,081
1 4,756
15,327
15,172
na
16,855

85 and over

$17,841
18,494
19,966
21 ,084
20,641
20,876
21,014
20,305
20,691
21,126
22,027
21 ,550
23,384
na
23,664
na: Data not available.
NOTES: Data include both out-of-pocket costs and costs covered by insurance. Dollars are inflation-adjusted to 2006 using the Consumer Price I
(Series CPI-U-RS).
Reference population: These data refer to Medicare enrollees.
SOURCE: Medicare Current Beneficiary Survey.
Table 30b. Major components of health care costs among Medicare enrollees age 65 and over, 1992 and 2006
7992
Cost component Average cost in dollars
Total
Inpatient hospital
Physician/outpatient
hospital
Nursing home/long-term
institution
Home health care
Prescription drugs
Other (short-term
institution/hospice/dental)
$6,551
2,107
2,071
1,325
244
522
282
Percent
100
32
32
20
4
8
4
2006
Average cost in dollars Percent
$15,081
3,695
5,246
2,034
442
2,351
1,313
100
25
35
13
3
16
9
NOTES: Data include both out-of-pocket costs and costs covered by insurance. Dollars are not inflation adjusted.
Reference population: These data refer to Medicare enrollees.
SOURCE: Medicare Current Beneficiary Survey.

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   INDICATOR 30
                                    Health Care Expenditures continued
Table 30c. Average annual health care costs among Medicare enrollees age 65 and over, by selected characteristics,
2006
 Characteristics
Average cost in dollars
   Total
   Race and ethnicity
      Non-Hispanic white
      Non-Hispanic black
      Hispanic
      Other
   Institutional status
      Community
      Institution
   Annual income
      < $10,000
      $10,000-$20,000
      $20,001-$30,000
      $30,001 and over
   Chronic conditions
      0
      1-2
      3-4
      5 and over
   Veteran status (men only)
      Yes
      No
       $15,081

       $14,980
       $18,098
       $14,144
       $13,350

       $12,383
       $57,022

       $21,033
       $16,674
       $13,881
       $12,440

       $5,186
       $9,971
       $16,936
       $25,132

       $14,424
       $15,114
NOTE: Data include both out-of-pocket costs and costs covered by insurance. See Appendix B for the definition of race and Hispanic origin in the Medicare Current
Beneficiary Survey.  Chronic conditions include cancer (other than skin cancer), stroke, diabetes, heart disease, hypertension, arthritis, and respiratory conditions
(emphysema, asthma, chronic obstructive pulmonary disease). Annual income includes that of respondent and spouse.
Reference population: These data refer to Medicare enrollees.
SOURCE: Medicare Current Beneficiary Survey.
Table 30d. Major components of health care costs among Medicare enrollees age 65 and over, by age group, 2006
                                                                              Age
 Cost component
                                                   65-74
                                                                             75-84
NOTE: Data include both out-of-pocket costs and costs covered by insurance.
Reference population: These data refer to Medicare enrollees.
SOURCE: Medicare Current Beneficiary Survey.
                                                                                                    85 and over

Total
Inpatient hospital
Physician/outpatient hospital
Nursing home/long-term institution
Home health care
Prescription drugs
Other (short-term institution/hospice/
dental)

$11,287
2,763
4,738
547
216
2,370
654
Average cost in dollars
$16,855
4,403
6,051
1,969
479
2,508
1,446

$23,664
5,150
5,070
7,182
1,115
1,935
3,211

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   INDICATOR 30
                                   Health Care Expenditures continued
Table 30e. Percentage of noninstitutionalized Medicare enrollees age 65 and older who reported problems with
access to health care, 1992-2005
 Reported problems   1992   1993   1994   1995   1996   1997   1998   1999   2000   2001   2002   2003  2004   2005
                                                        Percent

   obtaining care       3'1    2'6    2'6     2'6     2'3     2'4    2'4    2'8    2'9    2'8    2'5    2'3    2'3    2'5
caredtehj'cost    9'8
                                    7'6     6'8     5'5     48    4A    47    4'8
                                                                                                   5'3    5'3    4'8
Reference population: These data refer to Medicare enrollees.
SOURCE: Medicare Current Beneficiary Survey.1
1MCBS Project. (2008). Health and Health Care of the Medicare Population: Data from the 2005 Medicare Current Beneficiary Survey.
(Prepared under contract to the Centers for Medicare and Medicaid Services). Rockville, MD: Westat.
   INDICATOR 31
                                Prescription Drugs
Table 31a. Average prescription drug costs and sources of payment among noninstitutionalized Medicare enrollees
age 65 and over, 1992-2004
             7992    7993    7994     7995    7996    7997    7998    7999    2000    2007   2002   2003    2004
                                                Average cost in dollars
 Total        $570    $756    $802     $841     $907    $991  $1,147  $1,284  $1,469  $1,647 $1,827 $1,963  $2,107
    pocket
    Private     145
    Public
              82
                   439
                   190
                   127
436
220
146
441     451
248     302
                                       152
                                               155
491
323
177
530     565      616     658     721     736     763
401     449      512     573     666     747     810
                                                                215
                                                                        270
                                                                                341
                                                                                         416
                                                                                                 441
                                                                                                         480
                                                                                                                534
NOTE: Dollars have been inflation-adjusted to 2004 using the Consumer Price Index (Series CPI-U-RS). Reported costs have been adjusted by a factor of 1.205
to account for underreporting of prescription drug use. Public programs include Medicare, Medicaid, Department of Veterans Affairs, and other state and federal
programs. Data for 2005 and 2006 were not available in time to include in this report.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 31 b. Distribution of annual prescription drug costs among
noninstitutionalized Medicare enrollees age 65 and over, 2004
 Cosf in dollars
                                                       Percent of enrollees
   Total
      $0
      1-499
      500-999
      1,000-1,499
      1,500-1,999
      2,000-2,499
      2,500 or more
                                                           100.0
                                                             7.8
                                                            20.0
                                                            16.3
                                                            12.8
                                                            11.0
                                                             8.2
                                                            23.9
NOTE: Reported costs have been adjusted by a factor of 1 205 to account for underreporting of prescription drug
use. Data for 2005 and 2006 were not available in time to include in this report.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.

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   INDICATOR 31
Prescription Drugs continued
Table 31c.  Number of Medicare enrollees age 65 and over who enrolled in Part D prescription drug plans or who
were covered by retiree drug subsidy payments, June 2006 and December 2009
Part D benefit categories
All Medicare enrollees age 65 or over
Enrollees in prescription drug plans
Type of plan
Stand-alone plan
Medicare Advantage plan
Low-income subsidy
Yes
No
Retiree drug subsidy
Other
June 2006
36,052,991
18,245,980

12,583,676
5,662,304

5,935,532
12,310,448
6,498,163
11,308,848
December 2009
38,909,142
22,183,470

13,530,371
8,653,099

6,086,550
16,096,920
6,187,111
10,538,561
   Reference population: These data refer to Medicare enrollees.
   SOURCE: Centers for Medicare and Medicaid Services, Management Information Integrated Repository.
Table 31d.  Average prescription drug costs among noninstitutionalized Medicare enrollees age 65 and over, by
selected characteristics, 2000, 2002, and 2004
Characteristic

Number of chronic conditions
0
1-2
3-4
5 and over
Annual income
<$1 0,001
$10,001 -$20,000
$20,001 -$30,000
More than $30,000
2000


$551
1,153
2,030
2,772

1,383
1,402
1,571
1,520
2002
Average cost in dollars

$650
1,417
2,459
3,502

1,838
1,749
1,892
1,850
2004


$800
1,741
2,845
3,862

1,938
2,080
2,138
2,189
NOTE: Dollars have been inflation adjusted to 2004 using the Consumer Price Index (CPI-U-RS). Reported costs have been adjusted by a factor of 1.205 to account
for underreporting of prescription drug use. Chronic conditions include cancer (other than skin cancer), stroke, diabetes, heart disease, hypertension, arthritis, and
respiratory conditions (emphysema/asthma/chronic obstructive pulmonary disease). Annual income includes that of respondent and spouse. Data for 2005 and 2006
were not available in time to include in this report.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.

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    INDICATOR 32
Sources of Health Insurance
Table 32a. Percentage of noninstitutionalized Medicare enrollees age 65 and over with supplemental health
insurance, by type of insurance, 1991-2007
Types of supplemental insurance
Year

1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Private (employer or
union sponsored)

40.7
41.0
40.8
40.3
39.1
37.8
37.6
37.0
35.8
35.9
36.0
36.1
36.1
36.6
36.1
34.9
35.3
Private
(Medigap)*

44.8
45.0
45.3
45.2
44.3
38.6
35.8
33.9
33.2
33.5
34.5
37.5
34.3
33.7
34.6
32.5
31.5
HMO
Percent
6.3
5.9
7.7
9.1
10.9
13.8
16.6
18.6
20.5
20.4
18.0
15.5
14.8
15.6
15.5
20.7
21.8
Medicaid

8.9
9.0
9.4
9.9
10.1
9.5
9.4
9.6
9.7
9.9
10.6
10.7
11.6
11.3
11.8
11.9
11.9
Other public

4.0
5.3
5.8
5.5
5.0
4.8
4.7
4.8
5.1
4.9
5.4
5.5
5.7
5.2
5.6
4.3
4.0
No
supplement

11.3
10.4
9.7
9.3
9.1
9.4
9.2
8.9
9.0
9.7
10.1
12.3
11.8
12.6
12.0
12.5
13.3
* Includes people with private supplement of unknown sponsorship.
NOTE: HMOs include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and private fee-for-service plans (PFFSs). Not all types
of plans were available in all years. Since 2003 these types of plans have been known collectively as Medicare Advantage. Estimates are based on enrollees'
insurance status in the fall of each year. Categories are not mutually exclusive (i.e., individuals may have more than one supplemental policy). Table excludes
enrollees whose primary insurance is not Medicare (approximately 1 to 2 percent of enrollees). Medicaid coverage was determined from both survey responses and
Medicare administrative records.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 32b.  Percentage of people age 55-64 with health insurance coverage, by type of insurance and  poverty
status, 2008
Type of Insurance
Private
Medicaid
Medicare
Other coverage
Uninsured
Total
73.6
6.6
4.3
3.7
11.8

99 percent or less
16.4
39.8
7.6
5.2
31.0
Poverty Threshold
100-199 percent
40.0
14.5
13.6
5.2
26.7

200 percent
85.3
1.8
2.4
3.3
7.2
NOTE: Poverty status is based on family income and family size using the U.S. Census Bureau's poverty thresholds. Below poverty (99 percent or less) is defined
as people living below the poverty threshold. People living above poverty are divided between those with incomes between 100-199 percent of the poverty
threshold and those with incomes of 200 percent or more of the poverty threshold. A multiple imputation procedure was performed for the missing family income
data (unknown poverty). A detailed description of the multiple imputation procedure is available from http://www.cdc.gov/nchs/nhis htm via the Imputed Income
Files link under data year 2006. Classification of health insurance is based on a hierarchy of mutually exclusive categories. Health insurance categories are
mutually exclusive. Persons who reported  both Medicaid and private coverage are classified as having private coverage. Starting with 1997 data, state-sponsored
health plan coverage is included as Medicaid coverage. Starting with  1999 data, coverage by the Children's Health Insurance Program (CH P) is included with
Medicaid coverage.  In addition to private and Medicaid, the Other Insurance category includes military and other government. Persons not covered by private
insurance, Medicaid, CHIP, state-sponsored or other government-sponsored health  plans (starting in 1997), Medicare, or military plans are considered to have no
health insurance coverage. Persons with only Indian Health Service coverage are considered to have no health insurance coverage.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

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  INDICATOR 33
Out-of-Pocket Health Care Expenditures
Table 33a. Percentage of people age 55 and over with out-of-pocket expenditures for health care service use, by age
group, 1977, 1987, 1996, 2000-2006
Age Group 1977

65 and D., ~
over 83'3
55-64 81 .9
55-61 81 .6
62-64 82.6
65-74 83.4
75-84 83.8
ove"^ 80'8
7987

88.6
84.0
83.9
84.3
87.9
90.0
88.6
7996

92.4
89.6
89.5
89.7
91.8
92.9
93.9
2000

93.6
90.2
89.4
92.4
93.3
93.5
95.2
2007
Percent
94.7
90.4
90.2
91.1
94.1
95.6
94.6
2002

94.4
90.9
90.7
91.3
94.4
94.6
93.8
NOTE: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums.
comparability across years; for details, see Zuvekas and Cohen.51
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Agency for Healthcare Research and Quality, Medica









2003

94.7
90.4
89.6
92.7
93.7
95.7
95.8
2004

95.5
90.0
89.5
91.6
95.1
95.8
96.3
2005

95.0
90.5
89.6
93.3
94.2
96.1
95.1









2006

95.0
88.9
88.4
90.6
94.1
96.2
95.5
Data for the 1987 survey have been adjusted to permit
I Expenditure Panel Survey (MEPS) and MEPS predecessor surveys.
Table 33b. Out-of-pocket health care expenditures as a percentage of household income,
over, by selected characteristics, 1977, 1987, 1996, 2000-2006
Selected Characteristic
Total
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
Income Category
Poor/near poor
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
Low/middle/high
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
7977
7987
7996
2000
2007
2002
2003
among people age
2004
2005
55 and
2006
Percent
7.2
5.2
5.1
5.5
6.4
8.8
7.9


12.3
16.1
17.5
13.3
11.0
14.4
12.4

5.4
3.9
3.7
4.2
5.0
6.2
5.2
8.8
5.8
5.7
5.9
7.2
11.0
12.0


15.8
18.1
19.8
14.0
13.7
19.0
14.7

7.0
3.7
3.4
4.6
5.9
8.4
10.9
8.4
7.1
6.2
9.5
7.7
9.0
9.8


19.2
30.0
27.6
34.3
21.6
18.3
(B)

5.6
3.2
2.9
3.8
4.9
6.3
7.8
9.1
7.0
6.1
9.3
8.1
10.4
10.1


22.6
29.9
28.1
(B)
24.4
22.9
17.6

6.3
3.4
3.1
4.3
5.6
6.9
7.6
10.0
7.6
6.9
9.6
8.7
11.4
11.8


23.5
31.2
29.6
34.9
25.7
23.3
18.7

7.3
4.2
3.9
5.3
6.2
8.4
9.3
10.8
7.1
6.6
8.5
9.5
11.9
12.7


27.6
27.1
26.5
28.5
27.7
28.4
25.7

7.2
4.1
3.8
5.0
6.4
8.2
7.9
11.6
7.3
6.9
8.4
9.2
13.4
16.4


27.8
29.9
30.0
29.9
23.4
30.2
32.4

8.0
4.5
4.2
5.5
6.9
9.1
10.3
11.6
7.5
7.1
8.8
10.7
11.8
14.9


29.3
30.0
29.6
30.9
29.0
29.4
30.0

8.1
4.1
4.0
4.8
7.4
8.2
11.1
10,
7,
6,
8,
9
12,
13,


27,
27,
27,
27,
26
28,
28,

7,
.9
.1
.7
.2
.2
.5
.0


.6
.7
.9
.3
.2
.6
.6

.4
4.2
3
5
6,
8,
8,
.9
.3
.2
.8
.2
10.0
7.1
6.6
8.5
9.1
10.5
12.2


28.1
28.8
27.7
31.5
29.4
27.9
24.9

6.0
4.0
3.8
4.8
5.2
6.5
8.2

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    INDICATOR 33
Out-of-Pocket Health Care Expenditures continued
Table 33b.  Out-of-pocket health care expenditures as a percentage of household income, among people age 55 and
over, by selected characteristics, 1977,1987,1996, 2000-2006 (continued)
Selected Characteristic

Health Status Category
Poor or fair health
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
1977



9.5
8.7
8.8
8.6
8.7
11.3
8.9
7987



11.0
8.5
9.0
7.6
10.0
12.4
12.2
7996



11.7
13.0
11.8
15.9
10.7
11.8
(B)
2000



13.1
14.1
12.8
17.4
11.8
14.6
13.8
2007 2002
Percent


13.9
13.6
12.9
15.2
13.5
14.7
13.2



14.6
13.3
12.8
14.7
14.4
15.2
13.5
2003



16.0
13.3
12.4
15.9
13.8
17.5
19.5
2004



15.2
13.8
13.5
14.7
14.3
15.4
17.9
2005



15.5
12.7
11.8
15.3
14.3
17.1
14.5
2006



12.9
13.2
12.9
14.0
13.1
13.0
12.2
Excellent, very good, or good health
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
6.1
3.9
3.9
4.1
5.3
7.5
7.6
7.1
4.6
4.5
4.9
5.4
9.7
11.8
6.6
5.0
4.1
7.3
6.3
7.2
6.4
6.7
4.0
3.5
5.6
6.2
7.5
7.1
7.6
5.2
4.8
6.6
6.2
9.1
10.6
8.4
4.6
4.4
5.6
7.1
9.6
11.9
8.9
5.0
4.9
5.4
6.9
10.7
13.9
9.4
5.0
4.5
6.4
8.9
9.3
12.8
8.1
4.9
4.6
5.6
6.6
9.2
11.9
8.2
4.8
4.3
6.3
7.1
8.8
12.2
(B) Base is not large enough to produce reliable results.
NOTE: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Including expenditures for out-of-pocket premiums in the
estimates of out-of-pocket spending would increase the percentage of household income spent on health care in all years. People are classified into the "poor/near
poor" income category if their household income is below 125 percent of the poverty level; otherwise, people are classified into the "low/middle/high" income category.
The poverty level is calculated according to the U.S. Census Bureau guidelines for the corresponding year.  The ratio of a person's out-of-pocket expenditures to their
household income was calculated based on the person's per capita household income. For people whose ratio of out-of-pocket expenditures to income exceeded 100
percent, the ratio was capped at 100 percent. For people with out-of-pocket expenditures and with zero income (or negative income) the ratio was set at 100 percent.
For people with no out-of-pocket expenditures the ratio was set to zero. These methods differ from what was used in Older Americans 2004, which excluded persons
with no out-of-pocket expenditures from the calculations (17 percent of the population 65 and older in 1977, and 4.5 percent of the population age 65 and older in
2004). Data from the 1987 survey have been adjusted to permit comparability across years; for details see Zuvekas and Cohen.51
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS) and MEPS predecessor surveys.

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    INDICATOR 33
                                        Out-of-Pocket Health Care Expenditures continued
Table 33c.  Distribution of total out-of-pocket health care expenditures among people age 55 and over, by type of
health care services and age group, 2000-2006
Type of health care service, by year
2000
Hospital care
Office-based medical provider services
Dental services
Prescription drugs
Other health care
2001
Hospital care
Office-based medical provider services
Dental services
Prescription drugs
Other health care
2002
Hospital care
Office-based medical provider services
Dental services
Prescription drugs
Other health care
2003
Hospital care
Office-based medical provider services
Dental services
Prescription drugs
Other health care
2004
Hospital care
Office-based medical provider services
Dental services
Prescription drugs
Other health care
65 and over

6.4
9.8
15.8
53.6
14.3

5.4
9.4
13.0
56.0
16.2

5.0
10.5
14.0
58.2
12.3

5.2
8.7
11.8
58.3
16.0

5.0
10.1
11.8
61.4
11.8
55-64

8.5
18.9
20.0
44.7
7.8

9.8
19.8
18.6
45.7
6.1

10.2
21.3
18.1
43.8
6.6

9.2
18.8
16.7
48.5
6.8

9.2
20.1
16.9
46.0
7.8
55-61

7.5
19.8
21.3
44.0
7.5

9.4
19.9
20.0
44.3
6.4

9.2
21.6
18.3
43.5
7.4

8.8
18.3
16.7
49.0
7.3

10.1
18.7
18.5
45.0
7.7
62-64

*11.0
16.7
17.0
46.5
8.7

10.7
19.7
15.2
48.9
5.5

13.1
20.3
17.7
44.7
4.3

10.1
19.9
16.9
47.5
5.6

6.9
23.6
12.8
48.7
8.1
65-74

7.3
11.6
17.5
57.1
6.6

5.2
10.5
15.6
57.2
11.5

4.6
12.3
17.6
57.9
7.7

5.9
9.4
14.5
61.3
8.9

5.1
12.4
13.2
61.9
7.4
75-84

4.6
9.0
15.9
51.5
19.0

5.8
9.6
11.9
58.9
13.8

5.5
9.3
12.3
56.6
16.3

4.5
9.1
9.5
54.5
22.4

4.5
9.2
12.0
64.8
9.5
85 and
over

8.6
6.0
9.6
48.0
27.9

*4.8
6.0
8.3
45.1
*35.8

5.1
7.8
6.2
65.5
15.4

5.1
5.4
9.5
59.8
20.2

*5.9
5.3
7.5
51.9
29.5
* Indicates the relative standard error is greater than 30 percent.
NOTE: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Hospital care includes hospital inpatient care and care
provided in hospital outpatient departments and emergency rooms.  Office-based medical provider services include services provided by medical providers in non-
hospital-based medical offices or clinic settings. Dental services include care provided by any type of dental provider. Prescription drugs include prescribed medications
purchased, including refills. Other health care includes care provided by home health agencies and independent home health providers and expenses for eyewear,
ambulance services, orthopedic items, hearing devices, prostheses, bathroom aids, medical equipment, disposable supplies, and other miscellaneous services. The
majority of expenditures in the "other" category are for home health services and eyeglasses. Figures might not sum to 100 percent because of rounding.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS).

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    INDICATOR 33
Out-of-Pocket Health Care Expenditures continued
Table 33c.  Distribution of total out-of-pocket health care expenditures among people age 55 and over, by type of
health care services and age group, 2000-2006  (continued)
Type of health care service, by year
2005
Hospital care
Office-based medical provider services
Dental services
Prescription drugs
Other health care
2006
Hospital care
Office-based medical provider services
Dental services
Prescription drugs
Other health care
65 and over

5.4
11.4
15.3
57.8
10.1

7.2
12.3
16.2
51.1
13.2
55-64

12.2
19.6
15.7
45.9
6.5

*17.7
19.8
13.9
43.2
5.5
55-61

12.8
19.6
16.3
44.7
6.7

9.4
20.9
15.4
48.5
5.8
62-64

10.8
19.9
14.3
49.0
6.1

*35.2
17.4
10.6
32.0
4.9
65-74

5.1
11.4
19.4
57.9
6.2

6.6
14.1
19.7
51.5
8.1
75-84

5.7
12.3
12.6
59.1
10.4

5.9
11.0
15.3
53.2
14.7
85 and
over

5.4
8.7
9.8
53.3
22.7

12.2
9.5
7.6
45.2
25.5
* Indicates the relative standard error is greater than 30 percent.
NOTE: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Hospital care includes hospital inpatient care and care
provided in hospital outpatient departments and emergency rooms. Office-based medical provider services include services provided by medical providers in non-
hospital-based medical offices or clinic settings. Dental services include care provided by any type of dental provider. Prescription drugs include prescribed medications
purchased, including refills. Other health care includes care provided by home health agencies and independent home health providers and expenses for eyewear,
ambulance services, orthopedic items, hearing devices, prostheses, bathroom aids, medical equipment, disposable supplies, and other miscellaneous services. The
majority of expenditures in the "other" category are for home health services and eyeglasses.  Figures might not sum to 100 percent because of rounding.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS).

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   INDICATOR 34
Sources of Payment for Health Care Services
Table 34a. Sources of payment for health care services for Medicare enrollees age 65 and over, by type of
service, 2006
Service
Hospice
Inpatient hospital
Home health care
Short-term institution
Physician/medical
Outpatient hospital
Prescription drugs
Dental
Long-term care facility
All
Average cost
Dollars
$239
3,695
442
728
3,956
1,290
2,351
346
2,034
15,081
Total

100
100
100
100
100
100
100
100
100
100
NOTE: OOP refers to out-of-pocket payments. "Other" refers to private insurance,
Reference population: These data refer to Medicare enrollees.
Medicare

100
86
91
78
61
68
26
1
1
55
Medicaid
Percent
0
1
1
3
2
2
2
1
47
7
Department of Veterans Affairs, and other publ
OOP

0
4
7
9
18
9
26
77
45
19
ic programs.
Other

0
8
1
10
19
21
45
21
7
19

SOURCE: Medicare Current Beneficiary Survey.
Table 34b. Sources of payment for health care
Income

All
< $10,000
$10,000-$20,000
$20,001 -$30,000
$30,001 and over
Average cost
Dollars
$15,081
21,033
16,674
13,881
1 2,440
services for Medicare enrollees age 65 and
Total

100
100
100
100
100
Medicare

55
56
57
57
51
Medicaid
Percent
7
21
8
3
1
over, by income,
OOP

19
13
19
21
23
2006
Other

19
10
17
20
25
NOTE: Income refers to annual income of respondent and spouse. OOP refers to out-of-pocket payments. "Other" refers to private insurance, Department of
Veterans Affairs, and other public programs.
Reference population: These data refer to Medicare enrollees.
SOURCE: Medicare Current Beneficiary Survey.

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   INDICATOR 35
Veterans' Health Care
Table 35. Total number of veterans age 65 and over who are enrolled in or receiving health care from the Veterans
Health Administration, 1990-2008
Year

1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Total

7.9
8.3
8.7
9.0
9.2
9.4
9.7
9.8
9.9
10.0
10.0
9.9
9.8
9.7
9.5
9.3
9.2
9.3
9.2
VA enrollees
Number in millions
na
na
na
na
na
na
na
na
na
1.9
2.2
2.8
3.2
3.3
3.4
3.5
3.5
3.5
3.4
VA patients

0.9
0.9
1.0
1.0
1.0
1.1
1.1
1.1
1.3
1.4
1.6
1.9
2.2
2.3
2.4
2.4
2.4
2.4
2.2
na: Data not available.
NOTE: Department of Veterans Affairs (VA) enrollees are veterans who have signed up to receive health care from the Veterans Health Administration (VHA). VA
patients are veterans who have received care each year through VHA. The methods used to calculate VA patients differ from what was used in Older Americans 2004
and Older Americans Update 2006. Veterans who received care but were not enrolled in VA are now included in patient counts. VHA Vital Status files from the Social
Security Administration (SSA) are now used to ascertain veteran deaths.
Reference population: These data refer to the total veteran population, VHA enrollment population, and VHA patient population.
SOURCE: Department of Veterans Affairs, Veteran Population 2007; Fiscal 2009 Year-end Office of the Assistant Deputy Under Secretary for Health for Policy and
Planning Enrollment file linked with September 2009 VHA Vital Status data (including data from VHA, VA, Medicare, and SSA).

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    INDICATOR 36
   Residential Services
Table 36a. Percentage of Medicare enrollees age 65 and over residing in selected residential settings, by age group,
2007
                                                                                  Age
      Residential setting
                                      65 and over
                                                                    65-74
                                                                                               75-84
                                                                                                                      85 and over
                                                                         Number in thousands
    All settings
34,207
16,867
12,429
4,912
                                                                                Percent
Total
Traditional
community
Community housing
with services
Long term care
facilities
100.0
93.3
2.4
4.2
100.0
97.9
0.8
1.3
100.0
93.3
2.9
3.8
100.0
77.6
7.0
15.4
NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior citizen housing, continuing
care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations, AND who reported they had
access to one or more of the following services through their place of residence: meal preparation; cleaning or housekeeping services; laundry services; help with
medications. Respondents were asked about access to these services, but not whether they actually used the services. A residence (or unit) is considered a long-term
care facility if it is certified  by Medicare or Medicaid or has three or more beds and is licensed as a nursing home or other long-term care facility and provides at least
one personal care service or provides 24-hour, seven-day-a-week supervision by a non-family, paid caregiver.
Reference population: These data refer to Medicare beneficiaries.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.



Table 36b. Percentage of Medicare enrollees age 65 and over with functional limitations, by residential setting,  2007
 Functional status
  Traditional community
           Community housing
               with services
                Long-term care facility
    Total                                     100.0
       No functional limitations               60.0
       IADL limitation only                    14.6
       1-2 ADL limitations                    18.3

       3 or more ADL limitations               7.1
                                            Percent

                                          100.0

                                           35.6

                                           18.4

                                           31.7

                                           14.2
                                                100.0

                                                   5.0

                                                  11.6

                                                  16.4

                                                  67.0
NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior citizen housing, continuing
care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations, AND who reported they had
access to one or more of the following services through their place of residence: meal preparation; cleaning or housekeeping services; laundry services; help with
medications. Respondents were asked about access to these services, but not whether they actually used the services. A residence (or unit) is considered a long term
care facility if it is certified  by Medicare or Medicaid; or has three or more beds and is licensed as a nursing home or other long term care facility and provides at least
one personal care service; or provides 24-hour, seven-day-a-week supervision by a non-family, paid caregiver. Instrumental activities of daily living (IADL) limitations
refer to difficulty performing (or inability to perform, for a health reason) one or more of the following tasks: using the telephone; light housework; heavy housework;
meal preparation; shopping; managing money.  Only the questions on telephone use, shopping, and managing money are asked of long-term care facility residents.
activities of daily living (ADL) limitations refer to difficulty performing (or inability to perform, for a health reason) the following tasks: bathing; dressing; eating; getting
in/out of chairs; walking; toileting. Long-term care facility residents with no limitations may include individuals with limitations  in certain lADLs: doing light or heavy
housework or meal preparation. These questions were not asked of facility residents.
Reference population: These data refer to Medicare beneficiaries.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 36c. Availability of specific services among Medicare enrollees age 65 and over residing
in community housing with services, 2007

 Persons residing in community housing with services who have access to...            Percent

    Prepared meals                                                                           86.9

    Housekeeping, maid, or cleaning services                                               83.9

    Laundry services                                                                          71.9

    Help with medications                                                                    51.4

NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments,
senior citizen housing, continuing care retirement facilities, assisted living facilities, staged living communities, board and care
facilities/homes, and similar situations, AND who reported they had access to one or more services listed in the table through their
place of residence.  Respondents were asked about access to these services, but not whether they actually used the services
Reference population: These data refer to Medicare beneficiaries.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.

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    INDICATOR 36
   Residential Services continued
Table 36d. Annual income distribution of Medicare enrollees age 65 and over, by residential setting, 2007
 Income
Traditional community
Community housing
    with services
Long-term care facility

Total
$0-$1 0,000
$10,001 -$20,000
$20,001 -$30,000
$30,001 or more

100.0
13.1
24.5
20.6
41.8
Percent
100.0
14.0
28.3
16.9
40.8

100.0
38.2
38.8
10.2
12.8
NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior citizen housing, continuing
care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations, AND who reported they had
access to one or more of the following services through their place of residence: meal preparation; cleaning or housekeeping services; laundry services; help with
medications. Respondents were asked about access to these services, but not whether they actually used the services. A residence (or unit) is considered a long-term
care facility if it is certified by Medicare or Medicaid; or has three or more beds and is licensed as a nursing home or other long-term care facility and provides at least
one personal care service; or provides 24-hour, seven-day-a-week supervision by a non-family, paid caregiver. Income refers to annual income of respondent and
spouse. Table excludes data for respondents who reported only that their income was greater or less than $25,000.
Reference population: These data refer to Medicare beneficiaries.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 36e. Characteristics of services available to Medicare enrollees age 65 and over residing in community housing
with services, 2007
 Selected characteristic
                                                                                                  Percent
    Services included in housing costs
      All included
      Some included/some separate
      All separate
    Can continue living there if they need substantial services
      Yes
      No
                                                            100.0

                                                             34.5

                                                             52.1

                                                             13.4

                                                            100.0

                                                             56.5

                                                             43.5
NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior citizen housing, continuing
care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations, AND who reported they had
access to one or more of the following services through their place of residence: meal preparation; cleaning or housekeeping services; laundry services; help with
medications. Respondents were asked about access to these services, but not whether they actually used the services.
Reference population: These data refer to Medicare beneficiaries.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.

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   INDICATOR 37
Personal Assistance and Equipment
Table 37a. Distribution of noninstitutionalized Medicare enrollees age 65 and over who have limitations in activities
of daily living (ADLs), by types of assistance, selected years 1992-2007
                                          7992
                                                             7997
                                                                               2007
                                                                                                  2005
                                                                                                                     2007
Personal assistance only
Equipment only
Personal assistance and
equipment
None
9.2
28.3
20.9
41.6
5.6
34.2
21.4
38.8
6.3
36.3
22.0
35.3
6.6
36.3
21.9
35.2
6.0
37.6
22.1
34.3
NOTE: ADL limitations refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/
out of chairs, walking, or using the toilet. Respondents who report difficulty with an activity are subsequently asked about receiving help or supervision from another
person with the activity and about using special equipment or aids. In this table, personal assistance does not include supervision.
Reference population: These data refer to noninstitutionalized Medicare enrollees who have limitations with one or more ADLs.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 37b. Percentage of noninstitutionalized Medicare enrollees age 65 and over who have limitations in
instrumental activities of daily living (lADLs) and who receive personal assistance, by age group, selected years
1992-2007

65-74
75-84
85 and over
1992
58.9
63.2
69.2
1997
61.8
63.2
71.1
2007
60.9
66.5
73.7
2005
62.7
67.4
74.0
2007
65.4
66.0
69.7
NOTE: IADL limitations refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light
housework, heavy housework, meal preparation, shopping, or managing money. Respondents who report difficulty with an activity are subsequently asked about
receiving help from another person with the activity. In this table, personal assistance does not include supervision or special equipment.
Reference population: These data refer to noninstitutionalized Medicare enrollees who have limitations with one or more lADLs.
SOURCE:  Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.

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Appendix B: Data Source Descriptions

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Air Quality System

The Air Quality System (AQS) contains ambient
air   pollution  data   collected  by  the  U.S.
Environmental  Protection Agency  (EPA)  and
state, local,  and  tribal  air  pollution  control
agencies. Data  on criteria pollutants consist of
air quality  measurements collected by sensitive
equipment  at thousands of monitoring stations
located  across  all 50  states,  plus the District
of Columbia, Puerto Rico,  and the U.S. Virgin
Islands.  Each monitor measures the concentration
of a particular  pollutant in the air. Monitoring
data indicate the average pollutant concentration
during a specified time interval, usually 1 hour or
24 hours. AQS also contains meteorological data,
descriptive  information  about each monitoring
station (including its geographic location and its
operator), and data quality  assurance or quality
control information. The system is administered
by  EPA, Office  of Air  Quality  Planning  and
Standards,  Information  Transfer  and Program
Integration  Division, located in Research Triangle
Park, N.C.

For more information, contact:
David Mintz
U.S. Environmental Protection Agency
Phone: 919-541-5224
Website: http://www.epa.gov/air/data/aqsdb.html

American Housing Survey

The  American  Housing  Survey  (AHS)  was
mandated by Congress in  1968 to provide  data
for evaluating progress toward "a decent home
and  a suitable  living environment  for  every
American family." It  is the primary source of
detailed information  on housing in the United
States and  is used to generate a biennial report
to Congress on the conditions  of housing in the
United States, among other reports.  The survey
is conducted for the Department of Housing and
Urban Development by the U.S. Census Bureau.
The AHS encompasses a national survey and 21
metropolitan surveys and is designed to collect
data from the same housing units for each survey.
The  national  survey,  a representative sample of
approximately 60,000 housing units, is conducted
biennially in odd-numbered years; the metropolitan
surveys, representative samples of 3,500 housing
units, are conducted  in odd-numbered years on
a 6-year cycle.  The AHS collects data about the
inventory and condition of housing in the United
States and  the  demographics of its  inhabitants.
The survey provides detailed data on the types of
housing in the United States and its characteristics
and conditions; financial data on housing costs,
utilities, mortgages,  equity  loans,   and  market
value; demographic data on family composition,
income, education, and race; and information on
neighborhood quality and recent movers.

Race and Hispanic origin:  Data from this survey
are not shown by race and Hispanic origin in this
report.

For more information, contact:
Cheryl Levine
U.S. Department of Housing and Urban
Development
E-mail: Cheryl.A.Lcvinc'ajhnd.gov
Phone: 202-402-3928
Website: http ://www.census .gov/hhes/www/ahs.
html

American Time Use  Survey

The American  Time Use  Survey (ATUS)  is a
nationally representative sample survey conducted
for the Bureau of Labor Statistics by the U.S.
Census Bureau. The ATUS measures how people
living in the  United States  spend  their time.
Estimates show the kinds of activities people do
and the time they spent doing them by sex,  age,
educational  attainment,  labor force  status,  and
other characteristics,  as well as by weekday and
weekend day.

ATUS respondents are interviewed one time about
how they spent their time on the previous  day,
where they were, and whom they were with. The
survey is a continuous survey, with interviews
conducted nearly every day of the  year and a
sample that builds over time.   About  13,000
members  of  the  civilian  noninstitutionalized
population age  15 and over are interviewed each
year.

Race and Hispanic origin:  Data from this survey
are not shown by race and Hispanic origin in this
report.

For more information, contact:
American Time Use Survey Staff
E-mail: atusinfo(a)bls.gov
Phone: 202-691-6339
Website: http://www.bls.gov/tus

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Consumer Expenditure Survey

The  Consumer  Expenditure  Survey (CE) is
conducted for the Bureau of Labor Statistics by
the U.S. Census Bureau. The survey contains both
a diary component and an interview component.
Data are integrated before publication. The data
presented in this chartbook are derived from the
integrated data available on the CE website.  The
published data are weighted to reflect the U.S.
population.

In the interview portion of the CE, respondents are
interviewed once every 3 months for 5 consecutive
quarters. Respondents  report  information  on
consumer unit characteristics and expenditures
during each interview. Income data are collected
during the second and fifth interviews only.

Race and Hispanic origin: Data from this survey
are not shown by race and Hispanic origin in this
report.

For more information, contact:
E-mail: CEXINFO^bls.gov
Phone: 202-691-6900
Website: http://www.bls.gov/cex

Current Population Survey

The  Current  Population  Survey  (CPS)  is  a
nationally representative sample survey of about
60,000 households conducted monthly for the
Bureau  of Labor Statistics  (BLS) by the U.S.
Census  Bureau.  The  CPS  core  survey is the
primary source of information on the labor force
characteristics of the civilian  noninstitutionalized
population   age   16   and  over,   including  a
comprehensive body of monthly data on the labor
force, employment, unemployment, persons not in
the labor force, hours of work, earnings, and other
demographic and labor force characteristics.

In most  months, CPS supplements  provide
additional demographic and social data. The Annual
Social and Economic Supplement  (ASEC) is the
primary source of detailed information on income
and poverty in the United States. The ASEC is used
to generate the annual Population Profile of the
United States, reports on geographical mobility and
educational attainment, and is the primary source
of detailed information on income and poverty in
the United States. The ASEC, historically referred
to as the March supplement, now is conducted in
February, March, and April with a sample of about
100,000 addresses. The questionnaire asks about
income from more than 50 sources and records up
to 27 different income amounts, including receipt
of many  noncash benefits, such as food stamps
and housing assistance.

Race and Hispanic origin: In 2003, for the first
time CPS  respondents were  asked to identify
themselves as belonging to one or more of the
six racial groups (white, black, American Indian
and  Alaska  Native,  Asian,  Native  Hawaiian
and  other  Pacific Islander,  and   Some  Other
Race); previously they were to choose  only one.
People who responded to the question on race by
indicating only one race are referred to as the race
alone or  single-race  population and individuals
who chose more than one of the race categories are
referred to as the Two-or-More-Races population.

The CPS includes a separate question on Hispanic
origin.  Starting  in 2003, people  of Spanish/
Hispanic/Latino origin could identify themselves
as Mexican,  Puerto  Rican,  Cuban,  or  Other
Spanish/Hispanic/Latino.  People   of  Hispanic
origin may be of any race.

The 1994 redesign of the CPS had an impact on
labor force participation rates  for older men and
women. (See "Indicator 11: Participation in the
Labor Force.") For more information on the effect
of the redesign, see "The CPS After the Redesign:
Refocusing the Economic Lens."52

For more  information regarding  the  CPS, its
sampling structure, and estimation methodology,
see "Explanatory Notes and Estimates of Error."53

For more information, contact:
Bureau of Labor Statistics
Department of Labor
E-mail: cpsinfo44bls.gov
Phone: 202-691-6378
Website: http://www.bls.gov/cps
Additional Website: http://www.census.gov/cps

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Decennial Census
Health and Retirement Study
Every  10 years, beginning with the first census
in 1790, the United States government conducts
a census, or  count, of the  entire population as
mandated  by the U.S.  Constitution. The  1990
and 2000 censuses  were taken April  1 of their
respective years. As in several previous censuses,
two forms  were used: a short form and a long
form. The short form was sent to every household,
and the long form, containing the  100  percent
questions plus the sample questions, was sent to
approximately one in every six households.

The   Census  2000  short-form  questionnaire
included six  questions for each member of the
household (name, sex, age, relationship, Hispanic
origin, and race) and whether the housing  unit
was owned or rented. The long form asked more
detailed information on subjects such as education,
employment,  income, ancestry, homeowner costs,
units in a structure, number of rooms,  plumbing
facilities, etc.

Race  and  Hispanic  origin:  In  Census 2000,
respondents were given the option  of selecting
one or more race categories to indicate their racial
identities. People who responded to the question on
race indicating only one of the six race categories
(white, black, American Indian and Alaska Native,
Asian, Native Hawaiian and other Pacific Islander,
and Some Other Race) are referred to as the  race
alone or single-race population. Individuals who
chose more than one  of the race  categories  are
referred to as  the Two-or-More-Races population.
The  six single-race categories, which made up
nearly 98  percent of all respondents, and the
Two-or-More-Races category  sum to the  total
population. Because respondents were  given the
option of selecting one or more race categories to
indicate their racial identities, Census 2000  data
on race are not directly comparable with data from
the 1990 or earlier censuses.

As in earlier censuses, Census 2000 included a
separate question on Hispanic origin. In Census
2000, people of Spanish/Hispanic/Latino origin
could  identify  themselves  as Mexican, Puerto
Rican, Cuban, or Other Spanish/Hispanic/Latino.
People of Hispanic origin may be of any race.

For more information, contact:
Age and Special Populations Branch
Phone: 301-763-2378
Website: http://www.census.gov/main/www/
cen2000.html
The  Health and Retirement Study  (HRS)  is a
national panel study conducted by the University
of Michigan's Institute for Social Research under a
cooperative agreement with the National Institute
on Aging. In 1992, the study had an initial sample
of over 12,600 people from the 1931-1941 birth
cohort and their spouses.  The HRS was joined
in 1993 by a companion study, Asset and Health
Dynamics Among the Oldest Old (AHEAD), with
a sample of 8,222 respondents (born before 1924
who were age 70 and  over) and their spouses.
In 1998, these two  data collection efforts were
combined into a single survey instrument and field
period and were expanded through the addition of
baseline interviews with two new birth cohorts:
Children of the Depression Age (1924-1930) and
War Babies (1942-1947). Plans call for adding a
new 6-year cohort of Americans entering their 50s
every 6 years. In 2004, baseline interviews were
conducted with the Early Boomer birth cohort
(1948-1953). Telephone follow-ups are conducted
every second year,  with proxy interviews after
death.  Beginning in 2006, one-half of this sample
has  an enhanced  face-to-face  interview  that
includes the collection of physical measures and
biomarker collection. The Aging, Demographics,
and  Memory Study (ADAMS) is a supplement
to HRS with the specific aim of conducting a
population-based study of dementia.

The  combined  studies, which are  collectively
called HRS, have become a steady state sample
that is representative of the entire U.S. population
age 50 and over (excluding people who resided in
a nursing home or other institutionalized setting at
the time of sampling). HRS will follow respondents
longitudinally until they die (including following
people who move into  a nursing home or other
institutionalized setting).

The HRS is intendedto provide datafor researchers,
policy analysts, and program planners who make
major  policy decisions that affect retirement,
health insurance, saving, and economic well-being.
The  study is designed to explain the antecedents
and  consequences of  retirement;  examine the
relationship between health, income, and wealth
over time; examine life cycle patterns  of wealth
accumulation and  consumption; monitor work
disability; provide a rich source of interdisciplinary
data, including linkages with administrative data;

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monitor transitions  in physical, functional, and
cognitive health in advanced old age; relate late-
life changes in physical and cognitive health to
patterns of spending down assets and income flows;
relate changes in health to economic resources
and intergenerational transfers; and examine how
the mix and distribution of economic, family, and
program resources affect key outcomes, including
retirement,  spending down assets, health declines,
and institutionalization.

Race and Hispanic origin: Data from this survey
are not shown by race and Hispanic origin in this
report.

For more information, contact:
Health and  Retirement Study
E-mail: hrsqi     -,-.umich.edu
Phone:734-936-0314
Website: hrsonline.isr.umich.edu

Medical  Expenditure Panel Survey

The Medical Expenditure Panel Survey (MEPS)
is  an  ongoing annual  survey  of  the  civilian
noninstitutionalized   population   that   collects
detailed information  on health  care use and
expenditures  (including sources  of payment),
health  insurance,  income, health  status,  access,
and quality of care. MEPS, which began in 1996,
is  the  third in a series of national probability
surveys conducted by the Agency  for Healthcare
Research and Quality on the financing and use
of medical care  in the United  States. MEPS
predecessor surveys are the National  Medical
Care Expenditure Survey (NMCES) conducted
in 1977 and the National  Medical  Expenditure
Survey (NMES) conducted in 1987. Each of the
three surveys (i.e., NMCES, NMES, and MEPS)
used multiple rounds of in-person  data collection
to elicit expenditures and sources of payments for
each health care event experienced by household
members during the calendar year.  The  current
MEPS Household Component (HC) sample  is
drawn  from respondents to  the  National Health
Interview   Survey (NHIS)   conducted  by the
National  Center for Health Statistics (NCHS).
To yield more complete information on health
care spending and payment sources, followback
surveys of health providers were conducted for a
subsample  of events in MEPS (and events in the
MEPS predecessor surveys).
Since 1977, the structure of billing mechanism for
medical services has grown more complex as a
result of increasing penetration of managed care
and health maintenance organizations and various
cost-containment  reimbursement  mechanisms
instituted  by Medicare, Medicaid, and private
insurers. As a result, there has been  substantial
discussion about what constitutes an appropriate
measure of health care expenditures.54 Health care
expenditures presented in this report refer to what
is  actually paid  for health care  services.  More
specifically, expenditures are defined as the sum
of direct payments for care  received, including
out-of-pocket payments for care received. This
definition of expenditures differs somewhat from
what was  used in the 1987 NMES, which used
charges (rather than payments) as the fundamental
expenditure construct. To  improve comparability
of estimates between the 1987 NMES and  the
1996 and  2001  MEPS, the  1987 data presented
in  this  report were adjusted  using the  method
described by Zuvekas and Cohen.51 Adjustments
to  the  1977 data were considered unnecessary
because virtually all of the discounting for health
care services occurred after 1977  (essentially
equating charges with payments in 1977).

A number of quality-related enhancements were
made to the MEPS beginning in 2000, including
the fielding of an annual adult self-administered
questionnaire (SAQ). This questionnaire contains
items on patient satisfaction  and  accountability
measures  from  the  Consumer Assessment of
Healthcare Providers  and Systems  (CAHPSฎ;
previously known as the  Consumer Assessment
of Health Plans), the SF-12 physical and mental
health   assessment  tool,  EQ-5D  EuroQol  5
dimensions with visual scale (2000-2003), and
several  attitude items. Starting in 2004, the K-6
Kessler mental health distress scale and the PH2
two-item depression scale  were  added to  the
SAQ.

Race and Hispanic origin: Data from this survey
are not shown by race and Hispanic origin in this
report.

For more information, contact:
MEPS Project Director
E-mail: mcpsprqjcctdircctoraahrq.hhs.gov
Phone:  301-427-1406
Website: http://www.meps.ahrq.gov/mepsweb

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Medicare Current Beneficiary
Survey

The   Medicare   Current   Beneficiary  Survey
(MCBS) is a continuous, multipurpose survey of a
representative sample of the Medicare population
designed to help  the Centers for Medicare and
Medicaid Services (CMS) administer, monitor, and
evaluate the Medicare program. The MCB S collects
information on health care use, cost, and sources
of payment; health insurance coverage; household
composition;  sociodemographic  characteristics;
health status  and physical functioning;  income
and assets; access to care; satisfaction with care;
usual source of care; and how beneficiaries get
information about Medicare.

MCBS  data enable CMS to determine  sources
of payment for all medical services  used by
Medicare  beneficiaries, including copayments,
deductibles, and  noncovered services; develop
reliable and current information  on the use and
cost  of services not covered by  Medicare  (such
as long-term care);  ascertain all  types of health
insurance coverage and relate coverage to sources
of payment; and monitor the financial effects of
changes in the Medicare program. Additionally,
the MCBS is the only source of multidimensional
person-based information about the characteristics
of the Medicare population and their access to
and  satisfaction  with  Medicare  services  and
information about the  Medicare program.  The
MCBS sample consists of Medicare enrollees in
the community and in institutions.

The  survey is  conducted  in three rounds  per
year, with each round being 4 months in length.
MCBS has a multistage, stratified, random sample
design and a rotating panel survey design. Each
panel is followed for  12 interviews. In-person
interviews are conducted using computer-assisted
personal interviewing. A sample of approximately
16,000  people  are  interviewed  in each round.
However, because of the  rotating panel design,
only 12,000 people receive all three interviews
in a  given calendar year. Information collected
in the survey is combined with information from
CMS administrative data files and made available
through public-use data files.

Race and Hispanic origin: The MCBS defines race
as white, black, Asian, Native Hawaiian or Pacific
Islander, American Indian or Alaska Native, and
other. People are allowed to choose more than one
category. There is a separate question on whether
the person is of Hispanic or Latino origin. The
"other" category in Table 30c on page 121 consists
of people who answered "no" to the  Hispanic/
Latino question and who answered something
other than "white" or "black" to the race question.
People who answer with more than one  racial
category are assigned to the "other" category.

For more information, contact:
MCBS Staff
E-mail: MCBS44cms.hhs.gov
Website: http://www.cms.hhs.gov/mcbs
The Research Data Assistance Center
E-mail: rcsdnc 
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present, they have an increased chance of being
selected as  the sample  adult. The  new  design
reduces the  size of NHIS by approximately 13
percent relative to the  previous sample design.
The  interviewed  sample  for  2008 consisted of
28,709 households, which yielded 74,236  people
in 29,421 families.  More information on the
survey methodology and content of NHIS  can be
found at http://www.cdc.gov/nchs/nhis.htm.

Race and Hispanic origin: Starting with data year
1999, race-specific estimates in NHIS are tabulated
according to 1997 standards for federal data on
race and ethnicity and are not strictly comparable
with estimates for earlier years. The single race
categories for data from 1999 and later conform
to 1997 standards and are for people who reported
only one racial group. Prior to data year  1999, data
were tabulated according to the 1977  standards
and included people who reported one  race or, if
they reported more than one race, identified one
race as best representing their race.

For more information, contact:
NHIS staff
E-mail: nchsquery@cdc.gov
Phone: 866-441-6247
Website: http://www.cdc.gov/nchs/nhis.htm

National  Health and Nutrition
Examination  Survey

The National Health and Nutrition Examination
Survey (NHANES),  conducted by the National
Center for Health Statistics, is a family of cross-
sectional surveys  designed to assess the  health
and nutritional status of the noninstitutionalized
civilian  population  through  direct   physical
examinations  and  interviews.  Each   survey's
sample  was   selected   using  a   complex,
stratified,   multistage,    probability   sampling
design. Interviewers  obtain   information   on
personal   and    demographic   characteristics,
including  age, household income,  and race
and ethnicity directly from sample  persons (or
their proxies). In addition, dietary intake data,
biochemical tests, physical measurements,  and
clinical assessments are collected.

The NHANES  program  includes the  following
surveys conducted on a  periodic basis through
1994: the first, second, and third National  Health
Examination Surveys  (NHES  I,  1960-1962;
NHES II, 1963-1965; and NHES III, 1966-1970);
and the first, second,  and third National Health
and Nutritional Examination Surveys (NHANES
I,  1971-1974;  NHANES  II,  1976-1980;  and
NHANES III, 1988-1994). Beginning  in 1999,
NHANES changed to a continuous data collection
format without  breaks  in survey  cycles.  The
NHANES program now visits 15 U.S. locations per
year, surveying and reporting for approximately
5,000 people annually. The procedures employed
in  continuous   NHANES  to   select  samples,
conduct interviews,  and perform physical exams
have been preserved from previous survey cycles.
NHES I, NHANES  I,  and NHANES II  collected
information on people 6 months to 74 years of age.
NHANES III and later surveys include people age
75 and over.

With the advent of the continuous survey design
(NHANES III), NHANES moved from a 6-year
data release to a 2-year data  release schedule.
Estimates for 1999-2000, and later, are  based on
a smaller sample size than estimates for earlier
time periods and, therefore, are subject to greater
sampling error.

Race and Hispanic origin: Data from this survey
are not shown by race  and Hispanic origin in this
report.

For more information,  contact:
NHANES
E-mail: nchsquery@cdc.gov
Phone: 866-441-6247
Website: http://www.cdc.gov/nchs/nhanes.htm

National Vital Statistics System

Through the National Vital Statistics System, the
National  Center for  Health Statistics collects and
publishes data on births, deaths, and prior to 1996,
marriages and divorces occurring in the United
States  based on U.S.  standard  certificates.  The
Division of Vital Statistics obtains information on
births and deaths from the registration offices of
each of the 50 states, New York City, the District
of Columbia, Puerto Rico, the U.S. Virgin Islands,
Guam, American Samoa, and Northern Mariana
Islands. Geographic coverage for births and deaths
has been complete since  1933. Demographic
information  on the  death  certificate is  provided
by  the  funeral  director  based on  information
supplied by an informant. Medical certification of
cause of death is provided by a physician, medical

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examiner, or coroner. The mortality data file is a
fundamental source of cause-of-death information
by demographic characteristics and for geographic
areas such as states. The mortality file is one of
the few sources of comparable health-related data
for smaller geographic areas in the United States
and over a long time period. Mortality data can be
used not only to present the characteristics of those
dying in the United States but also to determine life
expectancy and to compare mortality trends with
other countries. Data in  this report for the entire
United States refer to events occurring within the
50 states and the District of Columbia;  data for
geographic areas are by place of residence.

Race and Hispanic origin: Race and  Hispanic
origin are reported  separately  on  the death
certificate. Therefore, data by race shown in Tables
14b,  15b, and  15c  include people of Hispanic
or non-Hispanic origin;  data for Hispanic origin
include people of any race.

For more information, contact:
Mortality Statistics Branch
E-mail: nchsqucry^cdc.gov
Phone: 866-441-6247
Website: http://www.cdc.gov/nchs/deaths.htm

Panel Study of Income Dynamics

The  Panel Study of Income Dynamics  (PSID)
is a  nationally representative, longitudinal study
conducted  by  the  University  of Michigan's
Institute for Social Research. It is a representative
sample  of U.S.  individuals (men, women, and
children) and the family units in which they reside.
Starting with a  national sample  of 5,000 U.S.
households in 1968, the PSID has reinterviewed
individuals from those households annually from
1968 to 1997 and biennially thereafter, whether or
not they are  living in the same  dwelling or with
the same people. Adults have been followed as
they have grown older,  and children have been
observed  as  they advance through  childhood
and into adulthood, forming family units of their
own. Information about the original 1968 sample
individuals and their current coresidents (spouses,
cohabitors, children, and anyone else living with
them) is collected each  year. In 1997 and 1999,
in order to  enhance  the  representativeness  of
the study, a refresher sample of 511 post 1968
immigrant families was  added to the PSID. With
low  attrition rates and successful  recontacts, the
sample size grew to approximately 8,330 as of
2007. PSID data can be used for cross-sectional,
longitudinal, and intergenerational analyses  and
for studying both individuals and families.

The central focus of the data has been economic
and  demographic,  with  substantial  detail  on
income   sources and  amounts,  employment,
family  composition  changes,  and  residential
location. Based  on  findings in the early years,
the PSID expanded to its present focus on family
structure and dynamics as well as income, wealth,
and expenditures. Wealth  and  health are other
important contributors to  individual  and  family
well-being that have been  the focus of the PSID
in recent years.

The PSID wealth modules  measure net equity
in homes and nonhousing  assets divided into six
categories: other real estate and vehicles; farm
or business ownership; stocks, mutual  funds,
investment  trusts,  and stocks held  in  IRAs;
checking  and  savings accounts,  CDs, treasury
bills,  savings bonds, and  liquid assets  in IRAs;
bonds, trusts, life insurance, and other assets;  and
other debts. The PSID measure of wealth excludes
private  pensions and rights  to  future  Social
Security payments.

Race  and Hispanic  origin:  The  PSID asks
respondents if they are white,  black, American
Indian, Aleut, Eskimo, Asian, Pacific Islander, or
another race. Respondents  are allowed to choose
more than one category. They are coded according
to the first category mentioned. Only respondents
who classified themselves  as white or black  are
included in Table 10 on page 87.

For information, contact:
Frank Stafford
E-mail: fsta"' ••• •;>: "   niich.edu or j
umich.edu
Phone:734-763-5166
Website:  http://psidonline.isr.umich.edu/

Population Projections

The population projections for the United States
are interim projections that take into account the
results of Census 2000. These interim projections
were created using the cohort-component method,
which uses  assumptions about the components
of population change. They are based on Census

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2000 results, official postcensus estimates, as well
as vital registration data from the National Center
for Health Statistics. The assumptions are based
on those used in the projections released in 2000
that used a 1998 population estimate base. Some
modifications  were made  to  the  assumptions
so that  projected  values were consistent with
estimates from 2001 as well as Census 2000.

Fertility is assumed  to increase  slightly from
current estimates. The projected total fertility rate
in 2025 is 2.180, and it is projected to increase to
2.186 by 2050. Mortality is assumed to continue
to improve overtime. By 2050, life expectancy at
birth is assumed to increase to 81.2 for men and
86.7 for women. Net immigration is assumed to
be 996,000 in 2025 and 1,097,000 in 2050.

Race  and Hispanic origin:  Interim projections
based on Census  2000 were also done by race
and  Hispanic  origin.  The  basic  assumptions
by race used  in the  previous projections were
adapted to reflect the Census 2000 race definitions
and results. Projections were developed  for the
following groups:  (1) non-Hispanic white alone,
(2) Hispanic white alone, (3) black alone, (4) Asian
alone, and (5) all other groups. The fifth category
includes the categories of American Indian  and
Alaska Native, Native Hawaiian and Other Pacifc
Islander, and all people reporting more than one of
the major race categories defined by the Office of
Management and Budget (OMB).

For a more detailed discussion  of the  cohort-
component method and the assumptions about
the   components   of  population  change,  see
"Methodology and Assumptions forthe Population
Projections of the United States: 1999 to 2100."55
While this paper does not incorporate the updated
assumptions made  for the interim projections,  it
provides a more extensive treatment of the earlier
projections, released in 2000, on which the interim
series is based.

For more information, contact:
Population Projections Branch
Phone: 301-763-2428
Website: http://www.census.gov/population/
www/projections/popproj .html
Survey of the Aged, 1963

The  major purpose of the  1963  Survey of the
Aged was to measure the economic  and social
situations of a representative sample of all people
age 62 and over in the United States  in 1963 in
order to serve the detailed information needs of
the Social  Security Administration (SSA). The
survey included a  wide range of questions  on
health insurance, medical care  costs,  income,
assets and liabilities, labor force participation and
work experience, housing and food expenses, and
living arrangements.

The sample consisted of arepresentative subsample
(one-half)  of  the  Current Population  Survey
(CPS) sample and  the full Quarterly Household
Survey.  Income was measured using answers to
17 questions about  specific sources. Results from
this survey have been combined with CPS results
from 1971 to the present in an income time series
produced by SSA.

Race and Hispanic origin: Data from this survey
are not shown by race and Hispanic origin in this
report.

For more information, contact:
Susan Grad
E-mail: snsan.grad@ssa.gov
Phone: 202-358-6220
Website: http://www.socialsecurity.gov

Survey of Demographic and
Economic Characteristics of the
Aged, 1968

The 1968 survey of Demographic and Economic
Characteristics of the Aged was conducted by the
Social Security Administration (SSA)  to provide
continuing  information  on the  socioeconomic
status  of the  older  population  for program
evaluation. Major issues addressed by the study
include  the adequacy  of Old-Age,  Survivors,
Disability, and  Health  Insurance benefit levels,
the impact of certain Social Security provisions on
the incomes of the older population, and the extent
to which other sources of income are received by
older Americans.

Data  for the 1968  survey  were  obtained  as a
supplement  to  the Current Medicare  Survey,
which yields current  estimates of health care

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services used  and charges incurred by  people
covered by the hospital insurance and supplemental
medical  insurance  programs.   Supplemental
questions covered work experience, household
relationships, income, and assets. Income was
measured using answers to 17 questions about
specific sources. Results from this survey have
been combined with results from the Current
Population Survey from 1971 to the present in an
income time series produced by SSA.

Race and Hispanic origin:  Data from this survey
are not shown by race and Hispanic origin in this
report.

For more information, contact:
Susan Grad
E-mail: susan.groJ  ^jgov
Phone: 202-358-6220
Website: http://www.socialsecurity.gov

Survey of Veteran Enrollees' Health
and Reliance  Upon VA, 2008

The 2008 Survey of Veteran  Enrollees'  Health
and Reliance Upon VA is the seventh in a series
of surveys of veteran enrollees for the Department
of Veterans Affairs (VA) health care conducted by
the Veterans Health Administration (VHA), within
the VA, under multiyear Office of Management
and Budget authority. Previous surveys of VHA-
enrolled veterans were conducted in 1999, 2000,
2002,2003,2005,and2007. All seven VHAsurveys
of enrollees consisted of telephone interviews with
stratified random  samples  of enrolled  veterans.
From 2000 on, the  survey instrument was modified
to reflect VA management's need for specific data
and information on enrolled veterans.

As with the other  surveys in the series, the 2008
Survey of Veteran Enrollees' Health and Reliance
Upon   VA sample was  stratified by  Veterans
Integrated Service Network, enrollment priority,
and type of enrollee (new or past user). Telephone
interviews averaged 17 minutes in length. In the
2008 survey, interviews were conducted beginning
on September 25, 2008, over a course of  11 weeks.
Of approximately 7.3 million eligible  enrollees
who had not declined enrollment as of April 30,
2008,  some  42,000 completed interviews in the
2008 telephone survey.

VHA  enrollee surveys provide a fundamental
source  of data and information on enrollees that
cannot be obtained in any other way except through
surveys and yet are basic to many VHA activities.
The primary purpose of the VHA enrollee surveys
is to provide critical inputs into VHA Health Care
Services  Demand Model  enrollment,  patient,
and expenditure projections, and the Secretary's
enrollment  level  decision  processes; however,
data from the enrollee surveys find their way
into a variety of strategic analysis areas related to
budget, policy, or legislation.

VHA  enrollee   surveys  provide  particular
value in  terms of their ability to help  identify
not  only who VA  serves but  also to  help
supplement VA's knowledge of veteran enrollees'
sociodemographic,   economic,   and   health
characteristics,  including  household  income,
health insurance  coverage status,  functional
status (limitations  in activities of daily living and
instrumental activities of daily living), perceived
health status,  race  and  ethnicity,  employment
status, smoking status,  period of  service and
combat status, other eligibilities  and resources,
their use  of VA and  non-VA health care  services
and "reliance" upon VA, and their potential future
use of VA health care services.

For more information, contact:
Marybeth Matthews
E-mail: Marvbeth.Matthe\YS/fl;va.gov
Phone: 414-384-2000, ext. 42359
Website: http://www4.va.gov/
HEALTHPOLICYPLANNING/reports 1 .asp

Veteran Population Estimates
and Projections (model name is
VetPop2007 (December 2007)

VetPop2007 provides estimates and projections
of the veteran population by age groups and other
demographic characteristics at the county and state
levels. Veteran estimates and  projections were
computed using a cohort-component approach,
whereby Census 2000 baseline data were adjusted
forward in time on the basis of separations from
the  Armed Forces (new veterans) and expected
mortality.

Race and Hispanic origin: Data from this model
are not shown by race and Hispanic origin in this
report.

For more information, contact:
Hyo Park
E-mail: hyo.park^va.gov
Phone: 202-226-4539
Website: http://wwwl .va.gov/vetdata

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Appendix C: Glossary

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 ••.:.:•.•   .  •..  !    • .       ••    • •   Activities
of daily living (ADLs) are basic activities that
support survival, including eating, bathing, and
toileting.  See  Instrumental  activities  of daily
living (lADLs).

In the Medicare Current Beneficiary Survey, ADL
disabilities are measured as difficulty performing
(or inability to  perform  because of  a  health
reason) one or more  of the following activities:
eating, getting in/out of chairs, walking, dressing,
bathing, or toileting.

                Asset income includes  money
income reported in the Current Population  Survey
from  interest (on savings  or bonds), dividends,
income from  estates or  trusts,  and net rental
income. Capital gains are not included.

Assist ivo device; Assistive device refers  to any
item,  piece of  equipment, or product system,
whether acquired  commercially, modified,  or
customized, that is used to increase, maintain,
or improve functional capabilities of individuals
with disabilities.

Body mass index; Body mass index (BMI) is a
measure of body weight adjusted for height and
correlates with  body fat. A tool for indicating
weight status in adults, BMI is generally computed
using metric units and is defined as weight divided
by height2 or  kilograms/meters2.  The categories
used in this report are consistent with  those set
by the World Health Organization. For adults 20
years of age and over,  underweight is defined
as having a BMI less than 18.5;  healthy  weight
is defined as having a BMI of at least  18.5 and
less  than 25;  overweight  is defined as  having
values of BMI equal to 25 or greater; and obese
is defined as having BMI values equal to 30  or
greater. To calculate your own body mass index,
goto http://www.nhlbisupport.com/bmi.  For more
information about BMI, see "Clinical guidelines
on the identification, evaluation, and treatment of
overweight and obesity in adults."56

  .     •••'•.•.     • •  , •        A  hybrid pension
plan that looks like a defined-contribution plan but
actually is a defined-benefit plan, a responsibility of
the employer. In a cash balance plan, an employer
establishes an account for employees, contributes
to the account, guarantees a return to the account,
and pays a lump  sum benefit from the account at
job termination.
        .'   . .     For the purpose  of national
mortality  statistics, every death is  attributed to
one underlying condition, based on  information
reported on the death certificate and using the
international  rules for selecting the underlying
cause-of-death  from  the conditions stated  on
the death  certificate. The conditions  that are not
selected as underlying cause of death constitute
the nonunderlying cause  of death,  also known
as multiple cause of death.  Cause  of  death  is
coded according to the appropriate revision of the
International Classification  of Diseases (ICD).
Effective  with deaths occurring in 1999, the
United States began using the Tenth Revision of
the ICD (ICD-10). Data from earlier time periods
were coded using the appropriate revision of the
ICD for that time period. Changes in classification
of causes  of death in successive revisions of the
ICD may introduce  discontinuities in  cause-of-
death statistics over time. These discontinuities
are measured using  comparability ratios. These
measures  of discontinuity are essential to the
interpretation  of mortality  trends.  For further
discussion, seethe "Mortality Technical Appendix"
available at http://www.cdc.gov/nchs/data/statab/
techap99.pdf.

            :  ;   i   • •-. • '••:   The  cause-of-death
ranking for adults is based on the  List of 113
Selected Causes of Death. The top-ranking causes
determine the leading  causes of death.  Certain
causes on the tabulation lists are not ranked if,
for example, the category title represents a group
title  (such as  "Major cardiovascular  diseases"
and "Symptoms, signs, and abnormal clinical and
laboratory findings,  not  elsewhere  classified")
or the  category  title  begins  with the  words
"Other" and "All  other." In addition, when a title
that  represents a subtotal (such as "Malignant
neoplasm") is ranked, its component parts are not
ranked. Causes that are tied receive the same rank;
the next cause is assigned the rank it would have
received had the lower-ranked causes not been
tied (i.e., they skip a rank).

      •  '.       >  v  Information about  cigarette
smoking in the National Health Interview Survey
is obtained for  adults age 18  and over. Although
there has been some variation in question wording,
smokers continue to be defined as people who have
ever smoked  100  cigarettes and currently smoke.
Starting in 1993, current smokers are identified
by asking the  following two questions: "Have

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you smoked at least 100 cigarettes in your entire
life?" and "Do you now smoke cigarettes every
day, some days, or not at all?" (revised definition).
People who smoked 100 cigarettes and who now
smoke every day or some  days are defined as
current  smokers.  Before 1992, current smokers
were  identified based  on positive responses to
the following two questions: "Have you smoked
at least 100 cigarettes  in your entire  life?" and
"Do you smoke now?" (traditional definition). In
1992, cigarette smoking data were collected for
a half sample with one-half the respondents (a
one-quarter sample) using the traditional smoking
questions and the other  half  of respondents (a
one-quarter sample)  using  the revised smoking
question. An unpublished analysis of the  1992
traditional  smoking  measure  revealed  that the
crude percentage  of current  smokers age 18 and
over remained the same as in 1991. The statistics
reported for 1992 combined data collected using
the traditional  and the revised  questions. The
information obtained  from the  two  smoking
questions listed above  is combined to create the
variables represented in Tables 26a and 26b on
pages 111 and 112.

•'  / r   -  -;<;'••.<•/•  There  are two categories of
current  smokers:  people  who  smoke  every day
and people who smoke  only on some days.

  - ;,     ••!•:<:••••••  This  category  includes people
who have smoked at least 100 cigarettes in their
lifetimes but currently do not smoke at all.

  <:?-/'<     This category  includes people who
have never smoked at least 100 cigarettes in their
lifetime.

           The death rate is calculated by dividing
the number of deaths in a population in a year by
the midyear resident population. For census years,
rates are based on unrounded census counts of the
resident population as of April 1. For the noncensus
years of 1981-1989 and 1991,  rates are based on
national estimates of the resident population as of
July  1, rounded to the  nearest  thousand. Starting
in 1992, rates are based on unrounded national
population  estimates. Rates for the Hispanic and
non-Hispanic white populations in each year are
based on unrounded state population estimates for
states in the Hispanic reporting  area through 1996.
Beginning  in  1997, all states  reported Hispanic
origin. Death rates are expressed as the number
of deaths per  100,000  people. The rate may be
restricted to deaths in specific age, race, sex, or
geographic groups or from  specific causes of
death (specific rate), or it may be related to the
entire population (crude rate).

Dental  services;   In  the   Medicare  Current
Beneficiary Survey (Indicators 30  and  34), the
Medical  Expenditure  Panel  Survey  (MEPS),
and the data used from  the  MEPS predecessor
surveys used in this report  (Indicator  33)  this
category covers expenses for any type of dental
care provider, including  general dentists,  dental
hygienists,  dental  technicians, dental surgeons,
orthodontists, endodontists, and periodontists.

t  :• VK-C/,.   In   the  Medical
Expenditure Panel Survey (MEPS) and  the data
used from the MEPS predecessor surveys used in
this report (Indicator 33), this category  includes
expenses for visits to medical providers seen in
emergency  rooms  (except visits  resulting in a
hospital  admission). These   expenses  include
payments for services covered under the basic
facility  charge  and  those for separately  billed
physician  services.  In  the  Medicare  Current
Beneficiary  Survey  (Indicators   30  and  34)
emergency  room  services  are included as  a
hospital outpatient service unless they are incurred
immediately prior to a hospital stay, in which case
they are included as a hospital inpatient service.

   , n - ,•      This is the method of reimbursing
health care providers on the basis of a fee for each
health service provided to the  insured person.

    ,i  .               See Activities of daily
living (ADLs) and Instrumental activities of daily
living (lADLs).

             •     For  Census 2000,  the U.S.
Census Bureau classified all people not  living in
households as living in group quarters. There are
two types of group quarters:  institutional (e.g.,
correctional facilities, nursing homes, and mental
hospitals)   and  noninstitutional  (e.g.,  college
dormitories,  military  barracks,  group  homes,
missions, and shelters).

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! • ;• ;•! "">! li'-in-M-li'-i!^.1 In the Consumer Expenditure
Survey head of household is denned as the first
person mentioned when the respondent is asked
to  name the person or people who own or rent the
home in which the consumer unit resides.

In  the Panel Study of Income Dynamics (within
each wave of data), each family unit has only one
current  head of household (Head). Originally,
if  the family contained a husband-wife pair, the
husband was arbitrarily designated the Head to
conform with U.S. Census  Bureau definitions in
effect at the time  the study  began. The person
designated as Head may change over time as a
result of other changes affecting the family. When
a new Head must be chosen, the following rules
apply: The Head of the family unit must be at
least  16 years  old and the person with the most
financial responsibility for the family unit.  If this
person is female and she has a husband  in the
family unit, then he is designated as Head. If she
has a boyfriend with whom she has been living for
at  least 1 year,  then he is Head.  However, if the
husband or boyfriend is incapacitated and unable
to  fulfill the functions of Head,  then the family
unit will have a female Head.

nv.nliii  ;•:•;; <;•  .'j.y-'niln;n :•••.:  In the  Consumer
Expenditure Survey (Indicator 12), health care
expenditures include out-of-pocket expenditures
for health insurance, medical services, prescription
drugs, and  medical supplies. In  the  Medicare
Current Beneficiary Survey (Indicators 30 and 34),
health care expenditures include  all expenditures
for inpatient hospital, medical, nursing home,
outpatient (including emergency  room  visits),
dental, prescription  drugs,  home  health  care,
and  hospice services,  including  both out-of-
pocket expenditures and expenditures covered by
insurance. Personal spending for health insurance
premiums is excluded. In the Medical Expenditure
Panel Survey (MEPS) and the data used from the
MEPS predecessor surveys used  in this  report
(Indicator 33), health care expenditures refers to
payments for health care services provided during
the year. (Data from the  1987 survey have been
adjusted  to  permit comparability  across  years;
see Zuvekas and Cohen.51) Out-of-pocket  health
care expenditures are the sum of payments paid to
health care providers by the person, or the person's
family, for health care services provided during
the year. Health care services include inpatient
hospital, hospital emergency room, and outpatient
department  care;  dental  services;  office-based
medical  provider  services;  prescription drugs;
home health care;  and other medical equipment
and  services.  Personal  spending  for health
insurance premium(s) is excluded.


An HMO  is a  prepaid health  plan  delivering
comprehensive   care   to  members   through
designated providers,  having  a  fixed  monthly
payment for health care services, and  requiring
members to be in a plan for a specified period of
time (usually 1 year).

UiMiuui   u..M:vur.   See   specific data  source
descriptions in Appendix B.

(/•-mi:- k-:-'hh .• :>••.< .•••.,')  ••. \c: • M-,--:'.'<....--rvii.•.••<.•;  Hospice  care  is  a
program of palliative and supportive care services
providing physical,  psychological, social,  and
spiritual care for dying persons, their families,
and other loved ones by  a hospice program or
agency. Hospice services  are available in home
and inpatient settings.  In the Medicare Current
Beneficiary  Survey (MCBS)  (Indicators 30  and
34) hospice care  includes only  those  services
provided as part of a Medicare benefit. In MCBS
Indicator  30 (Medicare)  hospice services  are
included as part  of the  "Other" category.  In
MCBS Indicator 34 (Medicare) hospice services

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are included as a separate category. In the Medical
Expenditure Panel Survey (MEPS) (Indicator 33)
hospice care provided in the home (regardless of
the source of payment) is  included in the "Other
health care" category, while hospice care provided
in an institutional setting (e.g., nursing home)  is
excluded from the MEPS universe.

i.l>i>  Vn'  = MV   Hospital  care in the  Medical
Expenditure Panel Survey (Indicator 33) includes
hospital  inpatient care and  care  provided in
hospital outpatient departments  and emergency
rooms.  Care  can be provided by  physicians or
other health practitioners; payments for hospital
care   include payments billed directly  by the
hospital and those billed separately by providers
for services provided in the hospital.

il'^H i  '• \r\\':-- -i  <-.'.-TV'>.:•.-•':  In the  Medicare
Current Beneficiary  Survey (Indicators  30 and
34) hospital inpatient services include room and
board and all hospital diagnostic and laboratory
expenses  associated  with  the  basic  facility
charge,  and emergency  room  expenses incurred
immediately prior to inpatient stays.  Expenses
for hospital stays with the same admission and
discharge dates are included if the Medicare bill
classified the stay as an "inpatient" stay. Payments
for separate billed physician  inpatient services
are excluded.  In the Medical Expenditure Panel
Survey (Indicator 33) these services include room
and board and all hospital diagnostic and laboratory
expenses associated with the basic facility charge,
payments for separately billed physician inpatient
services, and emergency room expenses incurred
immediately prior to inpatient stays. Expenses for
reported hospital stays with the  same admission
and discharge dates are also included.

!i>;vijhi!  >;.)inซiW i,  >,,•)", !;:;,  These  services
in the  Medicare  Current  Beneficiary  Survey
(Indicators 30  and  34)  include  visits to both
physicians  and other medical  providers  seen in
hospital  outpatient departments  or emergency
rooms (provided the emergency room visit does not
result in an inpatient hospital admission), as well
as diagnostic laboratory and radiology services.
Payments for these services include those covered
under the basic facility charge. Expenses for in-
patient hospital stays with the same admission and
discharge dates and classified on the Medicare bill
as "outpatient" are also included. Separately billed
physician services are excluded.
!fi"n i f! v.-.lyv.  Hospital  stays in the  Medicare
claims data (Indicator 29)  refers to admission
to and discharge from a short-stay acute care
hospital.

! i>;u':'  •.-. (•";!  lujivv   In  the American Housing
Survey,  housing  cost  burden   is  defined  as
expenditures on  housing utilities in excess of 30
percent of reported income.

  • •;.   •         •  '        In  the   Consumer
Expenditure Survey's Interview Survey, housing
expenditures   include  payments  for  mortgage
interest;  property  taxes;  maintenance, repairs,
insurance, and other expenses; rent; rent as pay
(reduced or free  rent for a  unit as  a form of pay);
maintenance, insurance, and other expenses for
renters; and utilities.

i  i;  >1.' ! ;,•-. Incidence is the number of cases of
disease having their  onset  during  a prescribed
period of time.  It is  often expressed as a rate.
For example, the incidence of measles per 1,000
children  ages  5  to 15 during a  specified  year.
Incidence is  a measure  of morbidity or other
events that occur within a specified period of time.
See Prevalence.

r H > ;•; i; •  In the Current Population Survey, income
includes  money  income (prior to payments for
personal  income taxes, Social  Security,  union
dues, Medicare deductions, etc.) from: (1) money
wages  or salary; (2)  net  income from nonfarm
self-employment; (3) net income from farm self-
employment;  (4)  Social  Security  or Railroad
Retirement;  (5)  Supplemental Security Income;
(6)  public assistance or welfare payments; (7)
interest (on savings  or bonds);  (8)  dividends,
income from estates or trusts, or net rental income;
(9)  veterans'  payment or  unemployment  and
worker's compensation; (10) private pensions or
government employee pensions; and (11) alimony
or child support, regular contributions from people
not living in the household, and other periodic
income.  Certain  money receipts  such as capital
gains are not included.

In the Medicare Current Beneficiary Study, income
is for the sample person,  or the  sample person
and  spouse  if the sample person was married
at the time of the survey.  All sources of income
from jobs, pensions,  Social  Security benefits,
Railroad  Retirement and other retirement income,

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Supplemental Security Income, interest, dividends,
and other income sources are included.

                     Two  income  categories
were used to examine out-of-pocket health care
expenditures using the Medical Expenditure Panel
Survey  (MEPS) and MEPS predecessor survey
data. The categories  were  expressed in  terms
of poverty status (i.e., the ratio of the  family's
income  to the  federal  poverty thresholds for
the corresponding year), which controls for the
size of the family and the age of the head of the
family. The income  categories were (1) poor and
near poor and (2) other income.  Poor and near
poor income category includes people in families
with income less than 100 percent of the poverty
line, including those whose losses exceeded their
earnings, resulting in negative income (i.e., the
poor), as well as people in families with income
from 100 percent to less than 125 percent of the
poverty line (i.e., the near poor).  Other income
category includes people in families with income
greater than or equal to 125 percent of the poverty
line. See Income, household.

                   Household income from the
Medical  Expenditure Panel Survey  (MEPS) and
the MEPS predecessor surveys used in this report
was  created by summing  personal income  from
each household member to create family income.
Family income was then divided by the number of
people that lived in the household during the year
to create per capita household income. Potential
income   sources  asked  about   in  the  survey
interviews include annual earnings  from wages,
salaries,  withdrawals;  Social Security  and VA
payments;  Supplemental  Security  Income and
cash welfare payments  from public  assistance;
Temporary  Assistance   for  Needy  Families,
formerly known as Aid to Families with Dependent
Children; gains  or losses from estates, trusts,
partnerships,  C corporations,  rent, and royalties;
and a small amount of other income. See Income
categories.

              A population can be divided into
groups with equal numbers of people based on the
size of their income to show how the population
differs on a characteristic at various income levels.
Income fifths are five groups of equal size, ordered
from lowest to highest income.
                      See  Hospital  inpatient
services.
             For Census 2000, the U.S. Census
Bureau defined institutions as correctional insti-
tutions;  nursing  homes;  psychiatric  hospitals;
hospitals or wards for chronically ill  or for the
treatment of substance abuse; schools, hospitals
or wards for the mentally retarded or  physically
handicapped;  and homes,  schools,   and  other
institutional settings providing care for children.64
See Population.

                            See Population.


lADLs are indicators of functional well-being that
measure the ability to perform more complex tasks
than the related activities of daily living (ADLs).
See Activities of daily living (ADLs).

In the  Medicare  Current Beneficiary  Survey.
lADLs are  measured as difficulty performing (or
inability to perform because of a health reason)
one  or more of the  following activities: heavy
housework, light housework, preparing  meals,
using a telephone, managing money, or shopping.

                        In the Medicare Current
Beneficiary Survey (MCBS) (Indicators 20 and
36),  a residence (or unit) is  considered a long-
term care facility if it is certified by Medicare or
Medicaid; has three or more beds and  is licensed
as a nursing home or other long-term care facility
and provides at least one personal care  service; or
provides 24-hour, 7-day-a-week supervision by a
non-family, paid caregiver.  In MCBS  (Indicators
30 and  34), a long-term care facility excludes
"short-term institutions" (e.g.,  sub-acute  care)
stays.  See Short-term institution (Indicators 30
and 34), and Skilled nursing home (Indicator 29).

                  Mammography  is  an  x-ray
image of the breast used to detect irregularities in
breast tissue.

       The mean is  an  average of n numbers
computed   by   adding   the   numbers   and
dividing by n.

         The median is a measure  of central
tendency, the  point on the scale that divides  a
group into two parts.

            This nationwide  health  insurance
program  is operated  and administered by the
states, with federal financial participation. Within
certain broad, federally  determined  guidelines,

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states decide who is eligible; the amount, duration,
and scope of services covered; rates of payment
for providers; and methods of administering the
program. Medicaid pays for health care services,
community-based  supports, and nursing home
care for certain low-income people. Medicaid does
not cover all low-income people in every state.
The program was authorized in 1965 by Title XIX
of the Social Security Act.

 v);-r;i,j , ,  This  nationwide  program provides
health insurance to people age 65 and over, people
entitled to Social Security disability payments for
2 years or more, and people with end-stage renal
disease, regardless of income. The program was
enacted July 30,  1965, as Title XVIII, Health
Insurance for the Aged of the Social Security Act,
and became effective on July  1, 1966. Medicare
covers acute care services and post-acute  care
settings such as rehabilitation and long-term care
hospitals, and generally does  not cover  nursing
home  care. Prescription  drug  coverage began
in 2006.

M.'Jicjiv "'.;h:ii>i..•-,;.;,•: See Medicare Part C.

M:'>-)ii.t'i,-:'  !''<'>•• I  \   Medicare Part A (Hospital
Insurance)  covers inpatient  care  in  hospitals,
critical access hospitals, skilled nursing facilities,
and  other  post-acute  care   settings  such as
rehabilitation and long-term care hospitals. It also
covers hospice and some home health care.

Yl.-'.lM-.j.v  \:.i--I  H:  Medicare Part B (Medical
Insurance)  covers doctors' services, outpatient
hospital care, and durable medical equipment.
It  also covers some  other  medical  services that
Medicare Part A does not cover,  such as physical
and occupational therapy and  some home health
care. Medicare Part B also pays for some supplies
when they are medically necessary.

\l,'vUi.,uv  r.'h'i  H  Medicare  Part D subsidizes
the costs   of prescription drugs  for  Medicare
beneficiaries.   It  was  enacted  as part of the
Medicare  Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) and went into
effect on January 1,2006. Beneficiaries can obtain
the Medicare drug benefit through two types of
private plans: beneficiaries can join a Prescription
Drug  Plan (POP) for drug coverage only or they
can join a Medicare Advantage plan (MA) that
covers both  medical services  and prescription
drugs (MA-PD). Alternatively, beneficiaries may
receive drug coverage through a former employer,
in which case the former employer may qualify for
a retiree drug subsidy payment from Medicare.

M ••••>! i>.•: ;i p  See Supplemental health insurance.
'."••-.ih;)..),-1!  j?;;rjy,jl,jjfO)> :v. I JM--I uvoi  nr.iin:-.  The
national population adjustment matrix adjusts the
population to account for net underenumeration.
Details on this matrix can be found on the U.S.
Census  Bureau website: http://www.census.gov/
population/www/censusdata/adjustment.html.

(.'! ."•••••,![; ; See Body mass index.

OfnO.-k>.-..'-d mL-'l'-.-Ul j..:V<, liU'i- ,..",",! ..-^'.  In tilC
Medical  Expenditure  Panel Survey  (Indicator
33) this category includes expenses for visits to
physicians and  other health practitioners seen
in office-based settings or clinics.  Other  health
practitioner includes audiologists,  optometrists,
chiropractors,    podiatrists,    mental    health
professionals, therapists, nurses, and physician's
assistants,  as  well as  providers  of diagnostic
laboratory  and  radiology  services.  Services
provided  in a hospital  based  setting, including
outpatient department services, are excluded.

        .   . .         In  the Medicare Current
Beneficiary Survey (Indicator  34),  this category
includes "short-term institution," "hospice," and
"dental"  services. In the Medical Expenditure
Panel  Survey   (MEPS)  (Indicator  33)   other
health care  includes  "home  health services"
(formal  care provided by home health agencies
and  independent  home health providers)  and
other medical equipment and services. The latter
includes expenses for eyeglasses, contact lenses,

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ambulance services,  orthopedic items,  hearing
devices,   prostheses,   bathroom  aids,   medical
equipment,   disposable   supplies,   alterations/
modifications, and other miscellaneous items or
services that were obtained, purchased, or rented
during the year.

                Other income  is  total  income
minus retirement benefits, earnings, asset income,
and  public  assistance. It includes,  but is  not
limited to, unemployment compensation, worker's
compensation, alimony, and child support.
                      See Hospital  outpatient
services.
                               These are health
care costs that are not covered by insurance.

             See Body mass index.

            Pensions  include   money  income
reported in the Current Population Survey from
Railroad Retirement, company or union pensions
(including profit sharing and 401(k) payments),
IRAs, Keoghs, regular payments from  annuities
and  paid-up  life  insurance  policies,  federal
government pensions, U.S. military pensions, and
state or  local government pensions.

                             In  the Medicare
Current Beneficiary Survey  (Indicator  34), this
category  includes  visits  to a  medical  doctor,
osteopathic doctor, and health practitioner as well
as diagnostic  laboratory and radiology services.
Health    practitioners   include   audiologists,
optometrists,     chiropractors,      podiatrists,
mental  health professionals, therapists,  nurses,
paramedics, and physician's assistants. Services
provided  in a hospital-based setting, including
outpatient department services, are included.

                               In the Medicare
Current Beneficiary Survey  (Indicator  30), this
term  refers  to  "physician/medical   services"
combined with "hospital outpatient services."

                                   In Medicare
claims data (Indicator 29)  physician visits and
consultations  include visits and  consultations
with primary  care physicians,  specialists, and
chiropractors in their offices, hospitals (inpatient
and outpatient), emergency rooms, patient homes,
and nursing  homes.
             Data on populations in the  United
States are often collected and published according
to several different definitions. Various statistical
systems then use the appropriate population for
calculating rates.

                    The resident population of
the United States includes people resident in the
50 states and the District of Columbia. It excludes
residents of the Commonwealth of Puerto Rico and
residents of the outlying areas under United States
sovereignty or jurisdiction (principally American
Samoa, Guam, Virgin Islands of the United States,
and the Commonwealth of the Northern Mariana
Islands). The definition of residence conforms to
the criterion used in Census 2000, which defines
a resident of a specified area as a person "usually
resident"  in  that area.  The resident population
includes people resident in a nursing home and
other types of institutional settings, but excludes
the U.S. Armed Forces overseas, as well as civilian
U.S. citizens whose usual place of residence is
outside the United States. As defined in "Indicator
6:  Older  Veterans,"  the  resident  population
includes Puerto Rico.

                                          The
resident  noninstitutionalized population  is  the
resident population not residing in institutions. For
Census 2000, institutions, as defined by the U.S.
Census Bureau, included correctional institutions;
nursing homes; psychiatric hospitals; hospitals
or wards for chronically ill or for  the treatment
of substance abuse; homes and schools, hospitals
or wards for the mentally retarded  or physically
handicapped;  and  homes,  schools,  and  other
institutional settings providing care for children.
People living in  noninstitutional group quarters
are  part  of  the  resident noninstitutionalized
population.  For  Census  2000,  noninstitutional
group  quarters  included  group  homes  (i.e.,
community-based   homes  that provide  care
and  supportive services);  residential  facilities
"providing protective oversight ... to people with
disabilities";  worker and college   dormitories;
military  and religious quarters; and emergency
and transitional shelters with sleeping facilities.64

                    The civilian population is
the U.S. resident population not in the active duty
Armed Forces.

                                          The
civilian  noninstitutionalized population  is  the

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civilian population not residing in institutions. For
Census 2000, institutions, as denned by the U.S.
Census Bureau, included correctional institutions;
nursing homes; psychiatric hospitals; hospitals or
wards  for chronically ill or for the treatment of
substance abuse; schools, hospitals or wards for
the mentally retarded or physically handicapped;
and  homes,  schools,  and   other  institutional
settings  providing  care for children. Civilians
living  in noninstitutional group quarters  are part
of the civilian  noninstitutionalized population.
For Census  2000, noninstitutional group  quarters
included group  homes  (i.e., "community  based
homes that provide care and supportive services");
residential   facilities  "providing    protective
oversight to people  with disabilities";  worker
and college dormitories; religious quarters;  and
emergency and transitional shelters with sleeping
facilities.57

• ::•:,;.;<•:•  ., ,., -,vi,.-,....-,.,,   For Census 2000, the
institutionalized population was the population
residing  in correctional  institutions;  nursing
homes; psychiatric hospitals;  hospitals or  wards
for chronically ill or for the treatment of substance
abuse;  schools,  hospitals,  or wards  for  the
mentally retarded or physically handicapped; and
homes, schools, and other institutional  settings
providing care  for children.  People  living  in
noninstitutional  group  quarters are  part of the
noninstitutionalized  population.  For  Census
2000,  noninstitutional  group quarters included
group homes (i.e., "community-based homes that
provide care and supportive services");  residential
facilities "providing  protective oversight  ...  to
people with disabilities"; worker and  college
dormitories; military and  religious quarters;  and
emergency and transitional shelters with sleeping
facilities.57

IV-v.') u:  The  official  measure of poverty is
computed each year by the U.S. Census Bureau
and is denned as being less than 100 percent of the
poverty threshold (i.e., $9,944 for one person age
65 and over in 2007).58 Poverty thresholds are the
dollar amounts used to  determine poverty status.
Each family (including single-person households)
is  assigned  a poverty threshold based upon the
family's  income, size of the  family,  and ages of
the family members. All  family members have
the same poverty status. Several of the indicators
included in this report  include  a  poverty  status
measure. Poverty status (less than  100  percent of
the poverty threshold) was computed for "Indicator
7: Poverty," "Indicator 8: Income," "Indicator 17:
Sensory Impairments and Oral Health," "Indicator
22: Mammography," and "Indicator 32: Sources of
Health Insurance," "Indicator 33: Out-of-Pocket
Health Care Expenditures" using the official U.S.
Census Bureau definition for the corresponding
year.  In addition, the  following above-poverty
categories are used in this report.

             / . . •  • •   The income categories are
derived from the ratio of the family's income (or
an unrelated individual's income) to the poverty
threshold. Being in poverty is measured as income
less than 100 percent of the poverty threshold. Low
income is between 100 percent and 199 percent
of the poverty threshold (i.e., $9,944 and $19,887
for one person age 65 and over in 2007). Middle
income is between 200 percent and 399 percent of
the poverty  threshold (i.e., between $19,888 and
$39,775 for one person age 65 and over in 2007).
High income is 400 percent or more of the poverty
threshold.
.':'".•••,   • ,<.' .'/••,•:'•••'••  :.•  •.::•:,•  Below poverty is
defined as less than  100 percent of the poverty
threshold. Above  poverty  is  grouped  into two
categories: (1) 100 percent to less than 200 percent
of the poverty threshold and (2) 200 percent of the
poverty threshold or greater.


              Below poverty is  defined as less
than 100 percent of the poverty threshold. People
are classified into the poor/near poor income
category  if the person's household income is
below 125 percent of the  poverty level. People
are classified into the other income category if the
person's household income is  equal to or greater
than 125 percent of the poverty level.

.[•V>"..i.-,-ij:.ii.:n! cij-u^.v'iii'.'-^in'ti-:"..;  In the Medicare
Current   Beneficiary  Survey  (Indicators  30,
31, 34) and  in  the Medical  Expenditure  Panel
Survey (Indicator  33) prescription drugs are all
prescription medications (including refills) except
those  provided  by the  doctor  or  practitioner
as samples and those provided  in an  inpatient
setting.

i  ((  H|.•..!;•,>: Prevalence is the  number of cases of
a disease, infected people, or people with some
other attribute present during a particular interval

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of time. It is often expressed as a rate (e.g., the
prevalence of diabetes per 1,000 people during a
year). See Incidence.
                                          See
Supplemental health insurance.
                   Public assistance is money
income reported in the Current Population Survey
from  Supplemental Security Income (payments
made to low-income people who are age 65 and
over, blind, or disabled) and public assistance or
welfare payments, such as Temporary Assistance
for Needy Families and General Assistance.

          See Income fifths.

       See specific data source descriptions in
Appendix B.

      A rate is a measure of some event, disease,
or condition in relation to a unit of population,
along with some specification of time.

                      The reference population
is the base population from which a sample is drawn
at the time of initial sampling. See Population.

                                       In  the
National  Health  Interview Survey,  respondent-
assessed health status is measured by asking the
respondent, "Would you say [your/subject name's]
health is  excellent, very good,  good, fair, or
poor?" The respondent answers for all household
members including himself or herself.

                        This  category in the
Medicare  Current Beneficiary Survey (Indicators
30 and 34) includes skilled nursing facility stays
and other short-term (e.g., sub-acute care) facility
stays (e.g., a rehabilitation facility stay). Payments
for these  services  include Medicare and other
payment  sources. See Skilled nursing  facility
(Indicator 29),  Nursing facility (Indicator  36),
and Long-term care facility (Indicators 20, 30, 34,
and 37.

                               Skilled nursing
facility stays in the Medicare claims data (Indicator
29) refers to admission to and  discharge from a
skilled nursing facility, regardless of the length of
stay. See Skilled nursing facility (Indicator 29).

                            A skilled nursing
facility (SNF) as  defined by Medicare (Indicator
29) provides short-term skilled nursing care on an
inpatient basis, following hospitalization. These
facilities provide the most intensive care available
outside  of inpatient  acute  hospital care. In the
Medicare  Current Beneficiary Survey (Indicators
30 and 34) "skilled nursing facilities" are classified
as a type  of "short-term institution." See Short-
term institution (Indicators 30 and 34), and Long-
term care  facility (Indicators 20, 30, 34, and 36).

                        Social Security benefits
include  money income reported  in  the Current
Population Survey from Social Security old-age,
disability, and survivors' benefits.

                       A  population  in which
the age  and sex composition is known precisely,
as a result of a census. A standard population is
used as  a  comparison group in the procedure  for
standardizing mortality rates.

                                 Supplemental
health insurance is designed to  fill  gaps in the
original Medicare plan coverage by paying  some
of the amounts that  Medicare does  not pay  for
covered services and may pay for certain services
not covered  by Medicare. Private  Medigap  is
supplemental  insurance  individuals  purchase
themselves orthrough organizations such as AARP
or other professional organizations. Employer-or
union-sponsored supplemental insurance policies
are provided through a Medicare enrollee's former
employer  or union. For dual-eligible beneficiaries,
Medicaid   acts  as  a  supplemental insurer   to
Medicare. Some Medicare beneficiaries enroll in
HMOs and other managed care plans that provide
many of the benefits of supplemental insurance,
such as  low copayments and coverage of services
that Medicare does not cover.

             TRICARE   is  the   Department
of  Defense's  regionally managed  health care
program for active duty and retired members of the
uniformed services, their families, and survivors.

                       TRICARE  for Life  is
TRIG ARE's  Medicare  wraparound  coverage
(similar to traditional  Medigap  coverage)  for
Medicare-eligible uniformed services beneficiaries
and their eligible family members  and survivors.

          Veterans include  those who served on
active duty in the Army, Navy, Air Force, Marines,
Coast Guard, uniformed Public Health Service,
or uniformed National Oceanic and Atmospheric

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Administration;  Reserve  Force  and  National
Guard called to federal active  duty;  and those
disabled while on active duty training. Excluded
are those  dishonorably  discharged  and  those
whose only active duty was for training or State
National Guard service.

Veterans'  health  care:  Health  care  services
provided by the Veterans Health Administration
(Indicator 35) includes preventive care, ambulatory
diagnosis and treatment, inpatient diagnosis  and
treatment  and  medications  and supplies. This
includes home- and community-based  services
(e.g.,  home health care) and long-term  care
institutional services (for those eligible to receive
these  services).

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                         The Historical Experience of Three Cohorts of Older Americans:
                                         A Timeline of Selected Events 1923-2010
                          1923 Cohort     Year
           Historical Events
             Legislative Events
                           5 years old
             1933 Cohort!
                                                       7929- Stock market crashes
              5 years old  15 years old
                                                                                                  7934- Federal Housing Administration created
                                                                                                        by Congress; 7935-Social Security Act
                                                                                                        passed; 7937- U.S. Housing Act passed,
                                                                                                        establishing Public Housing
1943 Cohort!
                                                       7947 - Pearl Harbor; United States enters WWII
 5 years old  15 years old  25 years old
                                                       7945-Yalta Conference;Cold War begins
                                                       7946 - Baby boom begins
                                                       7950 - United States enters Korean War
 15 years old  25 years old  35 years old
 25 years old  35 years old  45 years old
                                                       7955 - Nationwide polio vaccination program
                                                             begins
                                                        7964 - United States enters Vietnam War;
                                                             baby boom ends
                                                        7969 - First man on the moon
                                           7956 - Women age 62-64 eligible for reduced
                                                 Social Security benefits; 7957- Social
                                                 Security Disability Insurance implement-
                                                 ed; 7959-Section 202 of the Housing Act
                                                 established, providing assistance to older
                                                 adults with low income; 7967 - Men age
                                                 62-64 eligible for reduced Social Security
                                                 benefits; 7962- Self-Employed Individual
                                                 Retirement Act (Keogh Act) passed; 7964 -
                                                 Civil Rights Act passed; 7965- Medicare
                                                 and Medicaid established; Older Americans
                                                 Act passed; 7967- Age Discrimination in
                                                 Employment Act passed
 35 years old  45 years old  55 years old
45 years old  55 years old  65 years old
                                                        7980 - First AIDS case is reported to the
                                                             Centers for Disease Control and
                                                             Prevention
                                                        7989-Berlin Wall falls
                                                        7990-United States enters Persian Gulf War
                                           7972 - Formula for Social Security cost-of-living
                                                 adjustment established; Social Security
                                                 Supplemental Security Income legislation
                                                 passed; 7974- Employee Retirement
                                                 Income Security Act (ERISA) passed;
                                                 IRAs established; 7975-Age Discrimin-
                                                 ation Act passed; 7978 - 401 (k)s establish-
                                                 ed
                                           7983 - Social Security eligibility age increased
                                                 for full benefits; 7984 - Widows entitled
                                                 to pension benefits if spouse was vested
                                           7986 - Mandatory retirement eliminated for
                                                 most workers; 7987- Reverse mortgage
                                                 market created by the HUD Home Equity
                                                 Conversion Program
                                           7990 - Americans with Disabilities Act passed
 55 years old  65 years old  75 years old
65 years old  75 years old  85 years old
2007 - September 11-Terrorists attack United
States
2003 - United States enters Iraq war


2007- Economic downturn begins
      December 2007
2008 - First baby boomers begin to turn 62
      years old and become eligible for
      Social Security retired worker benefits
 7996 -Veterans'Health Care Eligibility Reform Act
       passed, creating access to community based
       long-term care for all enrollees; 7997- Bal-
       anced Budget Act passed changing Medi-
       care payment policies;2000- Social Secur-
       ity earnings test eliminated for full retire-
       ment age;2003 - Medicare Modernization
       Act passed

2005- Deficit Reduction Act passed realigning
      Medicaid incentives to provide noninsti-
      tutionalized long-term care;2006 - Medi-
      care presciption drug benefit implemented;
      Pension Protection Act passed

2070 - Patient Protection and  Affordable
      Care Act passed

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