OLDER
AMERICANS
2012
Key Indicators of Weil-Being
           ift
           Mr
DERAL
IRAGENCY
FORUM ON
           'RELATED
           " STATISTICS

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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 June 2012 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://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 Administration
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

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 2012:
Key Indicators ofWell-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office.
June 2012. Report availability: Single copies of this report are available at no charge through the National Center for Health Statistics while
supplies last. Requests maybe 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 1-866-441-NCHS (6247) or by e-mailing nchsquery@cdc.gov. This report is also
available on the World Wide Web at http://www.agingstats.gov.

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OLDER
AMERICANS
2012
Key Indicators of Weil-Being

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Foreword
Just last year, the oldest members of the "Baby
Boom" generation (that is, Americans born
between 1946 and 1964) turned 65. As has been
the case since the  birth of this cohort, this very
large generation will bring important challenges
to the systems and institutions that support and
enhance American life. Although many Federal
agencies provide data on aspects of older
Americans' lives,  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
of how older Americans fare.

Older Americans 2012: Key Indicators of Well-
Being (Older Americans 2012) provides a
comprehensive, easy-to-understand picture of
our older population's health, finances, and
well-being. It is the  sixth such chartbook
prepared by the Federal Interagency Forum on
Aging-Related Statistics (Forum). 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. In addition, the report contains a special
feature on end-of-life care and  place of death.

Many of the estimates reported in Older
Americans 2012 were collected in 2008 and 2009.
Thus, many of the indicators in this report reflect
the experience of older Americans during this
economically challenging time  period. What has
yet to be reported here is the longer-term impact
of the recession and its financial disruptions. In
response, the Forum has initiated a closer look
at the earnings, savings, and income of older
Americans, particularly given recent changes
to retirement and pension plans. Those findings
will be shared in a future report.
Although Federal agencies currently collect and
report substantial information on the population
age 65 and over, other important gaps in our
knowledge remain. Two years ago, in Older
Americans 2010, the Forum identified six such
data need areas: caregiving, elder abuse, functioning
and disability, mental health, residential  care, and
end of life. In Older Americans 2012,  we provide
updated information on the status of data availability
for these specific areas, in addition to the end of
life special feature.

We continue to appreciate users' requests for
greater detail for many existing indicators of
well-being. We also extend an invitation to all of
our readers and partners to let us know what else
we can do to make our reports and other products
more accessible and useful. Please send  your
comments to  agingforum@cdc.gov.

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 present
the American people with such valuable tools
for understanding the well-being of the older
population. 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 for the American people.

Katherine K. Wallman
Chief Statistician
Office of Management and Budget

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Acknowledgments
Older Americans 2012: Key Indicators ofWell-
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 John Wren,
Administration on Aging (AoA); Steven B.
Cohen, Agency for Healthcare Research and
Quality (AHRQ); Thomas Nardone, Bureau
of Labor Statistics  (BLS); Howard Hogan and
Nancy Potok, 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); Kathy Sykes,
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 laPuente, Social Security
Administration (SSA); and Dat Tran, Department
of Veterans Affairs (VA).

The following members of the Forum agencies
reviewed the chart book 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 Robert Hornyak, AoA; David Kashihara
and D.E.B. Potter, AHRQ; Emy Sok, BLS;
Amy Symens Smith and Samantha Cole, U.S.
Census Bureau; Gerald Riley, CMS; Meena
Bavan, HUD; Miranda Moore, Daniel Puskin
and Song Yi, EBSA; Kathy Sykes, EPA; Ellen
Kramarow and Julie Dawson Weeks, NCHS;
John Phillips, NIA; Helen Zayac Lament, ASPE;
Jennifer Park and Rochelle Wilkie Martinez, OMB;
Ingrid Goldstrom, Beth Han, and Jennifer Solomon,
SAMHSA; Howard lams, SSA; Jin Kim, VA; and
the Forum's Staff Director, Traci Cook.

In addition to the 15 agencies of the Forum, the
Department of Agriculture  (USDA) was invited
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; Deborah Kidd, Chris
McCormick, Maggie Murgolo, and Joseph Regan,
CMS; Ellen Baldridge and Rhonda Thompson,
EPA; Carolyn Lynch, HUD; Robin Cohen,
Nazik Elgaddal, Ginny Freid, and Cynthia L.
Ogden, NCHS; Vicky Cahan, NIA; Lynn Fisher,
SSA; and Peter Ahn, and Linda Bergofsky, VA.

The Forum is also indebted to the people outside
the Federal government who contributed to this
chart book: Gwen Fisher, Cathy Liebowitz, and
David Weir, University of Michigan; Xianfen Li,
Harris Corporation.

Member agencies of the Forum provided funds
and valuable staff time to produce this report.
NCHS and its contractor, American Institutes
for Research (AIR), facilitated the production,
printing, and dissemination of this report. Simone
Robers and Melissa Wentzel, AIR, managed
the report's production process. Katie Mallory,
AIR-MacroSys, designed the  layout and
supervised the overall presentation of the report;
Richard Devens, First XV Communications,
provided consultation and editing services.
Patricia L. Wilson, CDC, managed the printing
of the report.

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About This Report
Introduction
Older Americans 2012: Key Indicators of Weil-
Being (Older Americans 2012) is the sixth in
a series of reports by the Federal Interagency
Forum on Aging-Related Statistics (Forum)
describing the overall condition of the U.S.
population age 65 and over. The reports use
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 overtime. By following these
data trends, the reports make more information
available to target efforts to improve the lives
of older Americans.

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 2012,  by presenting data in a
nontechnical, user-friendly format, 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.

There is also a special feature on end-of-life
issues. A list of the  indicators included in this
report is located in the Table of Contents.

Each indicator includes the following:

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

•  One or more charts that graphically describes
    important aspects of the data.

•  Bulleted highlights  of salient findings from
    the data and other sources.
The data used to develop the indicators are
presented in table format in the back matter of
the report. Data source descriptions and a glossary
are also provided in the back matter of the report.

Selection Criteria for Indicators
Older Americans 2012 presents 37 key indicators
of critical aspects of older people's lives. The
Forum chose these  indicators because they meet
the following criteria:

•   Easy to understand by a wide range of
    audiences.

•   Based on reliable, nationwide data sponsored,
    collected, or disseminated by the Federal
    government.

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

•   Balanced so that no single section dominates
    the report.

•   Measured periodically (but not necessarily
    annually) so that they can be updated as
    appropriate and permit description of trends
    overtime.

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

Considerations When Examining the
Indicators
The data in Older Americans 2012 usually
describe the U.S. population age 65 and over.
Mutually exclusive and exhaustive 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
younger than 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.

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To standardize the age distribution of the age
65 and over population across years, some
estimates have been age adjusted by multiplying
age-specific rates by time-constant 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 table(s).

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 (both people living in the
community and people living in institutions).
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 2010,
12 percent of the population age 85  and over was
not 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: April 1, 2010.
      97           "

    •     •
Survey Years
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.
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 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 selected
estimates in the chartbook can be found on the
Forum's Web site 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. 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
the back of the report. Additional information
about these data sources is available on the
Forum's Web site at http://www.agingstats.gov.
For those who wish to access the survey data
used in this chartbook, contact information is
given for each of the data sources.

Occasionally, data from other publications are
included to give a more complete explanation
of the indicator. The citations for these sources
are included in the "References" section.

Data Needs
Because Older Americans 2012 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.

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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.

The specific goals of the Forum are:

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

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

•  Coordinating the development and use of
    statistical databases among Federal agencies.

•  Identifying information gaps and data
    inconsistencies.

•  Investigating questions of data quality.

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

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

More Information
If you would like more information about Older
Americans 2012  or other Forum activities,
contact:

Traci Cook
Staff Director
Federal Interagency Forum on Aging-Related
Statistics
3311 Toledo Road, Room 7108
Hyattsville, MD  20782
Phone:(301)458-4082
Fax:(301)458-4021
E-mail: agingforum@cdc.gov
Web site: http://www.agingstats.gov

Older Americans on the Internet
Supporting material for this report can be found at
http://www.agingstats.gov. The Web site contains
the following:

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

•   PowerPoint slides of the charts.

The Forum's Web site also provides:

•   Ongoing Federal data resources relevant
    to the study of the aging.

•   Links to aging-related statistical information
    on Forum member Web sites.

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

•   Workshop presentations, papers, and reports.

•   Agency contacts.

•   Subject area contact list for Federal statistics.

•   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 .gov/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

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

Centers for Medicare and Medicaid Services
CMS Research, Statistics, Data, and Systems
http ://www. cms .hhs .gov/Research-Statistics-
Data-and-Systems/Research-Statistics-Data-and-
Systems.html

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
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
Center for Behavioral Health Statistics and Quality
http: //www. samhsa.gov/data

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	ii
Acknowledgments	iii
About This Report	iv
List of Tables	x
Highlights	xv

Population
     Indicator 1. Number of Older Americans	2
     Indicator 2. Racial and Ethnic Composition	4
     Indicator 3. Marital Status	5
     Indicator 4. Educational Attainment	6
     Indicator 5. Living Arrangements	8
     Indicator 6. Older Veterans	10
Economics
     Indicator 7. Poverty	12
     Indicator 8. Income	13
     Indicator 9. Sources of Income	14
     Indicator 10. Net Worth	16
     Indicator 11. Participation in Labor Force	18
     Indicator 12. Total Expenditures	20
     Indicator 13. Housing Problems	21
Health Status
     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
     Indicator 21. Vaccinations	36
     Indicator 22. Mammography	37
     Indicator 23. Diet Quality	38
     Indicator 24. Physical  Activity	40
     Indicator 25. Obesity	41
     Indicator 26. Cigarette Smoking	43
     Indicator 27. Air Quality	44
     Indicator 28. Use of Time	46
Health Care
     Indicator 29. Use of Health Care Services	50
     Indicator 30. Health Care Expenditures	52
     Indicator 31. Prescription Drugs	54
     Indicator 32. Sources of Health  Insurance	56
     Indicator 33. Out-of-Pocket Health Care Expenditures	57
     Indicator 34. Sources of Payment for Health Care Services	58
     Indicator 35. Veterans'Health Care	59
     Indicator 36. Residential Services	60
     Indicator 37. Personal Assistance and Equipment	62
Special Feature
     End of Life	66
Data Needs	71
References	75
Tables	81
Data Sources	155
Glossary	167

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List of Tables

Population
Indicator 1. Number of Older Americans
Table la. Number of people age 65 and over and age 85 and over, selected years 1900-2010 and
projected 2020-2050	82
Table Ib. Percentage of people age 65 and over and age 85 and over from the 2010 Census and
projected 2020-2050	82
Table Ic. Population of countries or areas with at least 10 percent of their population age 65 and over, 2010	83
Table Id. Percentage of the population age 65 and over, by state, 2010	85
Table le. Percentage of the population age 65 and over, by county, 2010	86
Table If. Number and percentage of people age 65 and over and age 85 and over, by sex, 2010	86
Indicator 2. Racial and Ethnic Composition
Table 2. Population age 65 and over, by race and Hispanic origin, 2010 and projected 2050	86
Indicator 3. Marital Status
Table 3. Marital status of the population age 65 and over, by age group and sex, 2010	87
Indicator 4. Educational Attainment
Table 4a. Educational attainment of the population age 65 and over, selected years 1965-2010	88
Table 4b. Educational attainment of the population age 65 and over, by sex and race and Hispanic origin,
2010	88
Indicator 5. Living Arrangements
Table 5a. Living arrangements of the population age 65 and over, by sex and race and Hispanic origin, 2010	89
Table 5b. Population age 65 and over living alone, by sex and age group, selected years  1970-2010	89
Indicator 6. Older Veterans
Table 6a. Percentage of population age 65 and over who are veterans, by age group and sex, United States
and Puerto Rico, 2000 and projected 2010 and 2020	90
Table 6b. Estimated and projected number of veterans age 65 and over, by age group and sex, United States
and Puerto Rico, 2000 and projected 2010 and 2020 	90
Economics
Indicator 7. Poverty
Table 7a. Percentage of the population living in poverty, by age group, 1959-2010	91
Table 7b. Percentage of the population age 65 and over living in poverty, by selected characteristics, 2010	92
Indicator 8. Income
Table 8a. Income distribution of the population age 65 and over, 1974-2010	93
Table 8b. Median income of householders age 65 and over, in current and in 2010 dollars, 1974-2010	94
Indicator 9. Sources of Income
Table 9a. Percentage distribution of sources of income for married couples and nonmarried persons age 65
and over, 1962-2010	95
Table 9b. Percentage distribution of sources of income for married couples and nonmarried persons age 65
and over, by income quintile, 2010	95
Table 9c. Percentage of people age 55 and over with family income from specified sources, by age group,
2010	96
Indicator 10. Net Worth
Table lOa. Median household net worth of head of household, in 2007 dollars, by selected characteristics
and selected years 1983-2007	97
Table lOb. Value of household financial assets held in retirement investment accounts by selected
characteristics, 2007	97
Indicator 11. Participation in the Labor Force
Table 11. Labor force participation of persons age 55 and over, by sex and age group, annual averages,
1963-2011	98

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Indicator 12. Total Expenditures
Table 12. Percentage of total household annual expenditures, by age of reference person, 2010	100
Indicator 13. Housing Problems
Table 13a. Prevalence of housing problems among households with householder or spouse age 65 and over,
by type of problem, selected years 1985-2009	101
Table 13b. Prevalence of housing problems among households with a household member(s) age 65 and
over—excludes households with householder or spouse age 65 and over—by type  of problem, selected
years 1985-2009	103
Table 13c. Prevalence of housing problems among all U.S. households except those households with an
older person(s) age 65 and over by type of problem, selected years 1985-2009	105
Table 13d. Prevalence of housing problems among households with householder or spouse age 65 and over
with children, by type of problem, selected years 1985-2009	107
Table 13e. Prevalence of housing problems among households with a household member(s) age 65 and
over with children—excludes households with householder or spouse age 65 and over, by type of problem,
selected years 1985-2009	109
Table 13f. Prevalence of housing problems among all older households: householder, spouse, or member(s)
age 65 and over, by type of problem, selected years 1985-2009	Ill

Health Status
Indicator 14. Life Expectancy
Table 14a. Life expectancy, by age and sex, selected years 1900-2009	113
Table 14b. Life expectancy, by sex, selected race, and age, 2009	113
Table 14c. Average life expectancy at age 65, by sex and selected countries or areas, selected years 1980-2009	114
Indicator 15. Mortality
Table 15. Death rates for selected leading causes of death among people age 65 and over, 1981-2009	115

Indicator 16. Chronic Conditions
Table 16a. Percentage of people age 65  and over who reported having selected chronic health conditions,
by sex and race and Hispanic origin, 2009-2010	116
Table 16b. Percentage of people age 65  and over who reported having selected chronic health conditions,
1997-1998 through 2009-2010	116
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, 2010	117
Table 17b. Percentage of people age 65  and over who reported ever having worn a hearing aid, by sex, 2010	117

Indicator 18. Respondent-Assessed Health Status
Table 18. Percentage of respondent-assessed health status among people age 65 and over, by selected
characteristics, 2008-2010	118

Indicator 19. Depressive Symptoms
Table 19a. Percentage of people age 65  and over with clinically relevant depressive symptoms, by sex,
selected years 1998-2008	119
Table 19b. Percentage of people age 65  and over with  clinically relevant depressive symptoms, by age group
and sex, 2008	119

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
1992-2009	120
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, 2009	120
Table 20c. Percentage of Medicare enrollees age 65 and over who are unable  to perform certain physical
functions, by sex, 1991 and 2009	121
Table 20d. Percentage of Medicare enrollees age 65 and over who are unable to perform any one of five
physical functions, by selected characteristics 2009	121

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Health Risks and Behaviors
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 1989-2010	122
Table 21b. Percentage of people age 65 and over who reported having been vaccinated against influenza and
pneumococcal disease, by selected characteristics, 2010	122
Indicator 22. Mammography
Table 22. Percentage of women who reported having had a mammogram within the past two years, by selected
characteristics, selected years 1987-2010	123
Indicator 23. Diet Quality
Table 23. Average diet scores, population age 65 and over, by age group, 2007-2008	124
Indicator 24. Physical Activity
Table 24a. Percentage of people age 45 and over who reported participating in leisure-time aerobic and muscle-
strengthening activities that meet the 2008 Federal physical activity guidelines, by age group, 1998-2010	125
Table 24b. Percentage of people age 65 and over who reported participating in leisure-time aerobic and muscle-
strengthening activities that meet the 2008 Federal physical activity guidelines, by sex and race and ethnicity,
2010	125
Indicator 25. Obesity
Table 25. Body weight status among persons 65 years of age and over, by sex and age group, selected years
1976-2010	126
Indicator 26. Cigarette Smoking
Table 26a. Percentage of people age 45 and over who are current cigarette smokers, by selected characteristics,
selected years 1965-2010	127
Table 26b. Cigarette smoking status of people age 18 and over, by sex and age group, 2010	128
Indicator 27. Air Quality
Table 27a. Percentage of people age 65 and over living in counties with "poor air quality," 2000-2010	129
Table 27b. Counties with "poor air quality" for any standard in 2010	130
Indicator 28. Use of Time
Table 28a. Average number of hours per day and percentage of day that people age 55 and over spent doing
selected activities on an average day, by age group, 2010	133
Table 28b. Average number of hours and percentage of total leisure time that people age 55 and over spent
doing selected leisure activities on an average day, by age group, 2010	133
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, 1992-2009	134
Table 29b. Use of Medicare-covered home health care and skilled nursing facility services by Medicare enrollees
age 65 and over, by age group, 2009	134
Indicator 30. Health Care Expenditures
Table 30a. Average annual health care costs for Medicare enrollees age 65 and over, in 2008 dollars, by age
group, 1992-2008	135
Table 30b. Major components of health care costs among Medicare enrollees age 65 and over, 1992 and 2008	135
Table 30c. Average annual health care costs among Medicare enrollees age 65 and over,  by selected
characteristics, 2008	136
Table 30d. Major components of health care costs among Medicare enrollees age 65 and over, by age group,
2008	137
Table 30e. Percentage of noninstitutionalized Medicare enrollees age 65 and over who reported problems
with access to health care, 1992-2007	137
Indicator 31. Prescription Drugs
Table 3 la. Average prescription drug costs and sources of payment among noninstitutionalized Medicare
enrollees age 65 and over, 1992-2008	138
Table 3 Ib. Distribution of annual prescription drug costs among noninstitutionalized Medicare enrollees
age 65 and over, 2008	138

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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 October 2011	139
Table 3Id. Average prescription drug costs among noninstitutionalized Medicare enrollees age 65 and over,
by selected characteristics, 2000, 2004, and 2008	139

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, 1991-2009	140
Table 32b. Percentage of people age 55-64 with health insurance coverage, by type of insurance and poverty
status, 2010	140

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, and 2000-2009	141
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, and 2000-2009	142
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, 2000-2009	144

Indicator 34. Sources of Payment for Health Care Services
Table 34a. Average cost and percentage of sources of payment for health care services for Medicare enrollees
age 65 and over, by type of service, 2008	146
Table 34b. Average cost and percentage of sources of payment for health care services for Medicare enrollees
age 65 and over, by income, 2008	146

Indicator 35. Veterans' Health Care
Table 35. Total number of veterans age 65 and over who are enrolled in or are receiving health care from the
Veterans Health Administration, 1990-2011	147

Indicator 36. Residential Services
Table 36a. Percentage of Medicare enrollees age 65 and over residing in selected residential settings, by age
group, 2009	148
Table 36b. Percentage of Medicare enrollees age 65 and over with functional limitations, by residential setting,
2009	148
Table 36c. Percent availability of specific services among Medicare enrollees age 65 and over residing in
community housing with services, 2009	148
Table 36d. Percent distribution of annual income of Medicare enrollees age 65 and over, by residential setting,
2009	149
Table 36e. Characteristics of services available to Medicare enrollees age 65 and over residing in community
housing with services, 2009	149

Indicator 37. Personal Assistance and Equipment
Table 37a. 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 1992-2009	150
Table 37b. Percent distribution of noninstitutionalized Medicare enrollees age 65 and over who have limitations
in activities of daily living (ADLs), by type of assistance  and sex, 2009	150
Table 37c. 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
1992-2009	150
Table 37d. 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 and sex, 2009	150

Special Feature

End of Life
Table ELI. Percentage of Medicare decedents age 65 and over who used hospice or intensive care unit/coronary
care unit services in their last 30 days of life, selected years 1999-2009	151
Table EL2. Percentage of Medicare decedents age 65 and over who used hospice services in their last 30 days of
life, by age, sex, and race, 2009	151

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End of Life—continued
Table ELS. Percentage of Medicare decedents age 65 and over who used intensive care unit/coronary care unit
services in their last 30 days of life, by age, sex, and race, 2009	152
Table EL4. Number and percent distribution of lengths of stay in hospice among Medicare decedents age 65 and
over, 1999 and 2009	152
Table ELS. Percent distribution of primary diagnoses related to hospice among Medicare decedents age 65 and
over who used hospice services in their last 30 days of life, 1999 and 2009	152
Table EL6. Percent distribution of decedents age 65 and over by place of death, 1989-2009	153
Table EL7. Percent distribution of decedents age 65 and over by place of death and sex, 2009	153
Table ELS. Percent distribution of decedents age 65 and over by place of death and age group, 2009	154
Table EL9. Percent distribution of decedents age 65 and over by place of death and race and ethnicity, 2009	154

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Highlights
Older Americans 2012: Key Indicators ofWell-
Being is one in a series of periodic reports to
the Nation on the condition of older adults in
the United States. In this report, 37 indicators
depict the well-being of older Americans in the
areas of demographic characteristics, economic
circumstances, health status, health risks and
behaviors, and cost and use of health care
services. This year's report also includes a special
feature on the end of life. 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 began
turning age 65 in 2011), are accelerating this
growth. This large 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.

•   In 2010, there were 40 million people age  65
    and over in the United States, accounting for
    13 percent of the total population. The older
    population in 2030 is projected 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").

•   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 2010, 80 percent were high school
    graduates or more, and 23 percent had a
    Bachelor's degree  or more (See "Indicator 4:
    Educational Attainment").

Economics
There have been decreases in the proportion
of older people living in poverty or in the low-
income group just above the poverty line, both
in recent years and over the longer term. Among
older Americans, the share of income coming
from earnings has increased since the mid-1980s,
partly because more people, especially women,
continue to work past age 55. In addition, net
worth increased almost 80 percent, on average,
for older Americans between 1988 and 2007.
Although most older Americans live in adequate,
affordable housing, some live in costly, physically
inadequate, or crowded housing. Additionally,
major inequalities continue to exist: older blacks
and people without high school diplomas report
smaller economic gains and fewer financial
resources overall.

•   Between 1974 and 2010, there was a decrease
    in the proportion of older people with income
    below poverty from 15 percent to 9 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").

•   In 2007, the median net worth of households
    headed by white people age 65 and over
    ($248,300) was almost three times that of
    older black households ($87,800). This
    difference is less than in 1998 when the
    median net worth of households headed by
    older white people was about six times
    higher than that of households headed by
    older black people. The large increase in net
    worth in past years may not continue into
    the future due to recent declines in housing
    values (See "Indicator 10: Net Worth").

•   Over the past four decades, labor force
    participation rates have risen for women
    age 55 and over. This trend continued during
    the recent recession. Among men age 55 and
    over, the rise in participation rates that started
    in the mid-1990s also  has continued, although
    to a smaller extent. As "Baby Boomers"
    approach older ages, they are remaining in
    the labor force at higher rates than previous
    generations (See "Indicator 11: Participation
    in the Labor Force").

•   In 2009, approximately 40 percent of older
    American households had housing cost
    burden (expenditures on housing and utilities
    that exceed 30 percent of household  income).
    In addition to having cost burden as the
    most dominant housing problem, crowded
    housing was also fairly prevalent for some
    older American households with children
    in their homes (See "Indicator 13: Housing
    Problems").

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Health Status
Americans are living longer than ever before,
yet their life expectancies lag behind those of
other developed nations. Death rates for certain
diseases have declined overtime, while others
have increased. 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. Nevertheless, most
people age 65 and over report their health as
good, very good, or excellent.

•   Life expectancy at age 65 in the United
    States was lower than that of many other
    industrialized nations. In 2009, 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").

•   Death rates for heart disease and stroke
    declined by slightly more than 50 percent
    since 1981. Death rates for chronic lower
    respiratory disease increased by 57 percent
    in the same time period (See "Indicator 15:
    Mortality").

•   The prevalence of certain chronic conditions
    differed by sex. Women reported higher levels
    of arthritis than men (56 percent versus 45
    percent). Men reported higher levels of heart
    disease (37 percent versus 26 percent) (See
    "Indicator 16: Chronic Health Conditions").

•   During the period 2008-2010, 76 percent of
    people age 65 and over rated their health as
    good, very good, or excellent. Non-Hispanic
    Whites were  more likely to report good health
    than their non-Hispanic Black or Hispanic
    counterparts  (See "Indicator 18: Respondent-
    Assessed Health Status").

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 routine vaccinations along
with diet, physical activity, obesity, and cigarette
smoking. The quality of the air where people live
also affects health. Many of these health risks and
behaviors have shown long-term improvements,
even though recent estimates indicate no
significant changes.
•   In 2010, about 11 percent of people age 65
    and over reported participating in leisure-time
    aerobic and muscle-strengthening activities
    that met the 2008 Federal physical  activity
    guidelines (See "Indicator 24: Physical
    Activity").

•   As with other age groups, the percentage of
    people age 65 and over who are obese has
    increased since 1988-1994. In 2009-2010, 38
    percent of people age 65 and over were obese,
    compared with 22 percent in 1988-1994.
    Over the past several years however, that
    trend has leveled off for older women, with
    no statistically significant change in obesity
    between 1999-2000 and 2009-2010. During
    this same time period, the obesity prevalence
    increased for older men (See "Indicator 25:
    Obesity").

•   The percentage of people age 65 and over
    living in counties that experienced  poor air
    quality for any air pollutant decreased from
    64 percent in 2000 to 36 percent in 2010 (See
    "Indicator 27: Air Quality").

•   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, about 11
    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
In the 1990's and early 2000's, health care
costs rose rapidly for older Americans.  However,
average health care costs did not increase further
between 2006 and 2008, after adjustment for
inflation. Older Americans in the poor/near
poor income category continued to spend a high
proportion of their household income on health
care services through 2009. In recent years
increasing numbers of Medicare beneficiaries
enrolled in HMOs and other health plans under
the  Medicare Advantage (MA) program.

•   After adjustment for inflation, health care
    costs increased significantly among older
    Americans from $9,850 in 1992 to  $15,709
    in 2008. There was no significant change
    between 2006 and 2008 (See "Indicator 30:
    Health Care Expenditures").

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•   From 1977 to 2009, 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 22 percent (See "Indicator 33:
    Out-of-Pocket Health Care Expenditures").

•   Enrollment in health maintenance
    organizations (HMOs) and other health plans
    under the Medicare Advantage (MA) program
    has grown rapidly in recent years. In 2005,
    16 percent of Medicare beneficiaries age 65 or
    over were enrolled in an MA plan, compared
    with 28 percent in 2009 (See "Indicator 32:
    Sources of Health Insurance").

End of Life
In the last decade there has been a substantial
rise in the use of hospice services among older
Americans. During that time, there has also been
a smaller increase in the use of intensive care unit
(ICU) and coronary care unit (CCU) services
at the end of life. The percent of deaths among
older Americans that occurred in hospitals
declined over the last 20 years, with an increase
in the percent dying at home.

•   Use of hospice in the last month of life
    increased from 19 percent of decedents in
    1999, to 43 percent in 2009. Use of ICU/CCU
    services grew from  22 percent of decedents
    in 1999, to 27 percent in 2009.

•   Neoplasms accounted for 53 percent
    of hospice stays in 1999 and only 32
    percent in 2009. The next most common
    primary diagnoses in 2009 were diseases
    of the circulatory system (19 percent) and
    symptoms, signs, and ill-defined conditions
    (17 percent).

•   Among older Americans, 49 percent of
    deaths occurred in hospitals in 1989,
    declining to 32 percent in 2009. The percent
    dying at home increased from 15 in 1989,
    to 24 percent in 2009.

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            Population
INDICATOR 1. Number of Older Americans
INDICATOR 2. Racial and Ethnic Composition
INDICATOR 3. Marital Status
INDICATOR 4. Educational Attainment
INDICATOR 5. Living Arrangements
INDICATOR 6. 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 families,
  businesses, health care providers, and policymakers, among others, to meet the needs of aging individuals.
    Population age 65 and over and age 85 and over, selected years 1900-2010 and
    projected 2020-2050
    Millions
    100
                                                                                     Projected
     20 -
      0
      1900   1910  1920  1930  1940  1950  1960  1970  1980  1990  2000  2010  2020  2030  2040  2050

    NOTE: These projections are based on Census 2000 and are not consistent with the 2010 Census results. Projections based on the 2010
    Census will be released in late 2012.
    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 1; U.S. Census Bureau, Table 1: Intercensal Estimates of the Resident Population by Sex and Age for the U.S.: April
    1, 2000 to July 1, 2010 (US-ESTOOINT-01); U.S. Census Bureau, 2011. 2070 Census Summary File 1; U.S. Census Bureau, Table 2: Projections
    of the population by selected age groups and sex for the United States: 2010-2050 (NP2008-12).
     In 2010, 40 million people age 65 and over
     lived in the United States, accounting for
     13 percent of the total population. The older
     population grew from 3 million in 1900 to 40
     million in 2010. The oldest-old population
     (those age 85 and over) grew from just over
     100,000 in  1900 to 5.5 million in 2010.

     The "Baby Boomers" (those born between
     1946 and 1964) started 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.

     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 is projected to grow rapidly after
                               2030, when the "Baby Boomers" move into
                               this age group.

                               The U.S. Census  Bureau projects that the
                               population age 85 and over could grow
                               from 5.5 million in 2010 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
                                                                   2000
                                                                         2010
                                                                                2020
                                                                                                    2050

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Percentage of population age 65 and over, by county and state, 2010
                                                    a?
                                                                                                    g.
                                                                                                    o
                                                                                                    0
Reference population: These data referto the resident population.
SOURCE: U.S. Census Bureau, 2070 Census Summary File 1.
 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 2010, 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).

 The proportion of the population age 65
 and over varies even more by county. In
 2010, 43 percent of Sumter County, Florida,
 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 Aleutians West
 Census Area, Alaska, with only 3.5 percent
 of its population age  65 and over.
•   Older women outnumbered older men in
    the United States, and the proportion that is
    female increased with age. In 2010, women
    accounted for 57 percent of the population
    age 65 and over and for 67 percent of the
    population age 85 and over.

•   The United States is fairly young for a
    developed country, with 13 percent of its
    population age 65 and over in 2010. Japan
    had the highest percent of age 65 and over
    (23 percent) among countries with a
    population of at least 1 million. The older
    population made up more than 15 percent of
    the population in most European countries,
    around 20 percent in Germany and Italy.

Data for this indicator's charts and bullets can
be found in Tables la through If on pages 82-86.

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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,  2010 and projected 2050
   Percent
   100  r
    80
    60
   40
    20
                      2010
                               2050 (projected)
                                                                                               20
         Non-Hispanic White
               alone
                               Black alone
                                                  Asian alone
                                       All other races alone
                                        or in combination
  Hispanic
(of any race)
   NOTE: These projections are based on Census 2000 and are not consistent with the 2010 Census results. Projections based on the 2010
   Census will be released in late 2012. 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 chart 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, 2011. 2070 Census Summary File 1; U.S. Census Bureau, Table 4: Projections of the population by sex, race,
   and Hispanic origin for the United States: 2010-2050 (NP2008-14).
    In 2010, 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.

    Projections indicate that by 2050 the
    composition of the older population will be
    58 percent non-Hispanic White, 20 percent
    Hispanic,  12 percent Black, and 9 percent
    Asian. The older population among all racial
    and ethnic groups will grow; however, the
                                older Hispanic population is projected to
                                grow the fastest, from under 3 million in
                                2010 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 2010, over
                                1 million older Asians lived in the United
                                States; by 2050 this population is projected
                                to be about 7.5 million.

                            Data for this indicator's charts and bullets can
                            be found in Table 2 on page 86.

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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, 2010
   Percent
   100 r
   80
   60
   40
   20
            65-74  D 75-84  Q 85 and over

                       Percent
                       100 r
                         Men
                                 35
                               17
                  11
         5   4  3
                                                                    Women
       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, 2010.
    In 2010, older men were much more likely
    than older women to be married. Over
    three-quarters of men age 65-74 (78 percent)
    were married, compared with over one-half
    (56 percent) of women in the same age group.
    The proportion married was lower at older
    ages: 38 percent of women age 75-84 and
    18 percent of women age 85 and over were
    married. For men, the proportion married
    also was lower at older ages, but not as low
    as for older women. Even among the oldest
    old in 2010, the majority (58 percent) of men
    were married.
                          •  Widowhood was more common among
                             older women than among older men in 2010.
                             Women age 65 and over were three times as
                             likely as men of the same age to be widowed,
                             40 percent compared with 13 percent. Nearly
                             three-quarters (73  percent) of women age
                             85 and over were widowed, compared with
                             35 percent of men.

                          •  Relatively small proportions of older men
                             (9 percent) and women (11 percent) were
                             divorced in 2010. A small proportion (4
                             percent) of the older population had never
                             married.

                         All comparisons presented for this indicator are
                         significant at the 0.10 confidence level. Data for
                         this indicator's charts and bullets can be found
                         in Table 3 on page 87.

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 INDICATOR 4
Educational Attainment
 Educational attainment has effects throughout the life course, 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 1965-2010
    Percent
    100 r
     80
     60
    40
     20
                                     High school graduate or more
                                       Bachelor's degree or more
                                                                            I  I  I  I  I  I  I  I  I  I  I
      1965
                1970
                         1975
                                   1980
                                             1985
                                                       1990
                                                                 1995
                                                                          2000
                                                                                    2005
                                                                                              2010
    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, 2010.
     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
     2010, 80 percent were high school graduates
     or more and 23 percent had a Bachelor's
     degree or more.
                              In 2010, about 80 percent of older men and
                              79 percent of older women had at least a
                              high school diploma. Older men attained
                              at least a Bachelor's degree more often
                              than older women (28 percent compared
                              with 18 percent).
1900
         1910
                 1920
                                   1940
                                            1950
                          1960
                                                             1970
                                                                      1980
                                                                               1990
                                                                                        2000
                                                                                                  2012

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Educational attainment of the population age 65 and over, by race and Hispanic
origin, 2010
Percent
100
 80
 60
 40
 20
High school graduate or more   Q Bachelor's degree or more
          80
                                                                    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 chart 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 referto the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2010.
                                                                                  a?
  Despite the overall increase in educational
  attainment among older Americans,
  substantial educational differences exist
  among racial and ethnic groups. In 2010, 84
  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,
  65 percent of older Blacks and 47 percent of
  older Hispanics had completed high school.
                         •  In 2010, older Asians had the highest
                            proportion with at least a Bachelor's
                            degree (35 percent). About 24 percent of
                            older non-Hispanic Whites had this level of
                            education. The proportions were 15 percent
                            and 10 percent, respectively, for older Blacks
                            and Hispanics.

                        All comparisons presented for this indicator are
                        significant at the 0.10 confidence level. Data for
                        this indicator's charts and bullets can  be found
                        in Tables 4a and 4b on page 88.

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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.
   Living arrangements of the population age 65 and over, by sex and race and Hispanic
   origin, 2010
   Percent
   100
    80
    60
    40
    20
                          With spouse   HH With other relatives  Q With nonrelatives   D  Alone

                            Men                    Percent                  Women
          Total     Non-    Black
                  Hispanic  alone
                 White alone
         Asian   Hispanic
         alone    (of any
                  race)
Total     Non-    Black
        Hispanic   alone
      White alone
Asian    Hispanic
alone    (of any
         race)
  NOTE: The calculation of the living arrangements estimates in this chart changed from the previous edition of Older Americans to more
  accurately reflect the person's relationship to the householder, rather than an indication of whether the householder had relatives present in the
  household. 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 chart 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, 2010.
    Older men were more likely to live with their
    spouse than were older women. In 2010, 72
    percent of older men lived with their spouse,
    while less than half (42 percent) of older
    women did. In contrast, older women were
    twice as likely as older men to live alone
    (37 percent and 19 percent, respectively).

    Living arrangements of older people differed
    by race and Hispanic origin. Older Black,
    Asian, and Hispanic women were more
    likely than non-Hispanic White women to
    live with relatives other than a spouse. For
    example, in 2010, 33 percent of older Asian
    women, 35 percent of older Black women,
    and 36 percent of older Hispanic women,
    lived with other relatives, compared with
    only 13 percent of older non-Hispanic White
                                women. The percentages of Asian, Black and
                                Hispanic women (33 percent, 35 percent and
                                36 percent, respectively) were not statistically
                                different.

                                Older non-Hispanic White women and
                                Black women were more likely than women
                                of other races to live alone (39 percent
                                each, compared with about 21 percent for
                                older Asian women and 23 percent for
                                older Hispanic women). The percentages
                                of non-Hispanic White and Black women
                                (39 percent each) living alone were not
                                statistically different. Also, the percentages
                                of older Asian and  older Hispanic women
                                (21 percent and 23  percent, respectively)
                                living alone were not statistically different.

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Older Black men lived alone more than twice
as often as older Asian men (28 percent
compared with 12 percent). Older Black
men also lived alone more often than older
non-Hispanic White men (19 percent). The
percentages of older Asian and older Hispanic
men living alone (12 percent and 15 percent,
respectively) were not statistically different.

Older Hispanic men were more likely (17
percent) than non-Hispanic White men (4
    percent) to live with relatives other than a
    spouse. The percentages of Black and Asian
    men living with relatives other than a spouse
    were between those for Hispanic men and
    non-Hispanic White men, at 12 percent and
    8 percent, respectively.

All comparisons presented for this indicator are
significant at the 0.10 confidence level. Data for
this indicator's charts and bullets can be found
in Tables 5a and 5b on page 89.

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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, 2010, and projected 2020
                                      2000
                                              2010
                                                       2020 (projected)
   Percent
   100 r
    80
    60
    40
    20
                       Percent
                       100 r
                          Men
         64
                                                                      Women
         65 and over   65-74     75-84    85 and over
                                                       2   1  2    112       11    1  JL 1
                                                     ^	^^M i—i iyyj   ^B i—i L/1 ji	^^B I  I rrn
                                                      65 and over    65-74      75-84    85 and over
  Reference population: These data refer to the resident population of the United States and Puerto Rico.
  SOURCE: U.S. Census Bureau, Population Projections 2008, and 2070 Census Summary File 1; Department of Veterans Affairs, VetPop2011.
    According to Census 2000, there were 9.7
    million veterans age 65 and over in the United
    States and Puerto Rico. Two out of three men
    age 65 and over were veterans.

    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 male veterans age 65
    and over will gradually decline  from 9.4
    million in 2000 to a projected 8.4 million
    in 2020.

    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 increased from 400,000 in 2000 to
                             almost 1.3 million in 2010. The proportion
                             of men age 85 and over who are veterans
                             increased from 33 percent in 2000
                             to 68 percent in 2010.

                          •  Between 2000 and 2010, the number of
                             female veterans age 85 and over increased
                             from about 30,000 to 97,000 but is projected
                             to decrease to 60,000 by 2020.

                          Data for this indicator's charts and bullets can
                          be found in Tables 6a and 6b on page 90.

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           Economics
INDICATOR 7. Poverty
INDICATOR 8. Income
INDICATOR 9. Sources of Income
INDICATOR 10. Net Worth
INDICATOR 11. Participation in 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 living in poverty, by age group, 1959-2010
    Percent
    100 r
     80
     60
     40
     20
                                                                 Under 18

      1959
                1965
                         1970
                                 1975
                                          1980
                                                   1985
                                                           1990
                                                                    1995
                                                                            2000
                                                                                      2005
                                                                                               2010
         ~ 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. 239. 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, 2011.
     In 1959, 35 percent of people age 65 and over
     lived below the poverty threshold. By 2010,
     the proportion of the older population living
     in poverty had decreased dramatically to
     9 percent.

     Relative levels of poverty among the different
     age groups have changed overtime. 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
     2010, the proportions of the older population
     and those of working age living in poverty were
     about 9 percent and 14 percent, respectively,
     while 22 percent of children lived in poverty.

     Poverty rates differed by age and sex among
     the older population. Older women (11
     percent) were more likely than older men
     (7 percent) to live in poverty in 2010. People
     age 65-74 had a poverty rate of 8 percent,
                               compared with 10 percent of those age
                               75 and over.

                           •   Race and ethnicity are related to poverty
                               among older men. In 2010, older non-Hispanic
                               White men were less likely than older Black
                               men, older Hispanic men and older Asian men
                               to live in poverty; 5 percent compared with
                               14 percent each for older Black men, older
                               Hispanic men, and Asian men.

                           •   Older non-Hispanic White women (8 percent)
                               were less likely than older Black women (21
                               percent), older Hispanic women (21 percent)
                               and older Asian women (15 percent) to live
                               in poverty.

                           All comparisons presented for this indicator are
                           significant at the 0.10 confidence level. Data for
                           this indicator's charts and bullets can be found
                           in Tables la and 7b on pages 91-92.
1900
         1910
                  1920
                                   1940
                                            1950
                          1960
                                                              1970
                                                                       1980
                                                                                1990
                                                                                         2000
                                                                                                   2012

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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, 1974-2010
Perce
100

80
60
40
20
0
19
nt




	 \ 	
• 	 . 	
I I I I I I
74 1980
~-~^_
" — " 	 — — 	
Middle income

Low income
	 — ^
Poverty
i i i i i i i i i i i i i i i i i i i i i i i i i i i i i




1990 2000 2010
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. Income distribution 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, 2011.
     Since 1974, the proportion of older people
     living in poverty and in the low income
     group has generally declined so that, by
     2010, 9 percent of the older population
     lived in poverty and 26 percent of the older
     population was in the low income group.

     In 2010, people in the middle income group
     made up the largest share of older people by
     income category (34 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 2010.
                         •   The trend in median household income of
                             the older population also has been positive.
                             In 1974, the median household income for
                             householders age 65 and over was $21,100
                             when expressed in 2010 dollars. By 2010,
                             the median household income had increased
                             to $31,410.

                         All comparisons presented for this indicator are
                         significant at the 0.10 confidence level. Data for
                         this indicator's charts and bullets can be found
                         in Tables 8a and 8b on pages 93-94.
1900
        1910
                1920
                                 1940
                                         1950
                        1960
                                                          1970
                                                                  1980
                                                                           1990
                                                                                   2000
                                                                                             2012

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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. Over time, Social Security has taken on greater importance to many
 older Americans.
    Percentage distribution of sources of income for married couples and nonmarried
    persons age 65 and over,  1962-2010
                                i   i   i   i   i   i    i
                                                        J	L
                                                                  J_
                                                                                    Other
                                                                                    Earnings
                                                                                    Pensions
                                                                                    Asset income
                                                                                    Social Security
           1962
                   1967
                           1976   1980
                                                 1990
                                                                 2000
                                                                                 2010
    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, unemployment compensation, workers compensation, alimony, child support,
    and personal contributors.
    Reference population: These data refer to the civilian noninstitutionalized population.
    SOURCE: Current Population Survey, Annual Social and Economic Supplement, 1977-2011.
     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 a peak in  1992 and has fluctuated
     since then at about a fifth of aggregate income.
     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.

     In 2010, aggregate income for the population
     age 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 11 percent.
                               About 88 percent of people age 65 and over
                               lived in families (including families of one)
                               with income from Social Security. About
                               three-fifths (57 percent) were in families with
                               income from assets, and two-fifths (43  percent)
                               with income from pensions. About two-fifths
                               (38 percent) were in families with earnings.
                               About 1 in 20 (5 percent) were in families
                               receiving cash public assistance.

                               Among married couples and nonmarried
                               people age 65 and over in the lowest fifth of the
                               income distribution, Social Security accounted
                               for 84 percent of aggregate income, and cash
                               public assistance for another 7 percent. For
                               those whose income was in the highest income
                               category, Social Security, pensions, and asset
                               income each accounted for almost a fifth of
                               aggregate income, and earnings accounted
                               for the remaining two-fifths.
1900
        1910
                 1920
                                  1940
                                           1950
                         1960
                                                            1970
                                                                    1980
                                                                             1990
                                                                                      2000
                                                                                                2012

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Percentage distribution of sources of income for married couples and nonmarried
persons age 65 and over, by income quintile, 2010
Percent
100
 80
 60
 40
 20
                                           16
                                                          26
                                                                          45
                                                                           19
                                                                           16
                                Other

                               - Public assistance

                                Earnings
                                                                                   Pensions
                                                                                  Asset income
                                                                                   Social Security
        Lowest fifth
                       Second fifth
                                        Third fifth
                                                        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 wife is age 65
and over. The definition of "other" includes, but is not limited to, unemployment compensation, workers compensation, alimony, child support,
and personal contributors. Quintile limits are $12,600, $20,683, $32,880, and $57,565 for all units; $24,634, $36,288, $53,000, and $86,310 for
married couples; and $10,145, $14,966, $21,157, and $35,405 for nonmarried persons.
Reference population: These data referto the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2011.
  For the population age 80 and over, a larger
  percentage (92 percent) lived in families
  (including families of one) with Social
  Security income and a smaller percentage
  (21 percent) had earnings compared to the
  population age 65-69 (80 percent and 56
  percent, respectively).

  Pension coverage expanded dramatically
  in the two decades after World War II, and
  private pensions accounted for an increasing
  proportion of income for older people
  during the 1960s and early 1970s. In the past
  decade, the retirement-plan participation rate
  has been stable at about 50 percent of all
  private workers on their jobs.6

  There has been a major shift in the type
  of pensions provided by employers, from
  defined-benefit plans (in which a specified
  amount is typically paid as a lifetime
  annuity) to defined-contribution plans such
  as 401(k) plans (in which the amount of
  the benefit varies depending on investment
    returns). Employers increasingly offer
    defined-contribution plans to employees.
    The percentage of private workers who
    participated in defined-benefit plans decreased
    from 32 percent in 1992-93 to 21 percent
    in 2005 7 Over the same period, participation
    in defined-contribution plans increased from
    35 percent to 42 percent. In 2010, employer
    plans offered only 20 percent of private
    workers a defined-benefit plan and 59 percent
    of workers a defined-contribution plan.8

•   The pension measure includes regular income
    from retirement plans. Money taken from
    investment retirement accounts (IRAs,
    401(k)s, etc.) is largely not captured in the
    pension measure because it often is taken as
    an irregular distribution. See Data Needs.
    Table lOb measures the prevalence of these
    accounts for the aged.

Data for this indicator's charts and bullets can
be found in Tables 9a through 9c on pages 95-96.
                                                       w
                                                       o
                                                       o
                                                        ^^ *
                                                       2

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 INDICATOR  10
Net Worth
 Net worth (the value of real estate, stocks, bonds, retirement investment accounts and other assets minus
 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.
    Median household net worth in 2007 dollars, by race of head of household age 65 and
    over, selected years 1983-2007

    Dollars, in thousands
    $500  i-
     400
     300
     200
     100
                                                               White
                                                               Black
       1983
                            1989
                                       1992
                                                  1995
                                                             1998
                                                                        2001
                                                                                   2004
                                                                                             2007
    NOTE: The Survey of Consumer Finances has replaced the Panel Study of Income Dynamics as the data source for this indicator. Median net
    worth is measured in constant 2007 dollars. Net worth includes housing wealth, financial assets, and investment retirement accounts such as
    IRAs, Keoghs, and 401(k) type plans. Data are weighted. The term "household" here is similarto the Census Bureau's household definition. See
    Indicator 10 data source for more detail.
    Reference population: These data refer to the civilian noninstitutionalized population.
    SOURCE: Survey of Consumer Finances.
     Overall, between 1983 and 2007, the median
     net worth (including the value of retirement
     investment accounts) of households headed
     by people age 65 and over more than doubled
     (from about $103,750 to $220,800). The rate
     of change was quite variable over this time
     period. The largest increase was 28 percent,
     between 1995 and 1998. There was a slight
     decrease between 2001 and 2004.

     Between 1983 and 2007, the median net
     worth of households headed by White
     people age 65 and over doubled from about
     $122,320 to $248,300. The median net worth
     of households headed by Black people age
     65 and over increased almost five-fold from
     about $17,960 to $87,800.
                              In 1983, the median net worth of households
                              headed by White people age 65 and over was
                              almost seven times that of households headed
                              by Black people age 65 and over. In 2007, the
                              median net worth of older White households
                              was almost three times that of older Black
                              households.

                              In 2007, the median net worth of households
                              headed by married people age 65 and over
                              (about $300,500) was almost twice that of
                              households headed by unmarried people
                              in the same age group (about $165,090).
1900
         1910
                 1920
                                   1940
                                           1950
                          1960
                                                             1970
                                                                      1980
                                                                              1990
                                                                                       2000
                                                                                                  2012

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    Median household net worth in 2007 dollars, by educational attainment of head of
    household, age 65 and over, selected years 1983-2007

    Dollars, in thousands
    $600 i-
     500
     400
     300
     200
     100
                      At least some college
                      High school diploma only
       1983
                             1989
                                        1992
                                                   1995
                                                              1998
                                                                         2001
                                                                                   2004
                                                                                              2007
    NOTE: The Survey of Consumer Finances has replaced the Panel Study of Income Dynamics as the data source for this indicator. Median net
    worth is measured in constant 2007 dollars. Net worth includes housing wealth, financial assets, and investment retirement accounts such as
    IRAs, Keoghs, and 401 (k) type plans. Data are weighted. The term "household" here is similar to the Census Bureau's household definition. See
    Indicator 10 data source for more detail.
    Reference population: These data referto the civilian noninstitutionalized population.
    SOURCE: Survey of Consumer Finances.
     In both 1983 and 2007, households headed
     by people age 65 and over with at least some
     college reported a median household net
     worth about five times that of households
     headed by older people without a high
     school diploma.

     Between 1983 and 2007, the median net
     worth of people age 65 and over without a
     high school diploma and with some college
     grew at about the same rate (75 percent to
     80 percent).

     With the shift from traditional defined-benefit
     pension plans to investment retirement
     accounts such as 401(k) type Individual
     Retirement Accounts and Keogh Accounts,
     financial assets held in individual retirement
     accounts have become prevalent among
     older Americans. In 2007, about two-fifths of
     families with a family head age 65 and over
     held such accounts with a median value of
     about $61,000 (Table lOb). These accounts
     are more likely to be held by later birth
     cohorts with three-fifths of those age 55-64,
     half of those age 65-74, and three-tenths of
     those age 75 and over owning such accounts.
     This probably reflects the establishment
     of IRAs in the 1970s, 401(k) regulations
     in 1981, and Roth IRAs in the 1990s. Tax
     regulations require withdrawal of the money
     in these accounts at a rate based on life
     expectancy beginning in the year after 70
     and a half years of age and ending at the year
     of expected death. People rarely withdraw
     this account money as annuity payments
     or regular payments; rather, most are taken
     as ad hoc distributions.

 Data for this indicator's charts and bullets can
 be found in Tables Wa and Wb on page 97.
                                                       w
                                                       o
                                                       o
                                                        ^^ *
                                                       2
1900
         1910
                  1920
                                   1940
                                            1950
1960
                                                              1970
                                                                       1980
                                                                                1990
                                                                                        2000
                                                                                                   2012

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 INDICATOR 11
               Participation in Labor Force
 The labor force participation rate is the percentage of a population 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, 1963-2011
    Percent
    100 r
     80
     60
     40
     20
      0
      1963
                              55-61
                              62-64
i  i  i i  i  i  i  i i  i  i  l  l  l l  l  l  l
       1970     1975     1980
l  l  l l  l  l  l  l l  l  l  l  l  l l  l  l  l  l l  l  l  I  I I  I  I  I
1985     1990     1995     2000     2005       2011
    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.
    Reference population: These data refer to the civilian noninstitutionalized population.
    SOURCE: Bureau of Labor Statistics, Current Population Survey.
     In 2011, the labor force participation rate for
     men age 55-61 was 75 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. In 2011, the participation rate for
     men age 62-64 was 53 percent.

     Men age 65-69 also 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 from the mid-1980s to the
                                             early 1990s remained in the range of 24
                                             to 26 percent. Beginning in the mid-1990s,
                                             the labor force participation rate began to
                                             increase and reached 37 percent in 2011.

                                             The participation rate for men age 70 and
                                             over showed a somewhat similar pattern
                                             from 1963 to 2011. 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 the mid-
                                             1990s, the participation rate for men age
                                             70 and over has trended higher and reached
                                             15 percent in 2011.
1900
         1910
                 1920
                                  1940
                                           1950
                                        1960
                                                             1970
                                                                     1980
                                                                              1990
                                                                                      2000
                                                                                                 2012

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    Labor force participation rates of women age 55 and over, by age group, annual
    averages, 1963-2011
    Percent
    100 r
     80
     60
     40
     20
                             55-61
                             62-64
         i  i  i  i i  i  i  i  i  i i  i  i  i i  i  i  i  i i  i
                                                                                   I  I  I I  I  I  I
      1963
                   1970
                            1975
                                     1980
                                              1985
                                                      1990
                                                               1995
                                                                        2000
                                                                                  2005
                                                                                            2011
    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.
    Reference population: These data referto the civilian noninstitutionalized population.
    SOURCE: Bureau of Labor Statistics, Current Population Survey.
     Among women age 55 and over, the labor
     force participation rate rose over the past four
     decades. The increase has been largest among
     women age 55-61, rising from 44 percent in
     1963 to 65 percent in 2011, with a majority of
     the increase occurring after 1985. For women
     age 62-64, 65-69, and 70 and over, most of
     the increase in labor force participation began
     in the mid-1990s.

     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,
    65 percent of women age 55-61 were in
    the labor force in 2011, compared with 44
    percent in  1963. Over the same period, the
    labor force participation rate for women age
    62-64 increased from 29 to 45 percent, and
    the rate for women age 65-69 increased from
     17 percent to 27 percent.

    The difference between labor force
    participation rates for men and women
    has narrowed overtime. Among people
    age 55-61, for example, the gap between
    men's and women's rates in 2011  was
     10 percentage points, compared with 46
    percentage points in 1963.

 Data for this indicator's charts and bullets can
 be found in Table 11 on pages  98-99.
1900
         1910
                 1920
                          1930
                                  1940
                                           1950
1960
                                                            1970
                                                                     1980
                                                                             1990
                                                                                      2000
                                                                                                2012

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INDICATOR 12
Total Expenditures
Expenditures are another indicator of economic well-being and 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, 2010
   Percent
   100
    80
    60
    40
    20
              32.8
              15.9
               7.6
                               35.4
                               14.2
                               13.2
                                                34.8
                                                14.7
             55-64
                            65 and over
                                                11.9
                                               65-74
                                                                 19.6
                                                                 36.2
                                                                 13.6
                                                                 15.1
                                                              75 and over
                                                                           Other
                                                                           Food
                                                                           Housing
                                                 Transportation


                                                 Health care
                                                 Personal insurance and pensions
   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 over. 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 accounted for the largest share,
    one-third or more on average, of total
    expenditures for all groups of households
    with a reference person (i.e., a selected
    household owner or renter) age 55 or
    over. The share was largest (36 percent)
    for households with a reference person
    age 75 and over, even though this group
    was the most likely to own a home without
    a mortgage.

    As a share of total expenditures, health care
    expenditures increased dramatically with age.
    For the age 75 and over group, the share (15
    percent) was nearly twice as high as it was
    for the age 55-64 group (8 percent), and was
                                slightly higher than the share the older group
                                allocates to transportation (14 percent). For
                                the age 75 and over group, vehicle insurance
                                accounted for about one-fifth of transportation
                                expenditures.

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

                            Data for this indicator's charts and bullets can
                            be found in Table 12 on page 100.

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 INDICATOR 13
Housing Problems
 Most older Americans live in adequate, affordable housing. Some, however, live in costly, physically
 inadequate, and crowded housing, which can pose serious problems for an older person's physical or
 psychological well-being. Housing cost burden is the most prevalent housing problem for all household
 types and has increased over the years.

 The prevalence of housing problems is examined for two different groups of older American households
 and compared with all other U.S. households. The adequacy of housing for older American households
 with children in their home is also discussed.
    Percentage of older American households and all other U.S. households that report
    housing cost burden, selected years 1985-2009
    Percent
    100 r
     80
     60
     40
     20
                T All older-owner/renter households
                A All older-member households (not householder or spouse)
                                                                         I
                                                                                I
      1985
                    1989
                                          1995
                                                 1997
                                                         1999
                                                                2001
                                                                       2003    2005
                                                                                     2007
                                                                                             2009
    NOTE: Housing cost burden refers to expenditures on housing and utilities that exceed 30 percent of household income. All older-owner/renter
    households are households with a householder or spouse age 65 and over; all older-member households are households with an older member
    age 65 and over who is not the householder or spouse; and all other households are households without a person(s) age 65 and over.
    Reference population: These data refer to the resident non-institutionalized population. People residing in non-institutional group homes are
    excluded.
    SOURCE: Department of Housing and Urban Development, American Housing Survey.
     Approximately 40 percent of both older-
     owner/renter households (households with a
     householder or spouse age 65 and over) and
     older-member households (households with
     an older member age 65 and over who is not
     the householder or spouse) have housing
     problems. The most prevalent housing
     problem is cost burden (expenditures on
     housing and utilities that exceed 30 percent
     of household income) and it has been
     increasing overtime. Between 1985 and
     2009, the prevalence of cost burden increased
     from 31 to 40 percent for older-owner/renter
     households and from 18 to 39 percent among
                              older-member households. In comparison,
                              the prevalence of housing cost burden for all
                              other U.S. households (households without a
                              person(s) age 65 and over) increased from
                              24 to 36 percent over the same time period.

                              While cost burden is the most prevalent
                              housing problem, some households have other
                              housing problems. They include physically
                              inadequate housing, such as housing that lacks
                              complete plumbing or has multiple and major
                              upkeep problems, and crowded housing, which
                              is housing that has more household members
                              than the number of rooms in a unit. In 2009,

                                        Indicator 13 continued on page 22.
                                                                               W
                                                                               O
                                                                               o
                                                                                                          ^^ *
                                                                                                         2
1900
        1910
                 1920
                                  1940
                                           1950
                         1960
                                                            1970
                                                                     1980
                                                                              1990
                                                                                      2000
                                                                                                2012

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     4 percent of older-owner/renter households
     had physically inadequate housing, while
     less than one percent had crowded housing.
     For older-member households, 5 percent had
     physically inadequate housing and 6 percent
     had crowded housing in 2009. The prevalence
     of these problems was fairly similar for all
     other U.S. households, 5 percent of whom had
     physically inadequate housing and 3 percent
     of whom reported crowded housing in 2009.

 Intergenerational Households

     Similar to the households described above,
     cost burden is the most dominant housing
     problem for intergenerational households,
     or households with older people (age 65
     and over) and children (age 19 or younger)
     living in the household. Older-owner/
     renter and older-member intergenerational
     households are likely to represent households
     where grandparents are helping to raise their
     grandchildren or where three generations
     are living within the same household. From
     1985 to 2009, housing cost burden increased
     from 26 to 41 percent for older-owner/renter
     intergenerational households and from 18 to
     45 percent for older-member intergenerational
     households.

     For some intergenerational households,
     crowded housing is fairly prevalent. In 2009,
     14 percent of older-member intergenerational
     households reported overcrowding.
    Percentage of older American households and intergenerational households that
    report housing cost burden, selected years  1985-2009
                                                        Older-owner/renter households with children
               T All older-owner/renter households
                                           All older-member households
                                                                               Older-member households
                                                                               with children
      1985
                     1989
                                            1995
                                                    1997
                                                           1999    2001    2003    2005
                                                                                          2007    2009
    NOTE: Housing cost burden refers to expenditures on housing and utilities that exceed 30 percent of household income. All older-owner/renter
    households are households with a householder or spouse age 65 and over; all older-member households are households with an older member
    age 65 and over who is not the householder or spouse; older-owner/renter households with children are households with a householder or
    spouse age 65 and over and children (age 19 or younger); and older-member households with children are households with an older member
    age 65 and over and children (age 19 or younger).
    Reference population: These data refer to the resident non-institutionalized population. People residing in non-institutional group homes are
    excluded.
    SOURCE: Department of Housing and Urban Development, American Housing Survey.
 Data for this indicator's charts and bullets can be
 found in Tables 13a through 13f on pages 101-112.
1900
         1910
                  1920
                           1930
                                    1940
                                             1950
1960
                                                                         1980
                                                                                           2000
                                                                                                     2012

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             Health Status
             Life Expectancy
INDICATOR 15 Mortality
INDICATOR 16 Chronic Health Conditions
INDICATOR 17 Sensory Impairments and Oral Health
INDICATOR 18 Respondent-Assessed Health Status
INDICATOR 19 Depressive Symptoms
          20. 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 of life
                                   years 1900-2009
    25 r
    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
                                                                                                  2009
    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 forages 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.
     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 19.2 more years,
     nearly 5 years longer than people age  65 in
     1960. In 2009, the life expectancy of people
     who survive to age 85  was 7 years for women
     and 5.9 years for men.

     Life expectancy varies by race, but the
     difference decreases with age. In 2009, life
     expectancy at birth was 4.3 years higher
     for White people than  for Black people.
                                At age 65, White people can expect to live
                                an average of 1.3 years longer than Black
                                people. Among those who survive to age 85,
                                however, the life expectancy among Black
                                people is slightly higher (6.8 years) than
                                White people (6.6 years).

                                Life expectancy at age 65 in the United States
                                is lower than that of many other industrialized
                                nations. In 2009, 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
                                     1940
                                              1950
                           1960
                                                                1970
                                                                         1980
                                                                                   1990
                                                                                            2000
                                                                                                       2012

-------
    Average life expectancy for women at age 65, by selected countries or areas, selected
    years 1980-2009
    Years of life

    25
    20
    15
    10
            United States
          A United Kingdom
                                                                        V Japan
                                                                          Mexico
     1980
                                    1990
                                                                   2000
                                                                                   2005
                                                                                                2009
    SOURCE: Organisation for Economic Co-operation and Development (OECD) Health Data 2011, OECD. StatExtracts, available from: http://
    www.oecd.org.
    Average life expectancy for men at age 65, by selected countries or areas, selected
    years 1980-2009
    Years of life

    25 r
    20
    15
    10
     1980
                                                  United States
              A United Kingdom
                                    1990
                                                                    2000
                                                                                   2005
                                                                                                2009
    SOURCE: Organisation for Economic Co-operation and Development (OECD) Health Data 2011, OECD. StatExtracts, available from: http://
    www.oecd.org.


 Data for this indicator's charts and bullets can
 be found in Tables 14a through 14c on pages
 113-114.

1900
         1910
                  1920
                                    1940
                                             1950
1960
                                                               1970
                                                                        1980
                                                                                 1990
                                                                                          2000
                                                                                                    2012

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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,
    1981-2009
                                                               ICD-10*
                                                                        Chronic lower respiratory diseases
                                                                         Izheimer's disease!
                                                                         i
Influenza and pneumonia
    iabetes
                    1985
                                    1990
                                                    1995
                                                                    2000
                                                                                    2005
                                                                                                 2009
    * Change calculated from 1999 when 10th revision of the International Classification of Diseases (ICD-10) was implemented.
    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. For the period 1981-1998, causes were coded using ICD-9 codes that are nearly comparable with the 113 cause list
    for the ICD-10 and may differfrom 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.
     In 2009, the leading cause of death among
     people age 65 and over was heart disease
     (1,156 deaths per 100,000 people), followed
     by cancer (982 per 100,000), chronic lower
     respiratory diseases (291 per 100,000), stroke
     (264 per 100,000), Alzheimer's disease (184
     per 100,000), diabetes (121 per 100,000), and
     influenza and pneumonia (104 per 100,000).

     Between  1981 and 2009, age-adjusted death
     rates for all causes of death among people
     age 65 and over declined by 25 percent. Death
     rates for heart disease and stroke declined by
     more than 50 percent. Death rates for chronic
     lower respiratory diseases increased by 57
     percent. Age-adjusted death rates for diabetes
     were higher in 2009 than in 1981 but have
     declined since 2001.

     Heart  disease and cancer were the top two
     leading causes of death in 2009 among all
                                  people age 65 and over, irrespective of sex,
                                  race, or Hispanic origin. Diabetes was the
                                  6th leading cause of death among non-
                                  Hispanic Whites, but the 4th leading cause
                                  among non-Hispanic Blacks and Hispanics.9

                                  Other causes of death varied among older
                                  people by sex and race and Hispanic origin.
                                  For example, men had higher suicide rates
                                  than women at all ages, with the largest
                                  difference occurring at age 85 and over
                                  (43 deaths per 100,000 people for men,
                                  compared with 3 per 100,000 for women).
                                  Non-Hispanic White men age 85 and over
                                  had the highest rate of suicide overall
                                  in 2009, at 47 deaths per 100,000.9

                              Data for this indicator's charts and bullets can
                              be found in Table 15 on page 115.
1900
         1910
                  1920
                                    1940
                                             1950
                             1960
                                                               1970
                                                                        1980
                                                                                 1990
                                                                                          2000
                                                                                                     2012

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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.10 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").
Percentage of people age
65 and
over who
reported having selected chronic health
conditions, by sex, 2009-2010
Percent
100
80
60

40

20


0
~
-
_

_ 37
n
_




I I Men





26





Heart


57
54






























Hypertension








9










8













Stroke








10









13



Asthma
disease
I I Women



















10










11













Chronic bronchitis
or emphysema





28



























Any





24











18




Diabetes


56
45



























Arthritis
cancer
NOTE: Data are based on a 2-year average from 2009-2010.
Reference population: These data refer to the civilian noninstitutionalizec
SOURCE: Centers for Disease Control and
Prevention
population.
National Center for Health Statistics, National Health Interview Survey.











c/
ri
P
ri
C



    The prevalence of certain chronic health
    conditions differed by sex. Women reported
    higher levels of asthma, arthritis and
    hypertension than men. Men reported higher
    levels of heart disease, cancer, and diabetes.

    There were differences by race and ethnicity
    in the prevalence of certain chronic health
    conditions. In 2009-2010, among people age
    65 and over, non-Hispanic Blacks reported
    higher levels of hypertension and diabetes
    than non-Hispanic Whites (69 percent
    compared with 54 percent for hypertension,
    and 32 percent compared with 18 percent
                             for diabetes). Hispanics also reported higher
                             levels of diabetes (33 percent) than non-
                             Hispanic Whites, but lower levels of arthritis
                             (44 percent compared with 53 percent).

                             The prevalence of diabetes increased for
                             all racial and ethnic groups and for men and
                             women. Overall, the prevalence of diabetes
                             reported by persons age 65 and over increased
                             from 13 percent in 1997-1998 to nearly 21
                             percent in 2009-2010.

                         Data for this indicator's charts and bullets can
                         be found in Tables 16a and 16b on page 116.

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INDICATOR 17
Sensory Impairments and Oral Health
Vision limitations, 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.
Percentage of people age 65 and over who reported having any trouble hearing,
trouble seeing, or no natural teeth, by sex, 2010
Pera
100
80
60
40
20
0
snt Q Men Q
46
31
13
I
Women
24 25
15

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." Regarding their vision, respondents were asked "Do you have any trouble
seeing, even when wearing glasses or contact lenses?" The category "Any trouble seeing" includes those who responded yes or 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.
    In 2010, 46 percent of older men and 31
    percent of older women reported trouble
    hearing. The percentage of older Americans
    with trouble hearing was higher for people
    age 85 and over (59 percent) than for people
    age 65-74 (31 percent). Eleven percent of all
    older women and 18 percent of all older men
    reported having ever worn a hearing aid.

    Vision trouble affected 14 percent of the older
    population, 13 percent of men and 15 percent
    of women. Among people age 85 and over, 23
    percent reported trouble seeing.
                            The prevalence of edentulism, having no
                            natural teeth, was higher for people age
                            85 and over (33 percent) than for people
                            age 65-74 (19 percent). Socioeconomic
                            differences were large. Forty-two percent
                            of older people with family income below
                            the poverty line reported no natural teeth
                            compared with 22 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 117.

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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.11
  Percentage of people age 65 and over with respondent-assessed good to excellent
  health status by age group and race and Hispanic origin, 2008-2010
   Percent
   100 r
   80
   60
   40
   20
          78
                              Non-Hispanic
                              White
                                82
                    Non-Hispanic
                    Black
Hispanic or Latino
(of any race)
                63    63
                                                      76
                                      67
                                            66
                                                                            69
                                                            57
                                                                  60
                                                                                  54
                                                                                        52
             65 and over
                                     65-74
                                                           75-84
                                                                               85 and over
  NOTE: Data are based on a 3-year average from 2008-2010. See data sources 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.
                                                                                                           n
    During the period of 2008-2010, 76 percent
    of people age 65 and over rated their health as
    good, very good, or excellent. Older men and
    women reported similar levels of health.

    The proportion of people reporting good to
    excellent health was lower among the oldest
    age groups. Seventy-nine percent of those age
    65-74 reported good or better health. At age
    85 and over, 67  percent of people reported
    good or better health. This pattern was also
    evident within racial and ethnic groups.
                              Regardless of age, older non-Hispanic White
                              men and women were more likely to report
                              good to excellent health than their non-
                              Hispanic Black and Hispanic counterparts.
                              Non-Hispanic Blacks and Hispanics were
                              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 118.

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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.12
Percentage of people age 65 and over with clinically relevant depressive symptoms,
by sex, selected years 1998-2008
Percent
100

80
60
40
20

0
-


-
-

12

1998

















11

2000
















12

2002


Men




Percent
100

80
60
40
20
11 10 11

n
-
Women

-
-
- 19 19 18 17 18 16


2004 2006 2008 1998 2000 2002 2004 2006 2008
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.isrumich.edu/docs/userg/dr-005.pdf.
Proportions are based on weighted data using the preliminary respondent weight from MRS 2008.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Health and Retirement Study.
     Older women were more likely to report
     clinically relevant depressive symptoms
     than were older men. In 2008, 16 percent of
     women age 65 and over reported depressive
     symptoms compared with 11 percent of men.
     There was no significant change in this sex
     difference between 1998 and 2008.
                            The percentage of people reporting clinically
                            relevant symptoms remained relatively stable
                            over the past few years. Between 1998 and
                            2008, the percentage of men who reported
                            depressive symptoms ranged between 10
                            and 12 percent. For women, the percentage
                            reporting these symptoms ranged between
                            16 and 19 percent.
1900
        1910
                1920
                                1940
                                        1950
                        1960
                                                        1970
                                                                1980
                                                                        1990
                                                                                2000
                                                                                          2012

-------
Percentage of people age 65 and over with clinically relevant depressive symptoms,
by age group and sex,  2008
Percent
100 r
 80
 60
 40
                                       Total
                                                 Men
                                                           Women
 20
        12
                  15
             10
                          12
                         n
                                      14       14
                                                         17
                                10
                                                   10
                                                                 15
                                                                            18      18    19    18
                                                                       10
           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 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.isrumich.edu/docs/userg/dr-005.pdf.
Proportions are based on weighted data using the preliminary respondent weight from MRS 2008.
Reference population: These data referto the civilian noninstitutionalized population.
SOURCE: Health and Retirement Study.
  The prevalence of depressive symptoms
  was related to age. In 2008, the proportion
  of people age 65 and over with clinically
  relevant symptoms was higher for people age
  85 and over (18 percent) than for people in
  any of the younger groups (12 to 15 percent).

  In 2008, the percentage of men 85 and over
  (19 percent) reporting clinically relevant
  depressive symptoms was almost twice that of
  men in any of the younger age groups (about
    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 ranged
    between 14 percent and 18 percent, with little
    change across the age groups.

Data for this indicator's charts and bullets can
be found in Tables 19a and 19b on page 119.
I

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  INDICATOR 20
Functional Limitations
 As people age, functioning 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
    long-term care facility, selected years 1992-2009
    Percent
    100 r
     80
     60
     40
     20
              49
-
14
20

4
6

43
13
17
3
5

44
13
17

42
12
18

4


42
14
18

4


41
12
18

4
                                                                                     lADLs only
                                                                                     1 to 2 ADLs
                                                                                     3 to 4 ADLs
                                                                                     5 to 6 ADLs
                                                                                     Long-term care facility
             1992
                          1997
                                       2001
                                                   2005
                                                                2007
                                                                             2009
    NOTE: A residence is considered a long-term care facility if it is certified by Medicare or Medicaid; has three or more beds, 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.  Percents are age-adjusted using the 2000 standard population. Estimates 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.
     In 2009, about 41 percent of people age
     65 and over enrolled in Medicare reported
     a functional limitation. Twelve percent
     had difficulty performing one or more
     instrumental activities of daily living (lADLs)
     but had no activities of daily living (ADL)
     limitations. Approximately 25 percent had
     difficulty with at least one ADL and 4 percent
     were in a facility.

     The age-adjusted proportion of people age
     65 and over with a functional limitation
     declined from 49 percent in 1992 to 41
     percent in 2009. There was a decrease in the
     percent with limitations from 1992 to 1997.
                               From 1997 to 2009, the overall levels did
                               not significantly change, although a smaller
                               proportion of this population was in a facility
                               compared with earlier years.

                               Women reported higher levels of functional
                               limitations than men. In 2009, about
                               46 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 were
                               similar for men and women; however, a
                               higher proportion of women were in facilities
                               compared with men.
1900
         1910
                  1920
                                    1940
                                             1950
                           1960
                                                                1970
                                                                         1980
                                                                                  1990
                                                                                           2000
                                                                                                      2012

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In addition to ADLs and 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 2009
                                           1991
                                                    2009
Percent Percent
100

80
60
40



20


0
100
M
80
60
40



r^n- 20
14 15
8 I — I 9 7
I II I I II I I — li — i 1 II 1 n
-
Women

-

32
rn30
23 21 n
18 I li — I 18
15 I — I I I14
6 4 3 n
I II I I — li — i I I
Stoop/ Reach Write/ Walk 2-3 Lift Any of Stoop/ Reach Write/ Walk 2-3 Lift Any of
kneel over grasp blocks 10lbs. these kneel over grasp blocks 10lbs. these
head small five head small five
objects objects
  NOTE: Rates for 1991 are age-adjusted to the 2009 population.
  Reference population: These data referto Medicare enrollees.
  SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
    Older women reported more problems with
    physical functioning than older men did. In
    2009, about 30 percent of women reported
    they were unable to perform at least one
    of five activities, compared with 19 percent
    of men.

    Problems with physical functioning were
    more frequent at older ages. Among men age
    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, 19 percent of those age
    65-74 were unable to perform at least one
    activity, compared with 53 percent of those
    age 85 and over.
    Physical functioning was related to race and
    ethnicity in 2009. Among men, 18 percent
    of non-Hispanic Whites were unable to
    perform at least one activity, compared with
    23 percent of non-Hispanic Blacks. Among
    women, 29 percent of non-Hispanic Whites
    were unable to perform at least one activity,
    compared with 33 percent of non-Hispanic
    Blacks.

Data for this indicator's charts and bullets can
be found in Tables 20a through 20d on pages
120-121.

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Health Risks and Behaviors
INDICATOR
INDICATOR
INDICATOR
INDICATOR
INDICATOR
INDICATOR
INDICATOR
INDICATOR
21. Vaccinations
22. Mammography
23. Diet Quality
24. Physical Activity
25. Obesity
26. Cigarette Smoking
27. Air Quality
28. 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.13"16 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 people age 65 and over vaccinated against influenza and
    pneumococcal disease, by race and Hispanic origin, selected years 1989-2010
    Percent
    100 r
     80
     60
     40
     20
                                                                    . Influenza
                                                                     Not Hispanic or Latino White
                                    nfluenza Hispanic or Latino
                                   (of any race
                      Influenza
                      Not Hispanic or Latino Black
,^X^-»     Not Hispanic or sf*fm
+ ~*         LatinoWhiteV'      A Pneumococ
       „, _ _ _ ——^"ta"**^          Not Hispani
                                             imococcal disease
                                                lie or Latino Black
                                                 • A Pneumococcal disease
                                                     Hispanic or Latino
                                                     (of any race)
                        J
                             I
                                  I
                                          I
                                               I
                                                   I
                                                       I
                                                           I
                                                                I
                                                                    I
                                                                        I
                                                                             I
                                                                                 I
                                                                                     I
                                                                                          I
                                                                                              I
                                                                                                  I
      1989
               1991
                       199319941995
                                         1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
    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 data sources 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.
     In 2010, 63 percent of people age 65 and
     over reported receiving a flu shot in the past
     12 months; however, there were differences
     by race and ethnicity. Sixty-six percent of
     non-Hispanic Whites reported receiving a
     flu shot, compared with 52 percent of non-
     Hispanic Blacks and 54 percent of Hispanics.

     In 2010, about 60 percent of people  age
     65 and over had ever received a pneumonia
     vaccination. Despite increases in the rates for
     all groups over time,  in 2010, non-Hispanic
     Whites were more likely to have received
     a pneumonia vaccination (64 percent)
     compared with non-Hispanic Blacks
     (46 percent) or Hispanics (39 percent).
                           •  The percentage of older people receiving
                               vaccinations increased with age. In 2010,
                               about 70 percent of persons age 85 and
                               over had received a flu shot, compared
                               with 68 percent of persons age 75-84 and
                               59 percent of persons age 65-74. For
                               pneumonia vaccinations, 68 percent of
                               persons 85 and over had ever received a
                               pneumonia vaccination compared with 55
                               percent of persons age 65-74.

                           Data for this indicator's charts and bullets can
                           be found in Tables 2la and 21b on page 122.
1900
         1910
                  1920
                                    1940
                                             1950
                           1960
                                                               1970
                                                                        1980
                                                                                 1990
                                                                                          2000
                                                                                                     2012

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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 50-74.17
    Percentage of women age 50 and over who had a mammogram within the past two
    years, by age group, selected years, 1987-2010
    Percent
    100 i-
    80
    60
    40
    20
                                                       T 50-64
     1987
                1990
                              1994
                                            1998
                                                    2000
                                                              2003
                                                                     2005
                                                                                2008
                                                                                       2010
    NOTE: Questions concerning the 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 2011, 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.
     Among women age 65 and over, the
     percentage who had a mammogram within
     the preceding two years almost tripled
     from 23 percent in 1987 to 64 percent in
     2010. 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 but, in recent years, this
     difference has disappeared.

     Older women who were poor were less likely
     to have had a mammogram in the preceding
     two years than older women who were not
     poor. In 2010, 51 percent of women age 65
     and over who lived in families with incomes
     of less than 100 percent of the poverty
     threshold reported having had a mammogram.
                            Among older women living in families
                            with incomes of 400 percent or more of the
                            poverty threshold, 75 percent reported having
                            had a mammogram.

                         •  Older women without a high school diploma
                            were less likely to have had a mammogram
                            than older women with a high school
                            diploma. In 2010, 54 percent of women age
                            65 and over without a high school diploma
                            reported having had a mammogram in the
                            preceding two years, compared with 63
                            percent of women who had a high school
                            diploma and 71 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 123.
0>
fa
IB-
1900
        1910
                1920
                                1940
                                        1950
                        1960
                                                         1970
                                                                 1980
                                                                         1990
                                                                                 2000
                                                                                          2012

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INDICATOR 23
          Diet Quality
Dietary intake affects the health of older Americans, because poor diet quality is associated with
cardiovascular disease, hypertension, type 2 diabetes, osteoporosis, and some types of cancer.18 An
index that assesses the multidimensional components of diet is useful in describing diet quality. The
Healthy Eating lndex-2005,19-20 developed by the U.S. Department of Agriculture (USDA) Center for
Nutrition Policy and Promotion, measures compliance with the diet-related recommendations of the
2005 Dietary Guidelines for Americans.18 It has 12 components, and a higher score indicates a higher
quality diet. Intakes equal to or better than the standards set for each component are assigned a maximum
score of 100 percent. For the nine adequacy components (e.g., total fruit), no intake gets zero percent,
and scores increase up to 100 percent as the intakes increase towards the standard. The three moderation
components  (e.g., sodium) are scored in reverse; that is, excessively high intakes get zero percent and as
intakes decrease toward the standard, scores increase up to 100 percent. Scores are averages across all
adults based on usual dietary intake.
  Average diet scores,3 for the population age 65 and over, by age group, 2007-2008

                           A higher score means the average diet is closer to the standard.
                                          •  65-74  D  75 and older
   Score
   100
    80
    60
    40
    20
100100
                       100100
                                              100100
            94
         86
                                                                                               59 59
          Total    Whole   Total  DGOVL"  Total   Whole    Milk  Meat and  Oils
          fruit     fruit  vegetables         grains   grains           beans

                              Dietary adequacy components
                                                                Saturated Sodium  Calories
                                                                  fat            from
                                                                              SoFAAS0
                                                                    Dietary moderation
                                                                      components
   " Scores, reported as percentages in this chart, are average Healthy Eating lndex-2005 scores and not the percentages of individuals who meet
   the diet quality standards.
   b Dark green and orange vegetables and legumes.
   c Solid fats, alcoholic beverages, and added sugars.
   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,
   2007-2008 and U.S. Department of Agriculture, Center for Nutrition Policy and Promotion, MyPyramid Equivalents Database 2007-2008
   (preliminary), Healthy Eating lndex-2005.

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In 2007-2008, the average diet of older
Americans (age 65 and over) scored 100
percent for only three dietary components:
whole fruit, total grains, and meat and
beans. In other words, diets for these three
components met the standard, while nine
fell short—ranging from 33 percent (sodium)
to 90 percent (total fruit).

The average diet of adults age 75 and over
was superior in quality to the average diet
of their younger counterparts, age 65-74, for
total fruit, whole grains, milk, saturated fat,
and sodium. For total vegetables and oils,
adults' age 65-74 average diets were better
than those age 75 and over.
•  Average intakes of calories from solid fats,
   alcoholic beverages, and added sugars were
   too high and thus remained well below the
   quality standards for both age groups.

•  Major improvements in the nutritional
   health of older Americans could be made
   by increasing intakes of whole grains, dark
   green and orange vegetables and legumes,
   and fat-free or low-fat milk products and
   by incorporating foods and beverages that
   are lower in sodium and have fewer calories
   from solid fats, alcoholic beverages, and
   added sugars.

Data for this  indicator's charts and bullets can
be found in Table 23 on page 124.
                                                                                          0>
                                                                                          I"
                                                                                          SB-
                                                    5

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  INDICATOR 24
Physical Activity
  Physical activity is beneficial for the health of people of all ages, including the age 65 and overpopulation.
  It can reduce the risk of certain chronic diseases, may relieve symptoms of depression, helps to maintain
  independent living, and enhances overall quality of life.21-22 Research has shown that even among frail and
  very old adults, mobility and functioning can be improved through physical activity.23 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.24 In 2008, the Department of Health and Human Services
  released updated guidelines for aerobic activity and muscle-strengthening activities for Americans.
    Percentage of people age 45 and over who reported participating in leisure-time
    aerobic and muscle-strengthening activities that meet the 2008 Federal physical
    activity guidelines, by age group,  1998-2010
    Percent
    100 r
     80
     60
     40
     20
      1998
                                                      45-64
              1999
                      2000
                             2001
                                     2002
                                             2003
                                                     2004
                                                             2005
                                                                    2006
                                                                            2007
                                                                                    2008
                                                                                            2009
                                                                                                   2010
    NOTE: This measure of physical activity differs from previous editions of Older Americans. The measure reflects the 2008 Federal physical
    activity guidelines for Americans (available from: http://www.health.gov/PAGuidelines/). The 2008 Federal guidelines recommend that for
    substantial health benefits, adults perform at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour
    and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic
    activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week. The
    2008 guidelines also recommend that adults perform muscle-strengthening activities that are moderate or high intensity and involve all major
    muscle groups on two or more days a week, because these activities provide additional health benefits. The measure shown here presents the
    percentage of people who fully met both the aerobic activity and muscle-strengthening guidelines.
    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.
      In 2010, about 11 percent of people age 65
      and over reported participating in leisure-time
      aerobic and muscle-strengthening activities
      that met the 2008 Federal physical activity
      guidelines. The percentage of older people
      meeting the physical activity guidelines
      decreased with age,  ranging from 14 percent
      among people age 65-74 to 4 percent among
      people age 85 and over.

      Men age 65 and over were more likely than
      women in the same age group to meet the
      physical activity guidelines (14 percent and
                                8 percent, respectively, in 2010). Older non-
                                Hispanic Whites reported higher levels of
                                physical activity than non-Hispanic Blacks
                                (12 percent compared with 5 percent).

                            •  The percentage of older people meeting the
                                Federal physical activity guidelines increased
                                overtime. In 1998, about 6 percent of people
                                age 65 and over met the guidelines, compared
                                with 11 percent in 2010.

                            Data for this indicator's charts and bullets can
                            be found in Tables 24a and 24b on page 125.
1900
         1910
                  1920
                                     1940
                                              1950
                           1960
                                                                 1970
                                                                          1980
                                                                                   1990
                                                                                             2000
                                                                                                        2012

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 INDICATOR 25
Obesity
 Obesity is a major cause of preventable disease and premature death.25 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.26-27
    Percentage of population age 65 and over who are obese, by sex and age group,
    selected years, 1988-2010
                                         65-74
                                                  75 and over
                                                                     Women
     20  -
         1988- 1999-  2001- 2003- 2005- 2007- 2009-     1988-  1999- 2001- 2003- 2005- 2007- 2009-
          1994  2000  2002   2004  2006  2008   2010      1994  2000   2002   2004  2006  2008   2010

    NOTE: Data are based on measured height and weight. Height was measured without shoes. 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 data source 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.
     As with other age groups, the percentage of
     people age 65 and over who are obese has
     increased since 1988-1994. In 2009-2010,
     38 percent of people age 65 and over were
     obese, compared with 22 percent in 1988-
     1994.

     In 2009-2010, 45 percent of women age
     65-74 and 30 percent of women age 75 and
     over were obese. This is an increase from
     1988-1994, when 27 percent of women age
     65-74 and 19 percent of women age 75 and
     over were obese.
                         •   Older men followed similar trends: 24
                             percent of men age 65-74 and 13 percent
                             of men age 75 and over were obese in
                             1988-1994, compared with 43 percent of
                             men age 65-74 and 27 percent of men age
                             75 and over in 2009-2010.

                         •   Over the past 12 years, between 1999-2000
                             and 2009-2010, there has been no significant
                             trend in women, but among men there has
                             been an increase in obesity prevalence.

                         Data for this indicator's charts and bullets can
                         be found in Table 25 on page 126.
0>
fa
IB-
1900
        1910
                 1920
                                 1940
                                         1950
                        1960
                                                          1970
                                                                   1980
                                                                           1990
                                                                                   2000
                                                                                             2012

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This page is intentionally left blank.

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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 third leading cause of death among people age 65 and over) increased
  57 percent between 1981  and 2009 (see "Indicator 15: Mortality"). This increase reflects, in part, the
  cumulative effects of cigarette smoking overtime.28-29
    Percentage of people age 65 and over who are current cigarette smokers, by sex,
    selected years 1965-2010
    Percent
    100 r
     80
     60
     40
     20
                                                       i  i  i  i  i  i
                                                                            I  I  I  I  I  I  I  I  I I
      1965
                       1974
                                 1979
                                        1983
                                                      1990
                                                               1995
                                                                         2000
                                                                                  2005
                                                                                            2010
    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.
    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.
     The percentage of older Americans who were
     current cigarette smokers declined between
     1965 and 2010. Most of the decrease during
     this period was the result of the declining
     prevalence of cigarette smoking among men
     (from 29 percent in 1965 to 10 percent in
     2010). For the same period, the percentage of
     women who smoked cigarettes has remained
     relatively constant (10 percent in  1965 and 9
     percent in 2010).

     In 2010, the percentage of older Americans
     who were  current smokers was similar for
     Whites and Blacks.
                          •  A large percentage of both men and women
                             age 65 and over were former smokers.
                             In 2010, about 53 percent of older men
                             previously smoked cigarettes, while 29
                             percent of women age 65 and over were
                             former smokers.

                          Data for this indicator's charts and bullets can be
                         found in Tables 26a and 26b on pages 127-128.
0>

[?
o
V)
1900
        1910
                 1920
                                  1940
                                           1950
                         1960
                                                            1970
                                                                    1980
                                                                             1990
                                                                                     2000
                                                                                                2012

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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 chronic heart and lung diseases, leading to increased medication use, more visits
 to health care providers, admissions to additional 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 the 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.30"34
    Percentage of people age 65 and over living in counties with instances of "poor air
    quality," 2000-2010
                  8 hour Ozone

                 T Particulate Matter (PM 2.5)
      2000
               2001
                        2002
                                  2003
                                           2004
                                                    2005
                                                             2006
                                                                       2007
                                                                                2008
                                                                                         2009
                                                                                                  2010
    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. Data for previous years have been computed using the new daily PM 2.5 standard of 35 micrograms/m3 to enable comparisons over time.
    This results in percentages that are not comparable to previous publications of Older Americans. Measuring concentrations above the level
    of a standard is not equivalent to violating the standard. The level of a standard may be exceeded on multiple days before the exceedance is
    considered a violation of the standard.
    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, 2000-2010.
     In 2010, about 32 percent of people age
     65 and over lived in counties with poor air
     quality for ozone, compared with 52 percent
     in 2000.

     A comparison of 2000 and 2010 showed a
     reduction in exposure to PM 2.5 pollution.
     In 2000, about 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 5 percent of people
                                age 65 and over in 2010.

                                The percentage of people age 65 and over
                                living in counties that experienced poor air
                                quality for any air pollutant decreased from
                                64 percent in 2000 to 36 percent in 2010.
1900
         1910
                  1920
                                     1940
                           1960
                                                                1970
                                                                         1980
                                                                                   1990
                                                                                                       2012

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Counties with instances of "poor air quality" for any standard in 2010
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. Measuring concentrations above the level of a standard is not equivalent to violating the standard. The level of a standard may be
exceeded on multiple days before the exceedance is considered a violation of the standard.
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, 2000-2010.
  In 2010, nearly 40 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 124 million people
  lived in counties where monitored air in
  2010 was unhealthy at times because of high
     levels of at least one of the six principal air
     pollutants: ozone, particulate matter (PM),
     nitrogen dioxide, 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 2.5.

Data for this indicator's charts and bullets can be
found in Tables 27a and 27b on pages 129-132.
                                                                                                              fD

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INDICATOR 28
Use of Time
How individuals spend their time reflects their financial and personal situations, needs, and 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 spend doing selected activities on an
   average day, by age group, 2010
  Percent
  100 r
   80
   60
   40
   20
               22
               16
                                       29
                                               Sleeping
                                                              32
                                              -2
                                                                         Leisure activities
                                            1  Work and work-related activities
                                               Household activities
                                            1  Care for and helping others
                                               Eating and drinking
                                               Purchasing goods and services
                                               Grooming
                                               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 2010, older Americans spent on average
    more than one-quarter of their time in leisure
    activities. This proportion increased with age:
    Americans age 75 and over spent 32 percent
    of their time in leisure activities, compared
    with 22 percent for those age 55-64.
                               On an average day, people age 55-64 spent
                               16 percent of their time (almost four hours)
                               working or doing work-related activities
                               compared with 5 percent (about one hour)
                               for people  age 65-74 and 1 percent (about
                               15 minutes) for people age 75 and over.

-------
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 spend doing selected
  leisure activities on an average day, by age group, 2010
  Percent
  100 r
   80
   60
   40
   20
                                                                    Socializing and communicating
              58
                                    56
                                                          58
                                                          12
                                                                    Watching TV
                 Participation in sports, exercise,
                 and recreation
                 Relaxing and thinking

                 Reading

                 Other leisure activities
             55-64
                                   65-74
                                                       75 and over
  NOTE: "Other leisure activities" includes activities such as playing games, using the computer for leisure, arts and crafts as a hobby, arts and
  entertainment (other than sports), and related travel.
  Reference population: These data referto the civilian noninstitutionalized population.
  SOURCE: Bureau of Labor Statistics, American Time Use Survey.
    Watching TV was the activity that occupied
    the most leisure activity time—more than
    one-half of the total—for Americans age
    55 and over.

    Americans age 75 and over spent a higher
    percentage of their leisure time reading (12
    percent versus 7 percent) and relaxing and
    thinking (9 percent versus 5 percent) than
    did Americans age 55-64.
•   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,
    about 11 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 133.
0>

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o
V)

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             Health Care
INDICATOR
INDICATOR
INDICATOR
INDICATOR
INDICATOR
INDICATOR
INDICATOR
INDICATOR
INDICATOR
29. Use of Health Care Services
30. Health Care Expenditures
31. Prescription Drugs
32. Sources of Health Insurance
33. Out-of-Pocket Health Care Expenditures
34. Sources of Payment for Health Care Services
35. Veterans' Health Care
36. Residential Services
37. 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 overtime 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, 1992-2009

    Stays per 1,000
    500 ,-
                                                    Hospital stays
450

400

350

300

250

200

150

100

 50

  0
  1992 1993  1994  1995 1996  1997  1998 1999 2000  2001  2002 2003  2004  2005 2006  2007 2008 2009

NOTE: Data are for Medicare enrollees in fee-for-service only. 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.
SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
                                                    Skilled nursing facility stays
















     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 320 per 1,000
     enrollees in 2009. The average length of a
     hospital stay decreased from 8.4 days in
     1992 to 5.4 days in 2009.
                                                      Skilled nursing facility stays increased
                                                      significantly from 28 per 1,000 Medicare
                                                      enrollees in 1992 to 80 per 1,000 in 2009.
                                                      Much of the increase occurred from 1992
                                                      to 1997.
1900
         1910
                  1920
                                    1940
                                                  1960
                                                               1970
                                                                       1980
                                                                                 1990
                                                                                                    2012

-------
    Medicare-covered physician and home health care visits per 1,000 Medicare enrollees
    age 65 and over in fee-for-service, 1992-2009

    Visits per 1,000
    16,000 |-
    14,000
    12,000
    10,000
     8,000
     6,000
     4,000
     2,000
                                                                 Physician visits and consultations

















        0
        1992  1993  1994  1995 1996  1997 1998  1999  2000  2001  2002  2003  2004  2005  2006  2007 2008 2009

    NOTE: 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 data base used to generate rates of physician visits and consultations in previous Older
    American reports is no longer available. This chart uses a different data base that begins with 1999 data and yields slightly different rates.
    Therefore, this chart uses the new data base to estimate rates of physician visits and consultations for all years between 1999 and 2009 to get
    a consistently defined trend. 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.
    SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
      The number of physician visits and
      consultations increased from 11,395 per
      1,000 Medicare enrollees in 1999 to
      15,437 per 1,000 in 2009.

      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.35 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 3,864 per
     1,000 enrollees in 2009.

 •   Use of skilled nursing facility and home
     health care increased with age. In 2009,
     there were about 33 skilled nursing facility
     stays per 1,000 Medicare enrollees age 65-74,
     compared with about 222 per 1,000 enrollees
     age 85 and over. Home health care agencies
     made 1,896 visits per 1,000 enrollees age
     65-74, compared with 8,974 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 134.
1900
         1910
                   1920
                                      1940
1960
                                                                  1970
                                                                           1980
                                                                                     1990
                                                                                                         2012

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 INDICATOR 30
                       Health Care Expenditures
  Older Americans use more health care per capita than any other age group. Health care costs per capita
  are increasing at the same time the "Baby Boom" generation is approaching retirement age.
                               85 and over
 Average annual health care costs for Medicare enrollees age 65 and over, by age
 group, 1992-2008

 Dollars
$26,000
 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  2007 2008

    NOTE: Data include both out-of-pocket costs and costs covered by insurance. Dollars are inflation-adjusted to 2008 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.
     After adjusting for inflation, health care
     costs increased significantly among older
     Americans between 1992 and 2006, but
     did not increase in 2007 or 2008. Average
     costs were substantially higher at older ages.

     Average health care costs varied by
     demographic characteristics. Average costs
     among non-Hispanic Blacks were $19,839
     in 2008, compared with $15,362  among
     Hispanics. Low-income individuals incurred
     higher health care costs; those with less than
     $10,000 in income averaged $21,924 in health
     care costs whereas those with more than
     $30,000 in income averaged only $13,149.

     Costs also varied by health status. Individuals
     with no chronic conditions incurred $5,520 in
                                                     health care costs on average. Those with five
                                                     or more conditions incurred $24,658. Average
                                                     costs among residents of long-term care
                                                     facilities were $61,318, compared with only
                                                     $13,150 among community residents.

                                                     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 about 10 percent in 1992
                                                     to about 5 percent in 1997 and remained
                                                     relatively constant thereafter. The percentage
                                                     who reported difficulty obtaining care varied
                                                     between 2 and 3 percent.
1900
         1910
                 1920
                                  1940
                                                 1960
                                                             1970
                                                                     1980
                                                                              1990
                                                                                                 2012

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 Health care costs can be broken down among 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 2008
Pera
100
80
60
40
20
0
3Ht
-

4
8


32



9
16


36

Other (short-term institution/
hospice/dental)
Prescription drugs
Home health care
Nursing home/long-term
institution
Physician/outpatient hospital
Inpatient hospital
1992 2008
NOTE: Data include both out-of-pocket costs and costs covered by insurance. Dollars are not inflation-adjusted.
Reference population: These data referto Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
     Hospital and physician services are the
     largest components of health care costs.
     Long-term care facilities accounted for 12
     percent of total costs in 2008. Prescription
     drugs accounted for 16 percent of health
     care costs.

     The mix of health care services changed
     between 1992 and 2008. Inpatient hospital
     care accounted for a lower share of costs in
     2008 (24 percent compared with 32 percent
     in 1992). Prescription drugs increased in
     importance from 8 percent of costs in 1992
     to 16 percent in 2008. "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 $6,594
    among people age  85 and over, compared
    with just $526 among those age 65-74. Costs
    of home  health care and "other" services also
    were higher at older ages.

 Data for this indicator's charts and bullets can
 be found in Tables 30a through 30e on pages
 135-137.
1900
        1910
                 1920
                                  1940
                                           1950
1960
                                                            1970
                                                                     1980
                                                                             1990
                                                                                      2000
                                                                                                2012

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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 prescription drug costs among noninstitutionalized Medicare beneficiaries
    age 65 and over, by sources of payment, 1992-2008

    Dollars
   $3,000
    2,800
    2,600
    2,400
    2,200
    2,000
    1,800
    1,600
    1,400
    1,200
    1,000
     800
     600
     400
     200
        0
        1992  1993 1994  1995  1996  1997  1998 1999  2000  2001  2002  2003  2004  2005  2006  2007  2008

    NOTE: Dollars have been inflation-adjusted to 2008 using the Consumer Price Index (Research Series). Reported costs have been adjusted to
    account for underreporting of prescription drug use. The adjustment factor changed in 2006 with the initiation of the Medicare Part D prescription
    drug program. Public programs include Medicare, Medicaid, Department of Veterans Affairs, and other State and Federal programs.
    Reference population: These data refer to Medicare beneficiaries.
    SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
J_
     J_
           J_
                J_
                      J_
                           J_
                                i Private
                                Public
                                 i
                                                                                 j
     Average prescription drug costs for older
     Americans increased rapidly for many years
     but were relatively stable from 2005 to 2008.
     Average costs per person were $2,834 in 2008.

     Average out-of-pocket costs and costs
     covered by private insurance decreased
     after the introduction of the Medicare Part
     D prescription drug program in 2006. There
     was a corresponding increase in drug costs
     covered by public insurance. Older Americans
     paid 60 percent of prescription drug costs out-
     of-pocket in 1992, compared with 23 percent
     in 2008. Private insurance covered 24 percent
     of prescription drug costs in 2008; public
     programs covered 53 percent.
                                            Costs varied significantly among individuals.
                                            Approximately 6 percent of older Americans
                                            incurred no prescription drug costs in 2008.
                                            About 15 percent incurred $5,000 or more
                                            in prescription drug costs that year.

                                            Chronic conditions are associated with
                                            high prescription drug costs. In 2008, older
                                            Americans with no chronic conditions
                                            incurred average prescription drug costs
                                            of $1,230. Those with five or more chronic
                                            conditions incurred  $5,300 in prescription
                                            drug costs on average.
1900
         1910
                  1920
                                   1940
                                            1950
                                       1960
                                                              1970
                                                                       1980
                                                                                1990
                                                                                        2000
                                                                                                   2012

-------
 Under Medicare Part D, beneficiaries may join a stand-alone 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 beneficiaries age 65 and over who enrolled in Part D prescription
    drug plans or who were covered by retiree drug subsidy payments, June 2006 and
    October 2011
    Enrollment in millions
    25 r-
    20
 No low-income subsidy
Low-income subsidy
    15
    10
                12.3
                                      6.5
                                                             17.4
                                                                                   5.9
              Part D plan
Retiree drug subsidy
    Part D plan
Retiree drug subsidy
                         June 2006
                                                                     October 2011
    Reference population: These data referto Medicare beneficiaries.
    SOURCE: Centers for Medicare and Medicaid Services, Management Information Integrated Repository.
     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 23.8 million
     (58 percent of beneficiaries) in October 2011.
     In October 2011, 60 percent of plan enrollees
     were in stand-alone plans and 40 percent were
     in Medicare Advantage plans. Approximately
     5.9 million beneficiaries were covered by
     the retiree drug subsidy. Eleven million
     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.

                    •  In October 2011, 6.4 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.

                    Data for this indicator's charts and bullets can
                    be found in Tables 3la through 3Id on pages
                    138-139.
1900
        1910
                 1920
                                  1940
                                           1950
                   1960
                                                            1970
                                                                     1980
                                                                             1990
                                                                                      2000
                                                                                                2012

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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 to 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, 1991-2009
    Percent
    100 r-
     80
     60
     40
     20
             Private (Medigap)*
                                       y Private (employer- or union-sponsored)
             i
                  i
                       i
                           _L
                                 I
                                      I
                                           I
                                                                                              i
                                                                                                   i
      0
      1991  1992 1993 1994 1995 1996 1997  1998  1999  2000  2001  2002  2003  2004 2005 2006 2007 2008 2009

    * Includes people with private supplement of unknown sponsorship.
    NOTE: HMO/health plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and private fee-for-service
    plans (PFFS). 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). Chart excludes enrollees whose primary insurance is not Medicare (approximately 1 to 3 percent of
    enrollees). Medicaid coverage was determined from both survey responses and Medicare administrative records. TRICARE coverage was added
    to Medicare Current Beneficiary Survey Access to Care files beginning in 2003. Previous versions of Older Americans did not include data on
    TRICARE coverage. Adding TRICARE coverage changes the percentage of enrollees in the "No supplement" group.
    Reference population: These data refer to Medicare enrollees.
    SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
     Most Medicare enrollees have a private
     insurance supplement, either provided by
     a former employer or purchased as a Medigap
     policy. The percentage with Medicaid
     coverage has increased from 10 percent in
     2000 to  12 percent in 2009. Between 1991
     and 2009, 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 28 percent. About 9 percent of
     Medicare enrollees reported having no health
     insurance supplement in 2009.
                            •  While almost all older Americans have
                               health insurance via Medicare, a significant
                               proportion of people younger than age 65 have
                               no health insurance. In 2010, about 13 percent
                               of people age 55-64 were uninsured. The
                               percentage of people not covered by health
                               insurance varied by poverty status. In 2010,
                               about 31 percent of people age 55-64 who
                               lived either below the poverty level or below
                               200 percent of the poverty threshold had no
                               health insurance compared with 7 percent of
                               people who had incomes greater than or equal
                               to 200 percent of the poverty threshold.

                           Data for this indicator's charts and bullets can
                           be found in Tables 32a  and 32b on page 140.
1900
         1910
                  1920
                                    1940
                                             1950
                           1960
                                                               1970
                                                                        1980
                                                                                  1990
                                                                                          2000
                                                                                                     2012

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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.36-37 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
   people age 65 and over, by age group and income category, 1977 and 2009
                                            D  1977
   Percent
   100  i-
    80
    60
   40
    20
                Poor/near poor income category
             22
         12
                           3  2009

                           Percent
                           100  i-
                                                      80
                                                      60
                                                      40
                                                      20
                                        Low/middle/high income category
        65 and over    65-74
                                75-84    85 and over
                                                            5    5
                                                          65 and over    65-74
                                                                                  6    6
                                                                                   75-84    85 and over
   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. 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 over in 1977, and 4.5 percent of the
   population age 65 and over in 2004).
   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.
    The percentage of people age 65 and over
    with out-of-pocket spending for health care
    services increased between 1977 and 2009
    (from 83 percent to 94 percent).

    From 1977 to 2009 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 22 percent, whereas for the low/
    middle/high income category the percentages
    were lower (5 percent) for both years.

    In 2009, over two-fifths (41 percent) of out-
    of-pocket health care  spending by 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) and then decreased
                                starting in 2005.

                            •   In 2009, people age 85 and over spent a
                                lower proportion of out-of-pocket dollars
                                than people age 65-74 on dental services,
                                office-based medical provider visits, and
                                prescription drugs but a higher proportion
                                on hospital care and other health care
                                (primarily home health care).

                            Data for this indicator's charts and bullets can
                            be found in Tables 33a through 33c on pages
                            141-145.

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INDICATOR 34
Sources of Payment for Health Care Services
Medicare covers a little over one-half of the total health care costs of Medicare enrollees age 65 and over.
Medicare's payments are focused on acute care services such as hospitals and physicians. Historically,
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, 2008
Percent Average cost
$15,710 $260 $3,780 $520 _ $690 $4,170 $1,460 $2,530 $390 $1,900 perenrollee



80

60
40
20




-
1 £>







II

"




















8








— 1











— z
1






9












16






I







19




2












33



-






-1


22











X
7





52
/
Other



Out-of-pocket
Medicaid
, Medicare
0
All Hospice Inpatient Home Short- Physician/ Out- Pre- Dental Long-term
hospital health term medical patient scription care facility
care institution hospital drugs
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.
    Medicare paid for 60 percent of the health care
    costs of Medicare enrollees age 65 and over in
    2008. Medicare financed all of their hospice
    costs and most hospital, physician, home
    health care, and short-term institution costs.

    Medicaid covered 7 percent of health care
    costs of Medicare enrollees age 65  and over,
    and other payers (primarily private insurers)
    covered another 15 percent. Medicare
    enrollees age 65 and over paid 18 percent
    of their health care costs out-of-pocket, not
    including insurance premiums.

    In 2008, about 52 percent of long-term care
    facility costs for Medicare enrollees age 65
    and over were covered by Medicaid; another
    41 percent of these costs were paid out-of-
    pocket. Forty-five percent of prescription
    drug costs for Medicare enrollees age 65 and
    over were covered by Medicare, 33 percent
                             were covered by third-party payers other than
                             Medicare and Medicaid (consisting mostly
                             of private insurers), and 22 percent were paid
                             out-of-pocket. Seventy-six percent of dental
                             care received by older Americans was paid
                             out-of-pocket.

                         •   Other than Medicare, sources of payment for
                             health care varied by income. Individuals with
                             lower incomes relied heavily on Medicaid;
                             those with higher incomes relied more on
                             private insurance. As shown in Indicator 33
                             (Out-of-Pocket Health Care Expenditures),
                             people in the poor/near poor income category
                             spent a higher percentage of their household
                             income on health  care services than people in
                             the low/middle/high income category.

                         Data for this indicator's charts and bullets can
                         be found in Tables 34a and 34b on page 146.

-------
 INDICATOR 3 5
Veterans' Health  Care
 The number 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 long-term  care (nursing home care for eligible veterans and community-
 based care for all enrolled veterans) and specialized services for the disabled, including acute mental
 health services. In addition, as the largest integrated health care system in the country, VHA provides
 broad geographic access to these important services in rural and highly rural communities.
    Veterans age 65 and over who are enrolled in or are receiving care from the Veterans
    Health Administration, 1990-2011
    Millions
    12 r-
    10
VA health care  VA health care
reform begins enrollment begins
          VA patients age 65 and over
                                                Veteran population age 65 and over
                                                     VA enrollees age 65 and over
                                                                                            _L
                                                                                                j
     1990
              1992
                      1994
                               1996
                                       1998
                                                2000
                                                        2002
                                                                 2004
                                                                         2006
                                                                                  2008
                                                                                          20102011
    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, including those who received care but were
    not enrolled in VA.
    Reference population: These data refer to the total veteran population, VHA enrollment population, and VHA patient population.
    SOURCE: Department of Veterans Affairs, Veteran Population Projections; Office of the Assistant Deputy Undersecretary for Health for Policy
    and Planning, Fiscal 2011 Year-end Enrollment file linked with VHA Vital Status data (including data from VA, Medicare, and SSA).
     In 2011, approximately 2.6 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 2011.

     Older veterans continue to turn to VHA for
     their health care needs, despite their eligibility
     for other sources of health care. VHA
     estimates that about 38 percent of its enrollees
     age 65 and over are enrolled in Medicare Part
     D. Approximately 23 percent of enrollees
     age 65 and over have some form of private
     insurance. About 15 percent are enrolled in
     TRICARE for Life, and 14 percent are eligible
     for Medicaid. In contrast, about 5 percent of
                               VHA enrollees age 65 and over report having
                               no other public or private coverage.38

                           •  In rural and highly rural areas, the number of
                               VHA enrollees age 65 and over has increased
                               to about 47 percent of all enrollees. About
                               70 percent of older enrollees in these areas
                               used VHA health care in 2011. To further
                               enable veterans to receive quality health
                               care services within or near their home
                               communities, VHA has expanded Home-
                               Based Primary Care, telehealth and mobile
                               clinic services, transportation and outreach
                               services, and Project Access Received Closer
                               to Home (ARCH).

                           Data for this indicator's charts and bullets can
                           be found in Table 35 on page 147.
1900
         1910
                  1920
                                    1940
                                             1950
                          1960
                                                               1970
                                                                        1980
                                                                                 1990
                                                                                          2000
                                                                                                    2012

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INDICATOR 36
Residential Services
Most older Americans live independently in traditional communities. Others live in licensed long-term
care facilities, and some live in their communities and 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, 2009
   Percent
   100
    80
    60
    40
    20
                                                       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 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 3 or more beds, 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.
   Reference population: These data refer to Medicare beneficiaries.
   SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
    In 2009, about 3 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, 8 percent resided in community
    housing with services, and 14 percent
    resided in long-term care facilities. Among
    individuals age 65-74, about 97 percent
    resided in traditional community settings.
                                Among residents of community housing with
                                services, 84 percent reported access to meal
                                preparation services; 80 percent reported
                                access to housekeeping/cleaning services;
                                73 percent reported access to laundry
                                services; and 48 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.

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

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    Percentage of Medicare enrollees age 65 and over with functional limitations, by
    residential setting, 2009
    Percent
    100  r
      80
      60
     40
     20
                   18
                   13

                                                35
                                                14
                                                                            16
                                                                                        3 or more ADL limitations
           Traditional community
Community housing
   with services
                                                                            10
Long-term care
   facilities
                                                1-2 ADL limitations

                                                IADL limitations
                                                No functional limitations
    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 3 or more beds, 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. 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, toileting. Long-term care facility residents with no limitations may include
    individuals with limitations in certain lADLs such as doing light or heavy housework or meal preparation. These questions were not asked of
    facility residents.
    Reference population: These data referto Medicare beneficiaries.
    SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
      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. Fifty-one percent of individuals
      living in community housing with services
      had at least one activity of daily living (ADL)
      limitation compared with 26 percent of
      traditional community residents. Among  long-
      term care facility residents, 84 percent had at
      least one ADL limitation. Thirty-five percent
      of individuals living in community housing
      with services had no ADL or instrumental
      activities of daily living (IADL) limitations.

      The availability of personal services in
      residential settings may explain some of
      the observed decline in nursing  home use.
                    •  Residents of community housing with
                        services tended to have somewhat lower
                        incomes than traditional community residents,
                        and higher incomes than long-term care
                        facility residents. Forty-one percent of long-
                        term care facility residents had incomes of
                        $10,000 or less in 2009, compared with 11
                        percent of traditional community residents
                        and 17 percent of residents of community
                        housing with services.

                    •  Over one-half (53 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 through 36e on pages
                    148-149.
1900
          1910
                    1920
                                        1940
                                                  1950
                   1960
                                                                      1970
                                                                               1980
                                                                                         1990
                                                                                                   2000
                                                                                                               2012

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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 types of assistance, selected
    years 1992-2009
    Percent
    100 r
     80
     60
     40
     20
             42
             21
                         39
                         21
                                     35
                                     22
                                                 35
                                                 22
                                                             34
                                                             22
                                                                        32
                                                                        23
                                                                                None
                                                     Personal assistance
                                                     and equipment
                                                                                Equipment only
                                                                                Personal assistance only
            1992
                        1997
                                    2001
                                                2005
                                                            2007
                                                                        2009
    NOTE: ADL limitations refer to difficulty performing (or inability to perform fora 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 chart, personal
    assistance does not include supervision. Percents are age-adjusted using the 2000 standard population.
    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.
     Between 1992 and 2009, 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 32 percent.
     More people were 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.
                               In 2009, slightly more than 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 23 percent used both
                               personal assistance and equipment.

                               In 2009, there were no significant differences
                               in the percent of women and men with
                               limitations in ADLs who received personal
                               assistance only. However, men were more
                               likely than women to  receive no assistance
                               with their limitations.
1900
         1910
                  1920
                                    1940
                                            1950
                          1960
                                                               1970
                                                                       1980
                                                                                1990
                                                                                         2000
                                                                                                    2012

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    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 1992-2009
    Percent
    100 r
     80
     60
     40
     20
65-74  D 75-84  Q 85 and over
                    69
                                    71
                                                   74
                                                                  74
                63
            59
                           62
                                63
                                               67
                                          61
                                                              67
                                                          63
                                                                         65   66
                                                                                  70
                                                                                         65
                                                                                             67  68
               1992
                              1997
                                              2001
                                                             2005
                                                                             2007
                                                                                            2009
    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 chart, 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 1992, persons 85 and over who had
      difficulty with lADLs were more likely
      to receive personal assistance than those
      with IADL limitations, ages 65-74. In
      2009, the percentages between these two
      groups were similar.

      In 2009, two-thirds of people age 65 and over
      who had difficulty with one or more lADLs
      received personal assistance.
                •   Men age 75-84 were more likely than women
                    of the same age group to receive personal
                    assistance with their lADLs in 2009.

                Data for this indicator's charts and bullets can
                be found in Tables 37a through 37d on page 150.
1900
         1910
                  1920
                                     1940
                                              1950
               1960
                                                                1970
                                                                          1980
                                                                                   1990
                                                                                            2000
                                                                                                       2012

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Special Feature:
  End of Life

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  SPECIAL FEATURE
End of Life
 The end of life is a uniquely difficult time for patients and their families. Many issues tend to
 arise, including decisions about medical care, formal and informal caregiving, transitions in living
 arrangements among community, assisted living, and nursing homes, financial impacts, and whether
 to use advance directives and living wills. The previous edition of Older Americans identified this topic
 as one of the urgent data needs for which new data collection efforts are needed to address the lack of
 knowledge and research. While national data are still lacking in many areas, this special feature will
 highlight two important aspects of end-of-life care: the place of death and the type of care received
 (hospice and intensive care unit/coronary care unit [ICU/CCU]) in the month prior to death.

 The data on type of care received are derived from Medicare claims records. ICU/CCU use often
 represents an aggressive style of care, whereas hospice offers a contrasting style emphasizing
 palliation and psychosocial support. Many people receive both types of care at the end of life.
    Percentage of Medicare decedents age 65 and over who used hospice or intensive
    care unit/coronary care unit services in their last 30 days of life, for selected years
    1999-2009
    Percent
    100 r
     80
     60
    40
     20
                                                                 Hospice services
                                 Intensive care unit/
                                 coronary care unit services
      1999
                       2001
                                        2003
                                                         2005
                                                                          2007
                                                                                           2009
    NOTE: Chart is based on a 5 percent sample of deaths occurring between February and December of each year.
    Reference population: These data refer to Medicare enrollees in fee-for-service.
    SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
     Both hospice and ICU/CCU use are common
     in the last month of life. In 2009, 43 percent
     of elderly decedents used hospice services in
     the last 30 days of life, and 27 percent used
     ICU/CCU services.

     Use of hospice has increased substantially in
     recent years, from 19 percent of decedents in
     1999 to 43 percent in 2009. Use of ICU/CCU
     services has grown more slowly, from 22
     percent in 1999 to 27 percent in 2009.

     The primary diagnoses associated with
     hospice care have changed overtime.
                       Neoplasms accounted for 53 percent
                       of hospice stays in 1999 and only 32
                       percent in 2009. The next most common
                       primary diagnoses in 2009 were diseases
                       of the circulatory system (19 percent) and
                       symptoms, signs, and ill-defined conditions
                       (17 percent).

                       In 2009, length of stay in hospice varied
                       considerably, with 34 percent lasting 7 days
                       or less and 18 percent lasting more than 90
                       days. The percent of stays lasting more than
                       90 days increased from 13 percent in 1999
                       to 18 percent in 2009.
1900
        1910
                 1920
                                  1940
                                          1950
                  1960
                                                            1970
                                                                    1980
                                                                             1990
                                                                                     2000
                                                                                               2012

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Percentage of Medicare decedents age 65 and over who used hospice or intensive
care unit/coronary care unit services in their last 30 days of life, by age and sex, 2009
Percent
100 r
 80
 60
 40
 20
                                           Men
                                                   Women
                                        49*
                           44*     44
              38*
                      39
         32
                                                        32
                                                             34*
                                                                    31    31
                                                                                 26
                                                                                      20*
         Age 65-74
Age 75-84   Age 85 and over
Age 65-74
Age 75-84   Age 85 and over
                    Hospice use
                                   Intensive care unit/coronary care unit use
* p < 0.05 for difference between men and women.
NOTE: Chart is based on a 5 percent sample of deaths occuring between February and December of 2009.
Reference population: These data referto Medicare enrollees in fee-for-service.
SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
  Use of hospice services increased with age
  of decedent. Among women, 38 percent of
  those dying at age 65-74 received hospice
  care, compared with 49 percent of those age
  85 and over.

  Hospice care was much more common among
  White decedents than among Black decedents
  or those of other races. In 2009, 44 percent
  of White decedents received hospice services
  in the last 30 days of life, compared with 34
  percent of Blacks and 31 percent of decedents
  of other races.

  In contrast to hospice, the use of ICU/CCU
  services decreased with increasing age of
                               decedents, especially for those dying at age
                               85 and over.

                           •  Use of ICU/CCU services tended to be lower
                               among White decedents than among Black
                               decedents or those of other races, while
                               differences within age and sex groups were
                               not always  statistically significant. Overall,
                               26 percent of White decedents used ICU/CCU
                               services in the last 30 days of life compared
                               with 32 percent of Black decedents and 33
                               percent of decedents of other races.

                           Data for this indicator's charts and bullets can
                           be found in Tables ELI through EL5 on pages
                           151-152.

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  SPECIAL FEATURE
End of Life
 U.S. death certificates record the place of death of decedents. Where a person dies is the outcome of
 many factors, including cause of death, personal preferences, cultural beliefs, availability of social
 support, and access to medical and hospice care, among others. The trends in place of death of older
 Americans offer insights into the changing nature  of end-of-life care in the United States.
    Percent distribution of decedents age 65 and over by place of death, 1989-2009
    Percent
    100  r
     80
     60
     40
     20
                  Hospital-inpatient
                 —
                  Nursing home/long-term care facilities
      1989
                                1995
                                                      2000
                                                                            2005
                                                                                              2009
    NOTE: "Other" includes hospital outpatient or emergency department, including dead on arrival, inpatient hospice facilities, and all other places
    and unknown. Beginning in 2003, the term "long-term care facility" was added to the nursing home check box on the death certificate.
    Reference population: These data refer to the resident population.
    SOURCE: National Vital Statistics System. Mortality public use data files, 1989-2009.
     Nearly 1.8 million deaths occurred among
     persons age 65 and over in 2009. Thirty-two
     percent of these deaths occurred while the
     decedent was a hospital inpatient, and 27
     percent were in nursing homes or other long-
     term care facilities. Twenty-four percent of
     deaths to persons age 65 and over occurred
     at home.

     The percent of deaths that occurred while
     the decedent was a hospital inpatient declined
     over time, from 49 percent of all deaths to
                        persons 65 and over in 1989 to 32 percent in
                        2009. In addition, the percent of decedents
                        age 65 and over who died at home has
                        increased from 15 percent in 1989 to 24
                        percent in 2009.

                        In 2009, women age 65 and over were more
                        likely than men to die in nursing homes or
                        long-term care facilities (31 percent of female
                        decedents compared with 21 percent of male
                        decedents).
1900
         1910
                 1920
                                   1940
                                            1950
                   1960
                                                              1970
                                                                      1980
                                                                               1990
                                                                                        2000
                                                                                                  2012

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Percent distribution of decedents age 65 and over by place of death and race and
ethnicity, 2009
Percent
100 r
 80
 60
Non-Hispanic
White
Non-Hispanic
Black
                                                Hispanic
                              American Indian or
                              Alaska Native
Asian or
Pacific Islander
 40
 20
           38
               41  41
       31
                                                            28
                                                                27
                                                                    24
                                                                              22


16



15

14
15


          Hospital-inpatient
   Nursing home/
long-term care facilities
                                                         Residence
                                                                                  Other
NOTE: "Other" includes hospital outpatient or emergency department, including dead on arrival, inpatient hospice facilities, and all other places
and unknown.
Reference population: These data referto the resident population.
SOURCE: National Vital Statistics System. Mortality public use data files, 2009.
  The place of death for persons age 65 and
  over varied by race and ethnicity. In 2009,
  the percent of deaths occurring while a
  hospital inpatient was lower for non-Hispanic
  White decedents compared with other racial
  and ethnic groups. The percent of deaths in a
  nursing home or long-term care facility was
  higher for non-Hispanic Whites compared
  with other groups.

  The percent of decedents dying at home
  varied only slightly among racial and ethnic
  groups, with non-Hispanic Black decedents
  having the lowest percent of deaths at home
  (21 percent).
                     •   Place of death also varied by age within
                         the 65 and overpopulation. In 2009, 38
                         percent of decedents age 85  and over died
                         in a nursing home or long-term care facility,
                         compared with 12 percent of decedents age
                         65-74. Younger decedents were more likely
                         to die while a hospital inpatient compared
                         with older decedents.

                     Data for this indicator's charts and bullets can
                     be found in Tables EL6 through EL9 on pages
                     153-154.

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Data Needs

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In a previous version of Older Americans, the
Federal Interagency Forum on Aging-Related
Statistics (Forum) identified six areas where better
data were needed to support research and policy
efforts related to older Americans: caregiving,
elder abuse, functioning and disability, mental
health and cognitive functioning, pension
measures, and residential care. In this report, the
Forum updates those areas and identifies new data
sources when available. The report also includes
a special feature on end-of-life issues. As statistics
in these areas improve, the Forum will consider
expanding the list of existing indicators for
inclusion in future editions of Older Americans.

Informal 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. Informal family caregivers of older
people with high levels of personal care needs
can face considerable strain providing such care.

Data on this aspect of caregiving is still needed;
however, to begin addressing these concerns, the
National Health and Aging Trends Study (NHATS)
was initiated. NHATS, a representative study of
older adults, along with a supplemental survey
of informal caregivers, the National Study of
Caregiving (NSOC), will provide researchers and
policy makers with improved national estimates
of caregiving and its impact on care recipients and
caregivers. Annual NHATS data collection began
in May, 2011; NSOC data collection ended in
November, 2011. Public use files are planned for
release in 2012.39

Residential 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 characteristics of
facilities and the people living in these settings.

Recently completed, the 2010 National Survey of
Residential Care Facilities (NSRCF)—the first-
ever national survey of residential care providers
with as few as four beds—will fill essential data
gaps related to residential care facilities such as
assisted living communities. With the NSRCF,
both facility- and resident-level data can be
generated to produce estimates of residential
care facilities and their residents. The NSRCF
public use data files were released in December,
2011 and two initial National Center for Health
Statistics (NCHS) Data Briefs, one on facilities
and the other on residents, have been published.40

The NSRCF will fill many data gaps, but it is a
one-time survey. Its replacement is the National
Study of Long-Term Care Providers (NSLTCP),
which is intended to provide national and state
estimates, where possible, of the supply and use
of major types of paid, regulated long-term care
providers. NSLTCP includes residential care
facilities and adult day services centers using
survey data and home  health care agencies,
hospices and nursing homes using administrative
data. The NSLTCP survey components will be
fielded for the first time starting in late 2012.
The NSLTCP survey will not routinely collect
person-level data on a sample of residents  as the
NSRCF did;41 however, NSLTCP can be used as
a platform to which components may be added to
obtain person-level data.

Elder Abuse

Several expert panels and committees have
reported a "paucity of research" on elder abuse
and neglect. In response to this gap, the National
Institute on Aging (NIA) funded a series of
grants to develop survey methodologies for
abuse and neglect surveillance.42 The CDC (with
the assistance of the member agencies of the
Elder Justice Working Group) has developed
preliminary  definitions for elder abuse as a first
step in designing recommended data elements for
use in elder abuse surveillance.43 Additionally,
a new indicator is being included in the Healthy
People 2020 initiative, increasing the number of

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states that collect and publicly report incidences
of elder abuse.44 In 2010, the National Academy
of Sciences issued a report of a state-of-the-
science meeting of leading experts on elder abuse
held jointly by the National Institute on Aging
and the National Academy of Sciences.45 The
report highlights recent advances and  continuing
challenges. As part of the effort to meet these
challenges, for example, the CDC integrated
questions on elder abuse in a survey on intimate
partner violence that will provide routine data,
a promising prelude to CDC undertaking a full-
scale national prevalence and incidence survey.44
The NAS panel also agreed that more  innovative
methods are needed to gather longitudinal data
in this sensitive and complex area.

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.

Recent developments in the area of measurement
of functioning and disability among the older
population include:

•  Adoption of a common set of disability
    questions originally developed for use on
    the American Community Survey  (ACS),
    across Federal surveys. The National Health
    Interview Survey (NHIS) has added these
    new measures, which will enable continued
    comparison and testing of questions.46

•  Ongoing data collection of the National
    Health and Aging Trends Study  (NHATS),
    which will provide new estimates  of multiple
    components of disability.

•  Ongoing work of the UN-sponsored
    Washington Group on Disability Statistics
    to test and field a comparable set of disability
    questions across countries.4
Mental Health and Cognitive
Functioning

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 Initiative48 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. In 2011,  an
expert group meeting reviewed results of tested
survey measures and began to develop an
implementation project.

Although there are several studies which report
estimates of the prevalence of Alzheimer's
Disease (AD) and other age-related cognitive
impairment, 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 AD.
A meeting convened by the National Institute on
Aging (NIA) in 2009 to describe the prevalence
of AD and other age-related cognitive impairment
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.49 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.
The Toolbox will represent an attractive option
for researchers wishing to obtain state-of-the-art
data on cognition, emotion, sensation, and motor
function. NIH Toolbox will be available for use
in Fall 2012, and norms based on a nationally
representative sample of over 5000 English and
Spanish speakers between the ages of 3 and 85
will also be available (http://www.nihtoolbox.org/
default, aspx).

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Pension Measures
End-of-Life Issues
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 40Iks)
would result in improved measurement of
retirement income. For Older Americans 2012,
the Forum has modified Indicator 10 (Net Worth)
to better incorporate all types of wealth, including
pension wealth, using the Federal Reserve Board's
Survey of Consumer Finances (SCF). Previously,
the Panel Study of Income Dynamics was used to
measure Net Worth instead of the SCF.

Additionally, the Forum is working on a report
that documents the ongoing shift towards
defined-contribution plans and IRAs. The report
provides different measurements of yearly
pension withdrawals—the disparities in these
measurements highlight the difficulties of
measuring income for older Americans.
The previous edition of Older Americans
identified end-of-life issues as an urgent data
need requiring new data collection efforts.
This year's report addresses some of those data
needs by including an end-of-life special feature
highlighting two important aspects: the place of
death and the type of care received (hospice and
intensive care unit/coronary care unit (ICU/CCU))
in the month prior to death.

The end of life has been the subject of many
studies and reports, including the Health, United
States, 2010 which presents a special feature on
death and dying.50 Data are presented on trends
in the leading causes of death by age group
and place of death, as well as characteristics of
patients receiving hospice care and the services
received by hospice care patients' families. Types
of medications patients receive from hospice
care are also highlighted. State data include
preventable deaths (e.g., motor-vehicle traffic
fatalities) and average number of intensive care
days in the last 6 months of life for Medicare
beneficiaries.40

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References

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37 Rasell, E., Bernstein, J., and Tang, K. (1994).
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definitions.html.


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Tables

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INDICATOR  1
Number of Older Americans
 Table 1a.  Number of people age 65 and over and age 85 and over, selected years 1900-2010 and projected 2020-2050
Year
Estimates
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
2005
2010
Projections
2020
2030
2040
2050
65 and over
In millions
3.1
3.9
4.9
6.6
9.0
12.3
16.2
20.1
25.5
31.2
35.0
36.7
40.3

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
4.7
5.5

6.6
8.7
14.2
19.0
 NOTE: These projections are based on Census 2000 and are not consistent with the 2010 Census results. Projections based on the 2010 Census will be released in late 2012.
 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 1; U.S. Census Bureau, Table
 1: Intercensal Estimates of the Resident Population by Sex and Age for the U.S.: April 1, 2000 to July 1, 2010 (US-ESTOOINT-01); U.S. Census Bureau, 2011. 2010 Census
 Summary File 1; U.S. Census Bureau, Table 2: Projections of the population by selected age groups and sex for the United States: 2010-2050 (NP2008-t2).
 Table 1b.  Percentage of people age 65 and over and age 85 and over from the 2010 Census and projected 2020-2050
Year
Estimates
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
2000
2005
2010
Projections
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
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
1.6
1.8

1.9
2.3
3.5
4.3
 NOTE: These projections are based on Census 2000 and are not consistent with the 2010 Census results. Projections based on the 2010 Census will be released in late 2012.
 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 1; U.S. Census Bureau,
 Table 1: Intercensal Estimates of the Resident Population by Sex and Age for the U.S.: April 1, 2000 to July 1, 2010 (US-ESTOOINT-01); U.S. Census Bureau, 2011. 2010
 Census Summary File 1; U.S. Census Bureau, 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
Table 1c. Population of countries or areas with at least 10 percent of their population age 65 and over, 2010
Country or area
Japan
Germany
Italy
Greece
Sweden
Austria
Bulgaria
Portugal
Belgium
Estonia
Finland
Latvia
Spain
Croatia
Hungary
Switzerland
Serbia
Denmark
Slovenia
France
United Kingdom
Lithuania
Georgia
Czech Republic
Norway
Ukraine
Canada
Netherlands
Bosnia and Herzegovina
Romania
Puerto Rico
Belarus
Australia
Uruguay
Montenegro
Poland
Russia
Hong Kong
Population
Total
127,579
81 ,644
60,749
10,750
9,074
8,214
7,149
10,736
10,423
1,291
5,255
2,218
46,506
4,487
9,992
7,623
7,345
5,516
2,003
64,768
62,348
3,545
4,601
10,202
4,676
45,416
33,760
16,574
4,622
21,959
3,979
9,613
21,516
3,301
666,730
38,464
139,390
7,090
(number in thousands)
65 and over
29,103
16,803
12,206
2,081
1,749
1,490
1,279
1,906
1,853
227
905
377
7,869
757
1,665
1,267
1,221
914
333
10,692
10,157
578
743
1,619
728
7,045
5,231
2,570
688
3,248
579
1,367
2,957
450
90
5,174
18,516
946
Percent
65 and over
22.8
20.6
20.1
19.4
19.3
18.1
17.9
17.8
17.8
17.6
17.2
17.0
16.9
16.9
16.7
16.6
16.6
16.6
16.6
16.5
16.3
16.3
16.2
15.9
15.6 rr
15.5
^^
15.5
15.5 ^
14.9 ^
14.8
14.6
14.2
13.7
13.6
13.5
13.5
13.3
13.3
See notes at end of table.

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INDICATOR  1
Number of Older Americans
Table 1c. Population of countries or areas with at least 10 percent of their population age 65 and over, 2010—continued
Country or area
United States*
New Zealand
Slovakia
Macedonia
Cuba
Ireland
Korea, South
Argentina
Taiwan
Moldova
Albania
Armenia
Cyprus
Israel
Population
Total
308,746
4,252
5,470
2,072
11,098
4,623
48,636
41 ,343
23,025
3,732
2,987
2,967
1,103
7,354
(number in thousands)
65 and over
40,268
552
690
239
1,260
524
5,392
4,514
2,487
402
307
305
112
733
Percent
65 and over
13.0
13.0
12.6
11.5
11.4
11.3
11.1
10.9
10.8
10.8
10.3
10.3
10.2
10.0
* These data are from the 2010 Census, not from the I nternational Data Base.
NOTE: Table excludes countries and areas with less than 1,000,000 population.
SOURCE: U.S. Census Bureau, International Data Base, accessed on December 19, 2011; U.S. Census Bureau, 2010 Census Summary File 1.

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INDICATOR 1
Number of Older Americans
Table 1d. Percentage of the population age 65 and over, by state, 2010
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
13.0
13.8
7.7
13.8
14.4
11.4
10.9
14.2
14.4
11.4
17.3
10.7
14.3
12.4
12.5
13.0
14.9
13.2
13.3
12.3
15.9
12.3
13.8
13.8
12.9
12.8
14.0
14.8
13.5
12.0
13.5
13.5
13.2
13.5
12.9
14.5
14.1
13.5
13.9
15.4
14.4
13.7
14.3
13.4
10.3
9.0
14.6
12.2
12.3
16.0
13.7
12.4
14.5
State (ranked by percentage)
United States
Florida
West Virginia
Maine
Pennsylvania
Iowa
Montana
Vermont
North Dakota
Rhode Island
Arkansas
Delaware
Hawaii
South Dakota
Connecticut
Ohio
Missouri
Oregon
Arizona
Massachusetts
Michigan
Alabama
Wisconsin
South Carolina
New Hampshire
New York
Oklahoma
Nebraska
New Jersey
Tennessee
Kentucky
New Mexico
Kansas
Indiana
North Carolina
Minnesota
Mississippi
Illinois
Wyoming
Idaho
Washington
Louisiana
Maryland
Virginia
Nevada
District of Columbia
California
Colorado
Georgia
Texas
Utah
Alaska
Puerto Rico
Percent
13.0
17.3
16.0
15.9
15.4
14.9
14.8
14.6
14.5
14.4
14.4
14.4
14.3
14.3
14.2
14.1
14.0
13.9
13.8
13.8
13.8
13.8
13.7
13.7
13.5
13.5
13.5
13.5
13.5
13.4 ^
13.3 9£
13.2 Q
13.2 ^
13.0 ft
12.9 ^
12.9
12.8
12.5
12.4
12.4
12.3
12.3
12.3
12.2
12.0
11.4
11.4
10.9
10.7
10.3
9.0
7.7
14.5
Reference population: These data refer to the resident population.
SOURCE: U.S. Census Bureau, 2070 Census Summary File 1.

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INDICATOR  1
Number of Older Americans
Table 1e.  Percentage of the population age 65 and over, by county, 2010

Reference population: These data refer to the resident population.
SOURCE: U.S. Census Bureau, 2010 Census Summary File 1.
Data for this table can be found at http://www.agingstats.gov.
Table 1f.  Number and percentage of people age 65 and over and age 85 and over, by sex, 2010
Age and sex
                            Number (in thousands)
 Reference population: These data refer to the resident population.
 SOURCE: U.S. Census Bureau, 2010 Census Summary File 1.
                                                                                                                  Percent
65 and over
Total
Men
Women
85 and over
Total
Men
Women

40,268
17,363
22,905

5,493
1,790
3,704

100.0
43.1
56.9

100.0
32.6
67.4
INDICATOR 2
Racial  and Ethnic Composition
Table 2.  Population age 65 and over, by race and Hispanic origin, 2010 and projected 2050

                                                     2070 Census
                                                                                                2050 projections
Race and Hispanic origin
Total
Non-Hispanic White alone
Black alone
Asian alone
All other races alone or in combination
Hispanic (of any race)
Number (in thousands)
40,268
32,209
3,438
1,387
638
2,782
Percent
100.0
80.0
8.5
3.4
1.6
6.9
Number (in thousands)
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: These projections are based on Census 2000 and are not consistent with the 2010 Census results. Projections based on the 2010 Census will be released in late 2012.
 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 table 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, 2011. 2070 Census Summary File 1; U.S. Census Bureau, Table 4: Projections of the population by sex, race, and Hispanic origin for the
 United States: 2010-2050 (NP2008-t4).

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INDICATOR 3
Marital  Status
Table 3.  Marital status of the population age 65 and over, by age group and sex, 2010
Sex and marital status
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
57.6
28.1
10.0
4.3

100.0
74.5
12.7
8.7
4.1

100.0
44.5
39.9
11.1
4.5
65-74
Percent
100.0
66.2
15.8
13.1
4.9

100.0
78.0
6.4
11.0
4.5

100.0
55.9
24.0
15.0
5.1
75-84

100.0
52.8
36.5
7.1
3.6

100.0
73.2
17.2
6.1
3.5

100.0
38.1
50.4
7.9
3.6
85 and over

100.0
32.0
59.6
4.4
4.0

100.0
58.3
34.6
3.9
3.2

100.0
18.0
72.9
4.7
4.5
 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, 2010.
                                                                                                                          I
                                                                                                                          fir

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INDICATOR 4
Educational Attainment
 Table 4a. Educational attainment of the population age 65 and over, selected years 1965-2010
Educational attainment

High school graduate or more
Bachelor's degree or more

High school graduate or more
Bachelor's degree or more
7965

23.5
5.0
2002
69.9
16.7
7970

28.3
6.3
2003
71.5
17.4
7975

37.3
8.1
2004
73.1
18.7
7980

40.7
8.6
2005
74.0
18.9
7985
Percent
48.2
9.4
2006
75.2
19.5
7990

55.4
11.6
2007
76.1
19.2
7995

63.8
13.0
2008
77.4
20.5
2000

69.5
15.6
2009
78.3
21.7
2007

70.0
16.2
2070
79.5
22.5
 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, 2010.
 Table 4b. Educational attainment of the population age 65 and over, by sex and race and Hispanic origin, 2010
 Race and Hispanic origin and sex
                   High school graduate or more
Bachelor's degree or more

Both sexes
Non-Hispanic White alone
Black alone
Asian alone
Hispanic (of any race)
Men
Women
Percent
79.5
84.3
64.8
73.6
47.0
80.1
79.0

22.5
24.1
14.5
35.1
9.5
28.4
18.0
 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 table 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, 2010.

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INDICATOR 5
Living Arrangements
 Table 5a.  Living arrangements of the population age 65 and over, by sex and race and Hispanic origin, 2010
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 With other relatives With nonrelatives

71.7
74.0
54.8
78.7
61.9

42.4
44.9
23.5
44.4
38.7
Percent
5.9
4.2
11.5
7.5
17.4

17.9
13.3
35.2
33.0
35.8

3.4
3.1
5.3
2.0
5.3

2.4
2.6
2.0
1.5
2.0
Alone

19.0
18.7
28.4
11.9
15.4

37.3
39.1
39.3
21.1
23.4
 NOTE: The calculation of the living arrangements estimates in this table changed from the previous edition of Older Americans to more accurately reflect the person's
 relationship to the householder, rather than an indication of whether the householder had relatives present in the household. 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 table 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, 2010.
 Table 5b.  Population age 65 and over living alone, by sex and age group, selected years 1970-2010
Year

1970
1980
1990
2000
2003
2004
2005
2006
2007
2008
2009
2010

65-74

11.3
11.6
13.0
13.8
15.6
15.5
16.1
16.9
16.7
16.3
—
16.4
Men
75 and over
Percent
19.1
21.6
20.9
21.4
22.9
23.2
23.2
22.7
22.0
21.5
—
22.6
Women
65-74

31.7
35.6
33.2
30.6
29.6
29.4
28.9
28.5
28.0
29.1
—
27.7
75 and over

37.0
49.4
54.0
49.5
49.8
49.9
47.8
48.0
48.8
50.1
—
47.4
— Not available.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2010.
                                                                                                                                                I
                                                                                                                                                fir

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INDICATOR 6
Older Veterans
Table 6a. Percentage of population age 65 and over who are veterans, by age group and sex, United States and Puerto
          Rico, 2000, 2010 and projected 2020
65 and over
Year
Estimates
2000
2010
Projections
2020
Men

64.3
51.3

34.7
Women

1.7
1.3

1.5
65-74
Men

65.2
42.8

27.7
Women

1.1
1.1

1.7
75-84
Men

70.9
60.8

42.6
Women

2.7
1.1

1.1
85 and over
Men

32.6
68.3

56.6
Women

1.0
2.5

1.4
 Reference population: These data refer to the resident population of the United States and Puerto Rico.
 SOURCE: U.S. Census Bureau, Population Projections 2008, and 2010 Census Summary File 1; Department of Veterans Affairs, VetPop2011.
Table 6b. Estimated and projected number of veterans age 65 and over, by age group and sex, United States and Puerto
          Rico, 2000, 2010, and projected 2020
Age group and sex

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)

9,169
8,866
303

4,377
4,253
124

3,403
3,321
82

1,389
1,292
97
Projections
2020


8,892
8,444
448

4,467
4,173
294

3,039
2,944
95

1,387
1,327
60
 Reference population: These data refer to the resident population of the United States and Puerto Rico.
 SOURCE: U.S. Census Bureau, Population Projections 2008, and 2010 Census Summary File 1; Department of Veterans Affairs, VetPop2011.

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INDICATOR 7
Poverty
Table 7a. Percentage of the population living in poverty, by age group, 1959-2010
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
65 and over
35.2
—
—
—
—
—
—
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
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
78-64
17.0
—
—
—
—
—
—
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
65-74
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
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
75-84
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
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
85 and over























21.2
21.3
18.4
18.7
17.6
R
17.8 ^
18.4
20.2
18.9
19.9
19.7
18.0
15.7
16.5
15.7
14.2
14.2
See notes at end of table.

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INDICATOR 7
Poverty
 Table 7a.  Percentage of the population living in poverty, by age group, 1959-2010—continued
Year
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
65 and over
9.9
10.1
10.4
10.2
9.8
10.1
9.4
9.7
9.7
8.9
9.0
Under 18
16.2
16.3
16.7
17.6
17.8
17.6
17.4
18.0
19.0
20.7
22.0
18-64
9.6
10.1
10.6
10.8
11.3
11.1
10.8
10.9
11.7
12.9
13.7
65-74
8.6
9.2
9.4
9.0
9.4
8.9
8.6
8.8
8.4
8.0
8.1
75-84
10.6
10.4
11.1
11.0
9.7
10.9
10.0
9.8
10.7
9.4
9.2
85 and over
14.5
13.9
13.6
13.8
12.6
13.4
11.4
13.0
12.7
11.6
12.3
— 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. 239. 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, 2011.
 Table 7b. Percentage of the population age 65 and over living in poverty, by selected characteristics, 2010
Selected characteristic
65 and over, 65 and over,
65 and over living alone married couples
65-74
75 and over
Percent
Both Sexes
Total
Non-Hispanic White alone
Black alone
Asian alone
Hispanic (of any race)
Male
Total
Non-Hispanic White alone
Black alone
Asian alone
Hispanic (of any race)
Female
Total
Non-Hispanic White alone
Black alone
Asian alone
Hispanic (of any race)

9.0
6.8
18.0
14.6
18.0

6.7
5.0
14.2
14.0
14.2

10.7
8.3
20.5
15.1
20.9

16.8
13.3
30.9
30.4
35.2

14.6
11.2
29.7
33.0
24.0

17.8
14.2
31.4
29.3
41.5

4.2
3.1
6.6
11.3
10.2

4.2
3.1
6.5
11.2
10.8

4.2
3.1
6.7
11.5
9.5

8.1
5.8
16.2
13.3
17.3

6.5
4.6
14.8
12.8
13.9

9.5
6.9
17.2
13.6
19.9

10.0
7.9
20.7
16.7
19.0

7.0
5.4
13.3
15.8
14.5

12.1
9.7
24.7
17.4
22.4
 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. 239. 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 table 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, 2011.

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INDICATOR  8
Income
 Table 8a.  Income distribution of the population age 65 and over, 1974-2010
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
2008
2009
2010
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
9.7
8.9
9.0
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
26.5
24.8
25.6
Middle income
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
33.7
35.1
34.0
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
30.1
31.2
31.4
























1
fir







 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. Income distribution 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, 2011.

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INDICATOR 8
Income
Table 8b.  Median income of householders age 65 and over, in current and in 2010 dollars, 1974-2010
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
2008
2009
2010
Number (in thousands)
1 4,263
1 4,802
14,816
15,225
15,795
1 6,544
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
24,834
25,270
25,362
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
29,744
31 ,354
31 ,408
2070 dollars
21,102
20,579
20,773
20,802
21,718
22,053
22,122
22,780
23,952
24,380
25,582
25,612
26,278
26,517
26,429
26,776
27,257
26,501
26,090
26,375
26,324
27,128
26,911
28,120
29,026
29,831
29,226
28,471
28,059
28,199
28,299
29,078
30,061
29,764
30,120
31 ,872
31 ,408
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 1975-2011.

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INDICATOR 9
                                 Sources of Income
 Table 9a.
             Percentage distribution of sources of income for married couples and nonmarried persons age 65 and over,
             1962-2010
Year
1962
1967
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
1999
2000
2001
2002
2003
2004
2005
2006
2008
2009
2010
Total
100
100
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
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
11
11
Pensions
9
12
16
16
16
15
15
16
17
18
20
19
19
19
19
18
18
19
19
20
19
18
19
19
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
30
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
3
3
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, unemployment compensation, workers compensation, alimony, child support, and personal contributors.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Current Population Survey, Annual Social and Economic Supplement, 1977-2011.



Table 9b.   Percentage distribution of sources of income for married couples and nonmarried persons age 65 and over,
            by income quintile, 2010
Source of income
Total
Percentage of income from
Earnings
Retirement benefits
Social Security
Railroad Retirement
Government employee pensions
Private pensions or annuities
Income from assets
Cash public assistance
Other
Number (in thousands)

First
100.0

2.4
87.2
84.3
0.2
0.9
1.8
1.8
7.0
1.6
5,900

Second
100.0

4.1
90.2
83.3
0.5
2.3
4.1
2.6
1.6
1.4
5,900
All units
Third
100.0

9.6
81.7
65.7
0.5
6.0
9.4
5.4
0.5
2.8
5,900

Fourth
100.0

19.4
69.3
43.5
0.8
12.3
12.7
7.8
0.2
3.3
5,900

Fifth
100.0

44.9
36.4
17.3
0.2
10.3
8.6
16.1
0.1
2.4
5,900
 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, unemployment compensation, workers compensation, alimony, child support, and personal contributors. Quintile limits are $12,554, $20,145,
 $32,602, and $56,957 for all units; $24,470, $36,967, $54,360, and $86,754 for married couples; and $10,145, $14,966, $21,157, and $35,405 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, 2011.
                                                                                                                                           I
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INDICATOR 9
Sources  of Income
Table 9c.  Percentage of people age 55 and over with family income from specified sources, by age group, 2010
Age 65 and over
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 (in thousands)
Age
55-61
84.3
81.0
11.7
31.5
20.8
17.6
8.5
0.2
8.3
1.7
1.8
5.0
9.9
56.2
53.3
27.3
23.2
8.1
0.3
3.4
10.8
1.4
12.1
6.2
5.6
0.9
9.5
7.4
2.9
2.5
2.2
26,829
Age
62-64
72.6
68.5
10.5
61.3
51.5
32.1
13.7
0.5
13.3
1.9
3.3
8.4
20.1
57.6
55.5
27.5
23.5
8.5
0.3
5.1
9.0
1.2
11.5
5.5
4.8
0.8
8.8
6.6
2.5
2.4
1.8
10,155
Total
38.2
35.2
6.4
90.9
88.0
43.0
17.1
0.7
16.5
2.3
4.5
10.6
28.9
56.9
53.8
27.1
22.0
9.1
0.4
4.2
3.9
0.6
12.2
4.6
4.1
0.6
10.0
6.3
3.3
3.8
1.4
39,179
65-69
56.2
52.2
9.5
84.8
80.4
40.2
17.5
0.7
16.8
2.1
4.2
11.7
25.3
58.5
55.2
29.5
24.1
9.9
0.5
3.8
5.4
0.8
11.2
4.8
4.4
0.6
9.0
6.1
3.1
3.0
1.5
12,160
70-74
40.1
36.8
6.8
92.7
90.3
43.7
17.2
0.8
16.6
1.9
4.4
11.1
30.2
55.6
52.6
27.7
22.8
8.9
0.3
3.5
4.1
0.6
11.8
4.3
3.8
0.6
9.8
6.3
3.3
3.7
1.1
9,254
75-79
30.2
27.9
4.7
93.8
91.4
45.9
18.4
0.9
17.6
2.5
5.2
11.0
30.9
56.4
53.9
26.3
20.7
9.6
0.2
4.4
3.0
0.4
13.8
5.1
4.6
0.5
11.5
7.1
3.6
4.6
1.3
7,088
80 and
over
21.4
19.3
3.6
94.3
92.5
43.5
15.9
0.6
15.4
2.8
4.7
8.6
30.6
56.5
53.2
24.5
19.7
8.1
0.4
5.1
2.6
0.6
12.5
4.3
3.8
0.5
10.3
5.8
3.2
4.1
1.5
10,676
Reference population: These data refer to the civilian noninstitutional population.
SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2011.

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INDICATOR 10
Net Worth
Table 10a.  Median household net worth of head of household, in 2007 dollars, by selected characteristics and selected
            years 1983-2007
                                                                               In dollars
 Selected characteristic
                                                1983
                                                          1989
                                                                    1992
                                                                              1995
                                                                                        1998
                                                                                                  2001
                                                                                                             2004
                                                                                                                       2007
Age of family head
   65 and over
   45-54
   55-64
   65-74
   75 and over
Marital status, family head age 65 and over3
   Married
   Unmarried
Race, family head age 65 and over
   White
   Black
Education, family head age 65 and over
   No high school diploma
   High school diploma only
   Some college or more
            $103,750  $122,510  $132,780 $136,530 $175,040  $196,960  $195,380 $220,800
             109,360   157,930   113,310   125,320   134,490   157,100   159,030  185,000
             136,880   158,040   164,680   156,160   162,840   216,700   276,770  253,700
             121,110   124,930   142,830   150,000   186,520   208,190   208,890  239,400
              71,080   116,800   125,750   125,730   160,170   182,870   179,130  213,200

             139,870   216,130   219,390   216,570   270,300   332,050   311,030  300,500
              67,240    67,620    92,760   103,800   115,770   108,770   132,400  165,090

             122,320   154,870   157,590   158,310   200,400   252,400   231,110  248,300
              17,960    36,770    40,270    33,800    35,960    57,140    57,660   87,800

              58,030    64,400    56,310    77,600    69,260    85,850    59,830  101,800
             132,980   128,790   157,280   144,260   186,270   191,980   193,080  187,200
             283,200   392,960   284,930   274,160   307,730   464,630   394,280  510,750
a Married includes legally married couples; unmarried includes cohabitating couples, separated, divorced, widowed, and never married.
NOTE: The Survey of Consumer Finances has replaced the Panel Study of Income Dynamics as the data source for this indicator. Median net worth is measured in constant
2007 dollars. Net worth includes housing wealth, financial assets, and investment retirement accounts such as IRAs, Keoghs, and 401 (k) type plans. Data are weighted. The
term "household" here is similar to the Census Bureau's household definition. See Indicator 10 data source for more detail.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Survey of Consumer Finances.
Table 10b. Value of household financial assets held in retirement investment accounts by selected characteristics, 2007


In dollars


25th percentile (for Median (for 75th percentile (for
households with households with households with
Selected characteristic positive values) positive values) positive values) Percent holding
Age of family head
65 and over
45-54
55-64
65-74
75 and over
Marital status, family head age 65 and over3
Married
Unmarried
Race, family head age 65 and over
White
Black
Education, family head age 65 and over
No high school diploma
High school diploma only
Some college or more

$16,000
21 ,000
29,000
20,000
13,000

15,000
7,000

13,000
7,000

5,000
7,000
15,000

$61,000
66,000
98,000
77,000
35,000

61,000
27,000

51,000
25,000

15,000
29,000
60,000

$180,000
176,000
267,000
206,000
110,000

177,000
82,000

157,000
65,000

48,000
78,000
181,000

40.8
64.9
60.9
51.7
30.0

64.7
40.1

57.4
36.6

21.6
43.2
66.2
a Married includes legally married couples; unmarried includes cohabitating couples, separated, divorced, widowed, and never married.
NOTE: The Survey of Consumer Finances has replaced the Panel Study of Income Dynamics as the data source for this indicator. Values are measured in 2007 dollars.
Financial assets held in retirement investment accounts include IRAs, Keoghs, and 401 (k) type plans. Data are weighted. The term "household" here is similar to the Census
Bureau's household definition. See Indicator 10 data source for more detail.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Survey of Consumer Finances.
                                                                                                                                     I
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INDICATOR 11
Participation in the Labor Force
Table 11. Labor force participation of persons age 55 and over, by sex and age group, annual averages, 1963-2011
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
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
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
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
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
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
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
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
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
See notes at end of table.

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INDICATOR 11
Participation in the Labor Force
Table 11.  Labor force participation of persons age 55 and over, by sex and age group, annual averages, 1963-2011—
          continued
Men
Year

2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
55-61

74.9
75.4
74.9
74.4
74.7
75.2
75.4
75.8
75.4
75.6
75.4
62-64

48.2
50.4
49.5
50.8
52.5
52.4
51.7
53.0
55.1
54.6
53.2
65-69

30.2
32.2
32.8
32.6
33.6
34.4
34.3
35.6
36.3
36.5
37.4
70 and over
Percent
12.1
11.5
12.3
12.8
13.5
13.9
14.0
14.6
14.8
14.7
15.4
55-61

58.9
61.1
62.5
62.1
62.7
63.8
63.8
64.6
65.5
65.6
65.3
Women
62-64

36.7
37.6
38.6
38.7
40.0
41.5
41.8
42.0
44.0
45.3
44.7
65-69

20.0
20.7
22.7
23.3
23.7
24.2
25.7
26.4
26.6
27.0
27.3
70 and over

5.9
6.0
6.4
6.7
7.1
7.1
7.7
8.1
8.3
8.3
8.4
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.
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Bureau of Labor Statistics, Current Population Survey.
                                                                                                                     I
                                                                                                                     fir

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INDICATOR 12
Total Expenditures
 Table 12.  Percentage of total household annual expenditures, by age of reference person, 2010
                                                    45-54
                                                                       55-64
                                                                                    65 and over
                                                                                                             65-74
                                                                                                                          75 and over
Personal insurance and pensions
Health care
Transportation
Housing
Food
Other
13.3
5.6
16.0
32.7
12.5
19.9
12.6
7.6
15.9
32.8
11.9
19.2
5.1
13.2
14.2
35.4
12.4
19.7
6.4
11.9
14.7
34.8
12.4
19.8
3.2
15.1
13.6
36.2
12.3
19.6
 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 over. 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.

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INDICATOR 13
Housing Problems
Table 13a.  Prevalence of housing problems among households with householder or spouse age 65 and over, by type of
           problem, selected years 1985-2009
                                                     2009
                                                                                         2007
                                       Households
                                                      % Persons3
                                                                           Household
                                                              % Persons3
Householder or spouse age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
               24,128   100.0   32,527  100.0

               10,168    42.1   12,624   38.8
                9,618    39.9   11,890   36.6
                1,000     4.1     1,241    3.8
                   54     0.2       76    0.2

                         2005
23,858   100.0   32,153   100.0

 9,498    39.8   11,729    36.5
 8,955    37.5   11,016    34.3
 1,023     4.3    1,272     4.0
    61     0.3       80     0.2

          2003
                                       Households
                                                      % Persons3
                                                                           Household
                                                              % Persons3
Householder or spouse age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
               23,138   100.0   31,230  100.0

                9,570    41.4   11,994   38.4
                8,936    38.6   11,157   35.7
                1,090     4.7     1,370    4.4
                   64     0.3       86    0.3

                         2007
22,423   100.0   30,258   100.0

 8,120    36.2   10,298    34.0
 7,344    32.8    9,312    30.8
 1,138     5.1     1,413     4.7
   109     0.5      157     0.5

           7999
                                       Households
                                                      % Persons3
                                                                           Household
                                                              % Persons3
Householder or spouse age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
               22,366   100.0   30,083  100.0

                8,551    38.2   10,888   36.2
                7,833    35.0    9,962   33.1
                1,190     5.3    1,484    4.9
                  105     0.5      143    0.5
22,044  100.0   29,774   100.0

 8,038   36.5   10,187    34.2
 7,230   32.8    9,182    30.8
 1,265    5.7    1,547     5.2
    94    0.4      117     0.4
I
fir
See notes at end of table.

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INDICATOR 13
Housing Problems
Table 13a.  Prevalence of housing problems among households with householder or spouse age 65 and over, by type of
           problem, selected years 1985-2009—continued
                                                     7997
                                                                                         7995
                                       Households
                                                      % Persons3
                                                                            Household
                                                               % Persons3
Householder or spouse age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
                21,455   100.0    29,136  100.0
                   20,841   100.0    28,221   100.0
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing


8,071
7,243
1,222
98

Households
37.6 10,163
33.8 9,106
5.7 1,491
0.5 131
7989
% Persons3
34.9
31.3
5.1
0.4

%
7,177
6,306
1,251
67

Household
34.4
30.3
6.0
0.3
7985
8,840
7,730
1,552
89

31.3
27.4
5.5
0.3

% Persons3 %
Householder or spouse age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
                20,101   100.0    27,354  100.0
                   18,896   100.0    25,244   100.0
                 6,827    34.0
                 5,710    28.4
                 1,560     7.8
                   75     0.4
8,481    31.0
7,031    25.7
1,959     7.2
  100     0.4
6,970    36.9
5,879    31.1
1,563     8.3
   99     0.5
8,527    33.8
7,108    28.2
1,945     7.7
  127     0.5
a Number of persons age 65 or over.
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
Table 13b. Prevalence of housing problems among households with a household member(s) age 65 and over—excludes
         households with householder or spouse age 65 and over—by type of problem, selected years 1985-2009


2009
Households %
Households with household members age 65
(excluding household and spouse)
(Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

and over
2,031

896
783
95
126


100.0

44.1
38.6
4.7
6.2
2005
Households %
Households with household members age 65
(excluding household and spouse)
(Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

and over
1,844

583
463
98
89


100.0

31.6
25.1
5.3
4.8
2001
Households %
Households with household members age 65
(excluding household and spouse)
(Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing
and over
1,673

604
479
79
117

100.0

36.1
28.6
4.7
7.0

Persons3

2,232

1,014
882
104
154

Persons3

2,037

654
515
115
104

Persons3

1,852

689
539
83
145

%

100.0

45.4
39.5
4.7
6.9

%

100.0

32.1
25.3
5.6
5.1

%

100.0

37.2
29.1
4.5
7.8

Household

1,970

754
663
85
103

Household

1,718

598
450
92
116

Household

1,545

496
406
72
79
2007


% Persons3 %

100.0

38.3
33.7
4.3
5.2
2003

2,153

843
740
90
119


100.0

39.2
34.4
4.2
5.5

% Persons3 %

100.0

34.8
26.2
5.4
6.8
7999

1,904

669
496
104
143


100.0

35.1
26.1
5.5
7.5

% Persons3 %

100.0

32.1
26.3
4.7
5.1

1,713

563
460
80
92

100.0

32.9
26.9
4.7
5.4
                                                                                               I
                                                                                               fir
See notes at end of table.

-------
INDICATOR 13
Housing Problems
Table 13b. Prevalence of housing problems among households with a household member(s) age 65 and over—excludes
          households with householder or spouse age 65 and over—by type of problem, selected years 1985-2009—
          continued


7997
Households %
Households with household members age 65
(excluding household and spouse)
(Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

and over
1,520

495
400
99
68


100.0

32.6
26.3
6.5
4.5
7989
Households %
Households with household members age 65
(excluding household and spouse)
(Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing
and over
1,916

487
346
146
73

100.0

25.4
18.1
7.6
3.8

Persons3

1,641

552
433
101
93

Persons3

2,018

514
363
158
80

%

100.0

33.6
26.4
6.2
5.7

%

100.0

25.5
18.0
7.8
4.0

Household

1,950

664
509
151
83

Household

2,015

552
372
174
95
7995


% Persons3 %

100.0

34.1
26.1
7.7
4.3
7985

2,107

750
560
180
110


100.0

35.6
26.6
8.5
5.2

% Persons3 %

100.0

27.4
18.5
8.6
4.7

2,131

591
390
186
110

100.0

27.7
18.3
8.7
5.2
a Number of persons (excluding householder and spouse) age 65 or over.
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
Table 13c.  Prevalence of housing problems among all U.S. households except those households with an older person(s)
           age 65 and over by type of problem, selected years 1985-2009
                                                     2009
                                                                                         2007
                                       Households
                                                      %  Persons
                                                                            Household
                                                               %  Persons
Households with no household member
    age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
                85,702   100.0  233,583  100.0

                34,471    40.2    96,052   41.1
                30,874    36.0    82,939   35.5
                 4,655     5.4    11,828    5.1
                 2,330     2.7    14,328    6.1

                          2005
84,891   100.0  230,100   100.0

32,585    38.4   90,045    39.1
28,675    33.8   75,731    32.9
 4,651     5.5   11,961     5.2
 2,365     2.8   14,328     6.2

          2003
                                       Households
                                                      %  Persons
                                                                            Household
                                                               %  Persons
Households with no household member
    age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
                83,918   100.0  229,727  100.0

                30,625    36.5    85,542   37.2
                26,435    31.5    70,074   30.5
                 5,011     6.0    12,648    5.5
                 2,468     2.9    15,009    6.5

                          2007
81,727   100.0  223,588   100.0

27,683    33.9   76,617    34.3
23,250    28.4   60,750    27.2
 5,051     6.2   13,109     5.9
 2,334     2.9   13,975     6.3

           7999
                                       Households
                                                      %  Persons
                                                                            Household
                                                               %  Persons
Households with no household member
    age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
                81,397   100.0  223,724  100.0

                26,783    32.9    75,454   33.7
                21,940    27.0    57,817   25.8
                 5,342     6.6    14,473    6.5
                 2,408     3.0    14,514    6.5
79,214  100.0  218,183   100.0

25,420   32.1    71,513    32.8
20,568   26.0   54,026    24.8
 5,541     7.0   14,927     6.8
 2,398    3.0   14,359     6.6
I
fir
See notes at end of table.

-------
INDICATOR 13
Housing Problems
Table 13c.  Prevalence of housing problems among all U.S. households except those households with an older person(s)
           age 65 and over by type of problem, selected years 1985-2009—continued
                                                     7997
                                                                                         7995
                                       Households
                                                      %  Persons
                                                                           Household
                                                              %  Persons
Households with no household member
    age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
               76,512   100.0  214,267  100.0

               24,836    32.5   71,539   33.4
               19,802    25.9   53,200   24.8
                5,666     7.4   15,960    7.4
                2,641     3.5   15,742    7.3

                          7989
74,903   100.0  210,905   100.0

24,545    32.8   71,343    33.8
20,135    26.9   54,506    25.8
 4,969     6.6   14,612     6.9
 2,404     3.2   14,318     6.8

           7985

Households with no household member
age 65 and over
(Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing
Households


71 ,666

20,955
15,634
5,897
2,529
%


100.0

29.2
21.8
8.2
3.5
Persons


206,493

63,022
43,037
17,466
15,139
%


100.0

30.5
20.8
8.5
7.3
Household


67,513

21,187
16,382
5,636
2,303
%


100.0

31.4
24.3
8.3
3.4
Persons


195,416

63,645
45,456
16,967
13,782
%


100.0

32.6
23.3
8.7
7.1
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
Table 13d. Prevalence of housing problems among households with householder or spouse age 65 and over with
        children, by type of problem, selected years 1985-2009

Householder or spouse age 65 and over
with children (Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

Householder or spouse age 65 and over
with children (Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

Householder or spouse age 65 and over
with children (Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

Households

1,001

446
408
46
44

Households

1,064

482
414
79
49

Households

1,011

436
329
76
95
2009
%

100.0

44.6
40.8
4.6
4.4
2005
%

100.0

45.3
38.9
7.4
4.6
2001
%

100.0

43.1
32.5
7.5
9.4

Persons3

1,230

519
475
53
57

Persons3

1,297

565
485
86
61

Persons3

1,233

531
388
97
127

%

100.0

42.2
38.6
4.3
4.6

%

100.0

43.6
37.4
6.6
4.7

%

100.0

43.1
31.5
7.9
10.3

Household

1,039

445
401
31
55

Household

1,052

427
330
64
97

Household

1,000

374
285
72
83
2007


% Persons3 %

100.0

42.8
38.6
3.0
5.3
2003

1,272

526
470
36
70


100.0

41.4
36.9
2.8
5.5

% Persons3 %

100.0

40.6
31.4
6.1
9.2
7999

1,313

529
408
75
137


100.0

40.3
31.1
5.7
10.4

% Persons3 %

100.0

37.4
28.5
7.2
8.3

1,212

435
329
85
104

100.0

35.9
27.1
7.0
8.6
See notes at end of table.
                                                                                           I
                                                                                           oT

-------
INDICATOR 13
Housing Problems
Table 13d. Prevalence of housing problems among households with householder or spouse age 65 and over with
          children, by type of problem, selected years 1985-2009—continued

Householder or spouse age 65 and over
with children (Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

Householder or spouse age 65 and over
with children (Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

Households

916

371
282
89
82

Households

923

323
192
114
64
7997
%

100.0

40.5
30.8
9.7
9.0
7989
%

100.0

35.0
20.8
12.4
6.9

Persons3

1,117

440
329
106
105

Persons3

1,148

402
235
136
87

%

100.0

39.4
29.5
9.5
9.4

%

100.0

35.0
20.5
11.8
7.6

Household

1,360

525
385
136
61

Household

782

347
200
130
92
7995


% Persons3 %

100.0

38.6
28.3
10.0
4.5
7985

1,626

623
450
155
82


100.0

38.3
27.7
9.5
5.0

% Persons3 %

100.0

44.4
25.6
16.6
11.8

930

412
233
151
114

100.0

44.3
25.1
16.2
12.3
a Number of persons age 65 or over.
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
Table 13e. Prevalence of housing problems among households with a household member(s) age 65 and over with
         children—excludes households with householder or spouse age 65 and over, by type of problem, selected
         years 1985-2009

Household members (excluding
household or spouse) age 65 and
over with children (Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

Household members (excluding
household or spouse) age 65 and
over with children (Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

Household members (excluding
household or spouse) age 65 and
over with children (Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

Households

815

440
363
47
114

Households

808

278
219
29
72

Households

732

300
215
37
110
2009
%

100.0

54.0
44.5
5.8
14.0
2005
%

100.0

34.4
27.1
3.6
8.9
2001
%

100.0

41.0
29.4
5.1
15.0

Persons3

930

508
418
49
132

Persons3

895

310
248
37
74

Persons3

802

340
244
40
124

%

100.0

54.6
44.9
5.3
14.2

%

100.0

34.6
27.7
4.1
8.3

%

100.0

42.4
30.4
5.0
15.5

Household

785

356
291
37
98

Household

743

314
217
40
108

Household

622

236
171
33
71
2007


% Persons3 %

100.0

45.4
37.1
4.7
12.5
2003

878

400
323
39
113


100.0

45.6
36.8
4.4
12.9

% Persons3 %

100.0

42.3
29.2
5.4
14.5
7999

837

355
236
50
134


100.0

42.4
28.2
6.0
16.0

% Persons3 %

100.0

37.9
27.5
5.3
11.4

703

270
191
38
84

100.0

38.4
27.2
5.4
11.9
                                                                                                 I
                                                                                                 oT
See notes at end of table.

-------
INDICATOR 13
Housing Problems
Table 13e. Prevalence of housing problems among households with a household member(s) age 65 and over with
          children—excludes households with householder or spouse age 65 and over, by type of problem, selected
          years 1985-2009—continued

Household members (excluding
household or spouse) age 65 and
over with children (Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

Household members (excluding
household or spouse) age 65 and
over with children (Numbers in 1000s)
Total
Number and percent with
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing

Households

363

242
188
35
63

Households

686

205
128
61
71
7997
%

100.0

38.1
29.6
5.5
9.9
7989
%

100.0

29.9
18.7
8.9
10.3

Persons3

713

282
207
35
88

Persons3

732

228
141
73
78

%

100.0

39.6
29.0
4.9
12.3

%

100.0

31.1
19.3
10.0
10.7

Household

622

262
173
60
80

Household

652

221
115
70
81
7995


% Persons3 %

100.0

42.1
27.8
9.6
12.9
7985

705

313
193
75
108


100.0

44.4
27.4
10.6
15.3

% Persons3 %

100.0

33.9
17.6
10.7
12.4

709

246
124
74
95

100.0

34.7
17.5
10.4
13.4
a Number of persons age 65 or over.
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
Table 13f.  Prevalence of housing problems among all older households: householder, spouse, or member(s) age 65 and
           over, by type of problem, selected years 1985-2009
                                                     2009
                                                                                         2007
                                       Households
                                                      %  Persons3
                                                                           Household
                                                              % Persons3
Householder, spouse, or member(s)
    age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
               26,159   100.0   34,759  100.0

               11,064    42.3   13,638   39.2
               10,401    39.8   12,772   36.7
                 1,095     4.2    1,345    3.9
                  180     0.7      230    0.7

                         2005
25,828   100.0   34,306   100.0

10,252    39.7   12,572    36.6
 9,618    37.2   11,756    34.3
 1,108     4.3    1,362     4.0
   164     0.6      199     0.6

          2003
                                       Households
                                                      %  Persons3
                                                                           Household
                                                              % Persons3
Householder, spouse, or member(s)
    age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
               24,982   100.0   33,267  100.0

               10,153    40.6   12,648   38.0
                9,399    37.6   11,672   35.1
                1,188     4.8    1,485    4.5
                  153     0.6      190    0.6

                         2007
24,141   100.0   32,162   100.0

 8,718    36.1    10,967    34.1
 7,794    32.3    9,808    30.5
 1,230     5.1     1,517     4.7
   225     0.9     300     0.9

           7999
                                       Households
                                                      %  Persons3
                                                                           Household
                                                              % Persons3
Householder, spouse, or member(s)
    age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
               24,039   100.0   31,935  100.0

                9,155    38.1   11,577   36.3
                8,312    34.6   10,501   32.9
                1,269     5.3    1,567    4.9
                  222     0.9      288    0.9
23,589   100.0   31,487   100.0

 8,534    36.2   10,750    34.1
 7,636    32.4    9,642    30.6
 1,337     5.7    1,627     5.2
   173     0.7     209     0.7
I
fir
See notes at end of table.

-------
INDICATOR 13
Housing Problems
Table 13f.  Prevalence of housing problems among all older households: householder, spouse, or member(s) age 65 and
           over, by type of problem, selected years 1985-2009—continued
                                                     7997
                                                                                         7995
                                       Households
                                                      % Persons3
                                                                            Household
                                                               % Persons3
Householder, spouse, or member(s)
    age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
                22,975   100.0    30,777  100.0
                   22,800   100.0    30,300   100.0
One or more of the housing problems
Housing cost burden (> 30%)
Physically inadequate housing
Crowded housing


8,566
7,643
1,321
166

Households
37.3 10,715
33.3 9,539
5.7 1 ,592
0.7 224
7989
% Persons3
34.8
31.0
5.2
0.7

%
7,841
6,815
1,402
150

Household
34.4
29.9
6.2
0.7
7985
9,590
8,290
1,732
199

31.6
27.3
5.7
0.7

% Persons3 %
Householder, spouse, or member(s)
    age 65 and over
    (Numbers in 1000s)
Total
Number and percent with
   One or more of the housing problems
     Housing cost burden (> 30%)
     Physically inadequate housing
       Crowded housing
                22,017   100.0    29,372  100.0
                   20,911   100.0    27,375   100.0
                 7,314    33.2
                 6,056    27.5
                 1,706     7.7
                  148     0.7
8,995    30.6
7,394    25.2
2,117     7.2
  180     0.6
7,522    36.0
6,251    29.9
1,737     8.3
  194     0.9
9,118    33.3
7,498    27.4
2,131     7.8
  237     0.9
a Number of persons age 65 or over.
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 1900-2009
Age and sex
At birth
Both sexes
Men
Women
At age 65
Both sexes
Men
Women
At age 85
Both sexes
Men
Women
7900

49.2
47.9
50.7

11.9
11.5
12.2

4.0
3.8
4.1
7970

51.5
49.9
53.2

11.6
11.2
12.0

4.0
3.9
4.1
7920

56.4
55.5
57.4

12.5
12.2
12.7

4.2
4.1
4.3
7930

59.2
57.7
60.9

12.2
11.7
12.8

4.2
4.0
4.3
7940

63.6
61.6
65.9

12.8
12.1
13.6

4.3
4.1
4.5
7950

68.1
65.5
71.0

13.8
12.7
15.0

4.7
4.4
4.9
7960

69.9
66.8
73.2

14.4
13.0
15.8

4.6
4.4
4.7
7970

70.8
67.0
74.6

15.0
13.0
16.8

5.3
4.7
5.6
7980

73.9
70.1
77.6

16.5
14.2
18.4

6.0
5.1
6.4
7990

75.4
71.8
78.8

17.3
15.1
19.0

6.2
5.3
6.7
At birth
   Both sexes
                              2000
                               76.8
                                         2001
                                                    2002
                                                               2003
                                                                          2004
                                                                                    2005
                                                                                               2006
                                                                                                          2007
                                          76.9
                                                    76.9
                                                               77.1
                                                                          77.5
                                                                                     77.4
                                                                                                77.7
                                                                                                           77.9
                                                                                                                     2008
                                                                                                                      78.1
                                                                                                                                2009
                                                                                                                                 78.5
Men
Women
At age 65
Both sexes
Men
Women
At age 85
Both sexes
Men
Women
74.
79.

17.
16.
19.

6.
5.
6.
1
3

6
0
0

1
4
5
74.2
79.4

17.7
16.2
19.0

6.1
5.5
6.5
74.3
79.5

17.8
16.2
19.1

6.1
5.4
6.5
74.5
79.6

17.9
16.4
19.2

6.1
5.5
6.5
74.9
79.9

18.2
16.7
19.5

6.3
5.6
6.7
74.9
79.9

18.2
16.8
19.5

6.2
5.6
6.6
75.1
80.2

18.5
17.0
19.7

6.4
5.7
6.8
75.4
80.4

18.6
17.2
19.9

6.5
5.8
6.8
75.6
80.6

18.8
17.3
20.0

6.4
5.7
6.8
76.0
80.9

19.2
17.6
20.3

6.7
5.9
7.0
 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.
                                                                                                             I
                                                                                                             fir
 Table 14b.  Life expectancy, by sex, selected race, and age, 2009
                                    Total
                                                                             Men
 NOTE: See data sources 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.
                                                                                                                    Women
Age
At birth
At age 65
At age 85
White
78.8
19.1
6.6
Black
74.5
17.8
6.8
White
76.4
17.7
5.8
Black
71.1
15.8
5.9
White
81.2
20.4
7.0
Black
77.6
19.3
7.2

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INDICATOR 14
Life  Expectancy
 Table 14c.  Average life expectancy at age 65, by sex and selected countries or areas, selected years 1980-2009
Country
Australia
Austria
Belgium
Canada
Chile
Czech Republic
Denmark
Estonia
Finland
France
Germany1
Greece
Hungary
Iceland
Ireland
Israel2
Italy
Japan
Korea (Republic of)
Luxembourg
Mexico
Netherlands
New Zealand
Norway
Poland
Portugal
Slovak Republic
Slovenia
Spain
Sweden
Switzerland
Turkey
United Kingdom
United States

1980
13.7
12.9
12.9
14.5
—
11.2
13.6
—
12.6
13.6
12.8
15.2
11.6
15.8
12.6
—
13.3
14.6
10.5
12.6
15.4
13.7
13.2
14.3
12.0
13.1
12.3
—
14.6
14.3
14.3
11.7
12.6
14.1

1990
15.2
14.4
14.3
15.7
13.7
11.7
14
11.9
13.8
15.5
14.0
15.7
12.0
16.2
13.3
15.7
15.2
16.2
12.4
14.3
16.0
14.4
14.6
14.6
12.4
14.0
12.2
13.2
15.5
15.3
15.3
12.8
14.0
15.1
Men
2000
16.9
16
15.6
16.5
15.5
13.8
15.2
12.5
15.5
16.7
15.8
16.1
12.7
18.1
14.6
17.0
16.7
17.5
14.3
15.5
16.5
15.3
16.5
16.1
13.6
15.4
12.9
14.1
16.7
16.7
17.0
13.4
15.8
16.0

2005
18.1
17
16.6
17.6
16.2
14.4
16.1
13.1
16.8
17.7
16.9
17.1
13.1
18.0
16.7
18.0
17.4
18.1
15.8
16.7
16.8
16.4
17.7
17.2
14.4
16.1
13.2
15.5
17.3
17.4
18.1
13.9
17.0
16.8

2009
18.7
17.7
17.5
—
16.8
15.2
16.8
14.4
17.3
—
17.6
18.1
13.7
18.3
17.2
18.9
—
18.9
17.1
17.6
16.8
17.4
18.6
18.0
14.7
17.1
13.9
16.3
18.3
18.2
19.0
14.0
18.1
17.6

1980
17.9
16.3
16.8
18.9
—
14.4
17.6
—
17.0
18.2
16.3
17.0
14.6
19.1
15.7
—
17.1
17.7
15.1
16.5
17.0
18.0
17.0
18.2
15.5
16.1
15.4
—
17.8
17.9
18.2
12.8
16.6
18.3

1990
19
18.1
18.8
19.9
17.2
15.3
17.9
15.5
17.8
19.8
17.7
18.0
15.3
19.5
17.0
17.8
18.9
20.0
16.3
18.5
17.8
18.9
18.3
18.7
16.1
17.1
15.7
16.7
19.3
19.0
19.7
14.3
17.9
18.9
Women
2000
20.4
19.6
19.7
20.2
19.3
17.3
18.3
16.8
19.5
21.2
19.6
18.4
16.5
19.7
18.0
19.0
20.7
22.4
18.2
20.1
18.1
19.2
19.8
19.9
17.5
18.9
16.5
17.9
20.8
20.0
20.9
15.1
19.0
19.0

2005
21.4
20.3
20.2
20.9
19.7
17.7
19.1
18.1
20.9
22.0
20.1
19.2
16.9
20.7
19.8
20.2
21.3
23.2
19.9
20.4
18.2
20.0
20.5
20.9
18.6
19.4
16.9
19.9
21.3
20.6
21.7
15.6
19.7
19.5

2009
21.8
21.2
21.1
—
19.9
18.8
19.5
18.3
21.5
—
20.8
20.2
17.6
20.6
20.6
21.2
—
24.0
21.5
21.4
18.3
20.8
21.1
21.1
19.1
20.5
17.6
20.1
22.4
21.0
22.2
15.9
20.8
20.3
— Not available.
1 Germany (code DELI) was created 3 October 1990 by the accession of the Democratic Republic of Germany (code DDR) to the then Federal Republic of Germany (code
DEW).
2 The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the
status of the Golan Heights, East Jerusalem, and Israeli settlements in the West Bank under the terms of international law.
NOTE: Estimates for the United States for 2009 are from the National Vital Statistics System and may differ from the OECD estimates published elsewhere.
SOURCE: Organisation for Economic Co-operation and Development (OECD) Health Data 2011, OECD.StatExtracts, available from: http://www.oecd.org.

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INDICATOR  15
Mortality
 Table 15.  Death rates for selected leading causes of death among people age 65 and over, 1981-2009
Year
Total
Heart
disease
Cancer
Chronic
lower
respiratory Influenza and
Stroke diseases pneumonia
Alzheimer's
Diabetes 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
2007
2008
2009
5,714
5,610
5,685
5,645
5,694
5,629
5,578
5,625
5,457
5,353
5,291
5,205
5,349
5,270
5,265
5,222
5,179
5,168
5,220
5,137
5,044
5,001
4,907
4,699
4,676
4,519
4,418
4,420
4,300
2,547
2,503
2,512
2,450
2,431
2,372
2,316
2,306
2,172
2,091
2,046
1,990
2,024
1,952
1,927
1,878
1,827
1,792
1,767
1,695
1,632
1,585
1,525
1,418
1,376
1,297
1,232
1,200
1,156
1,056
1,069
1,078
1,087
1,091
1,101
1,106
1,114
1,133
1,142
1,150
1,151
1,159
1,155
1,153
1,141
1,127
1,119
1,126
1,119
1,100
1,091
1,073
1,052
1,041
1,025
1,015
997
982
624
585
564
546
531
506
496
489
464
448
435
425
435
434
438
433
424
412
433
423
404
393
373
346
320
297
288
277
264
Percent change between

-24.7
-54.6
-7.0
-57.7
186
186
204
211
225
228
230
240
240
245
252
253
274
271
271
276
280
269
313
304
301
301
299
284
299
279
281
304
291
1981 and 2009
56.7
207
181
207
214
243
245
237
263
253
258
245
233
248
238
237
234
236
247
167
167
155
161
155
139
142
124
112
116
104

-37.9
106
102
104
103
103
101
102
105
120
120
121
121
128
133
136
139
140
143
150
150
151
152
151
146
147
137
132
128
121

14.7
6
9
16
24
31
35
42
45
47
49
49
49
55
60
65
66
68
67
129
140
148
159
168
171
179
177
178
192
184

*42.7
 * Change calculated from 1999 when 10th revision of the International Classification of Disease (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 (NCHS) 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.
 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.
                                                                                                                                                          I
                                                                                                                                                          fir

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INDICATOR 16
Chronic Health Conditions
Table 16a.  Percentage of people age 65 and over who reported having selected chronic health conditions, by sex and
           race and Hispanic origin, 2009-2010




Heart Hyper-
disease tension
Total
Men
Women
Non-Hispanic White
Non-Hispanic Black
Hispanic
NOTE: Data are based on a






2-year ave
30.4
36.9
25.5
32.1
25.1
22.2
55.9
54.1
57.2
54.2
69.2
57.2

Stroke
8.6
9.1
8.2
8.5
11.7
7.2

Chronic
bronchitis or
Asthma emphysema
11.3
9.7
12.5
11.3
11.5
11.1
10.3
9.6
10.8
10.9
8.4
7.1

Any
cancer
24.0
27.6
21.2
26.9
13.9
10.4


Diabetes Arthritis
20.5
23.5
18.2
18.0
31.6
32.5
51.2
44.8
56.1
52.6
51.0
43.8
;rage from 2009-2010. See data sources 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, N;
Table 16b. Percentage of people age 65
through 2009-2010
Heart
Year disease
1 997-1 998
1 999-2000
2001-2002
2003-2004
2005-2006
2007-2008
2009-201 0
32.3
29.8
31.5
31.8
30.9
31.9
30.4
Hyper-
tension
46.5
47.4
50.2
51.9
53.3
55.7
55.9
ational Center for Health Statistics, National Health
and over who reported
Stroke
8.2
8.2
8.9
9.3
9.3
8.8
8.6
Emphy-
sema
5.2
5.2
5.0
5.2
5.7
5.1
6.2
Interview Survey
having selected chronic
Asthma
7.7
7.4
8.3
8.9
10.6
10.4
11.3
Chronic
bronchitis
6.4
6.2
6.1
6.0
6.1
5.4
6.2



health conditions, 1997-1998
Any
cancer
18.7
19.9
20.8
20.7
21.1
22.5
24.0
Diabetes Arthritis
13.0
13.7
15.4
16.9
18.0
18.6
20.5
—
—
—
50.0
49.5
49.5
51.2
— Not available.
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, 2010
Sex, age, and poverty status
Both sexes
65 and over
65-74
75-84
85 and over
Below poverty
Above poverty
Men
65 and over
65-74
75-84
85 and over
Women
65 and over
65-74
75-84
85 and over
Any trouble hearing

37.5
31.2
40.3
58.6
31.4
37.5

46.1
41.0
50.8
61.7

30.9
22.8
32.4
57.1
Any trouble seeing

14.0
12.2
13.8
22.5
24.0
13.1

12.7
10.5
14.6
19.5

14.9
13.6
13.2
23.9
No natural teeth

24.3
19.3
29.8
32.5
42.3
21.6

23.5
18.4
30.0
33.4

24.9
20.0
29.6
32.1
 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."
 Regarding their vision, respondents were asked "Do you have any trouble seeing, even when wearing glasses or contact lenses?" The category "Any trouble seeing" includes
 those who responded yes or 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, by sex, 2010
Age group
65 and over
65-74
75-84
85 and over
Both sexes
14.3
9.1
15.7
34.2
Men
18.4
12.5
22.9
40.0
Women
11.2
6.2
10.3
31.4
 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?"
 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.
                                                                                                                                          I
                                                                                                                                          fir

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INDICATOR 18
Respondent-Assessed Health Status
Table 18.  Percentage of people age 65 and over with respondent-assessed good to excellent health status by age group
          and race and Hispanic origin, 2008-2010.
Selected characteristics
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


24.4
20.9
26.9
33.0

24.4
21.2
27.2
34.4

24.4
20.7
26.8
32.3


75.6
79.1
73.1
67.0

75.6
78.8
72.8
65.6

75.6
79.3
73.2
67.7
Not Hispanic
or Latino
White only


21.7
18.1
23.9
30.6

22.2
19.1
24.7
31.8

21.3
17.3
23.4
29.9


78.3
81.9
76.1
69.4

77.8
80.9
75.3
68.2

78.7
82.7
76.7
70.1
Not Hispanic
or Latino
Black only


37.5
32.8
43.4
45.8

36.3
32.1
42.3
46.0

38.3
33.3
44.1
45.7


62.5
67.2
56.6
54.2

63.7
67.9
57.8
54.0

61.8
66.7
55.9
54.3
Hispanic
or Latino
(of any race)


37.3
34.5
40.2
48.2

35.7
33.0
39.3
45.1

38.5
35.6
40.8
50.2


62.7
65.6
59.9
51.8

64.3
67.0
60.8
54.9

61.5
64.4
59.2
49.9
NOTE: Data are based on a 3-year average from 2008-2010. See data sources for the definition of race
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National He
                                      and Hispanic origin in the National Health Interview Survey.

                                     ;alth Interview Survey.

-------
INDICATOR  19
Depressive  Symptoms
 Table 19a.  Percentage of people age 65 and over with clinically relevant depressive symptoms, by sex, selected years
             1998-2008

Both sexes
Men
Women
7998
15.9
11.9
18.6
2000
15.6
11.4
18.5
2002
15.4
11.5
18.0
2004
14.4
11.0
16.8
2006
14.6
10.1
17.9
2008
13.7
10.7
15.7
 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.isrumich.edu/docs/userg/dr-005.pdf. Proportions are based on weighted data using the preliminary respondent weight from MRS 2008.
 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,
             2008
                                                         Both sexes
                                                                                               Men
                                                                                                                           Women
 65 and over
   65-69
   70-74
   75-79
   80-84
   85 and over
                               13.6
                               12.3
                               11.9
                               13.8
                               14.6
                               18.3
10.7
 9.7
 9.6
10.1
 9.9
18.9
15.7
14.5
13.7
16.5
17.6
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.isrumich.edu/docs/userg/dr-005.pdf. Proportions are based on weighted data using the preliminary respondent weight from MRS 2008.
 Reference population: These data refer to the civilian noninstitutionalized population.
 SOURCE: Health and Retirement Study.
                                                                                                                                             I
                                                                                                                                             fir

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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 long-term care facility, selected years 1992-2009

Total
lADLsonly
1-2 ADLs
3-4 ADLs
5-6 ADLs
Long-term care facility
7992
48.8
13.7
19.6
6.1
3.5
5.9
7997
42.5
12.7
16.6
4.9
3.2
5.1
2007
43.7
13.4
17.2
5.3
3.0
4.8
2005
42.1
12.3
18.3
4.7
2.5
4.3
2007
42.2
13.8
17.7
4.5
2.3
3.9
2009
41.4
12.1
17.6
5.1
2.7
3.9
 NOTE: A residence is considered a long-term care facility if it is certified by Medicare or Medicaid; has three or more beds, 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.
 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 long-term care facility, by sex, 2009
                                                      Both Sexes
                                                                                                 Men
                                                                                                                                Women
Total
lADLsonly
1-2 ADLs
3-4 ADLs
41.4
12.1
17.6
5.1
35.5
9.5
16.1
4.3
45.8
14.2
18.8
5.8
 5-6 ADLs
 Long-term care facility
                            2.7
                            3.9
2.7
2.9
2.6
4.4
 NOTE: A residence is considered a long-term care facility if it is certified by Medicare or Medicaid; has 3 or more beds, 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.
 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
Table 20c.  Percentage of Medicare enrollees age 65 and over who are unable to perform certain physical functions, by
           sex, 1991 and 2009
Function
Men
Stoop/kneel
Reach over head
Write/grasp small objects
Walk 2-3 blocks
Lift 10lbs.
Any of these five
Women
Stoop/kneel
Reach over head
Write/grasp small objects
Walk 2-3 blocks
Lift 1 0 Ibs.
Any of these five
NOTES: Rates for 1991 are age-adjusted to the 2009 population.
Reference population: These data refer to Medicare enrollees.
SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 20d. Percentage of Medicare enrollees age 65 and over who are
functions, by selected characteristics 2009
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)
1991

8.0
3.1
2.3
14.2
9.4
19.1

15.2
6.2
2.6
23.1
18.4
32.0



unable to perform any one of five physical
Men

12.9
22.1
39.6

18.4
23.1
20.4
2009

10.2
3.1
1.5
14.5
7.1
19.0

17.9
4.1
1.8
21.4
13.5
29.7




Women

18.7
33.7
53.0

28.6
33.4
33.6
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.
                                                                                                                      I
                                                                                                                      oT

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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 1989-2010
Influenza
Not Hispanic Not Hispanic
Year or Latino White or Latino Black
1989 32.0
1991 42.8
1993 53.1
1994 56.9
1995 60.0
1997 65.8
1998 65.6
1999 67.9
2000 66.6
2001 65.4
2002 68.7
2003 68.6
2004 67.3
2005 63.2
2006 67.3
2007 69.3
2008 69.9
2009 69.0
2010 65.5
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
50.2
52.9
52.1
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
56.9
53.6
Pneumococcal disease
Not Hispanic
or Latino 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
64.9
63.6
Hispanic
Not Hispanic or Latino
or Latino Black (of any race)
6.2
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
44.8
45.9
9.8
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
40.1
39.0
NOTE: For influenza, the percentage vaccinated consists of people who reported having a flu shot during the past 1 2 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 data sources 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, N;
ational Center for Health Statistics, National Health Interview Survey.
Table 21b. Percentage of people age 65 and over who reported having
pneumococcal disease, by selected characteristics, 2010
Selected characteristic
Both Sexes
Men
Women
65-74
75-84
85 and over
High school graduate or less
More than high school









Influenza
63.3
63.7
63.1
59.1
68.1
70.0
60.3
67.1
been vaccinated
against influenza and

Pneumococcal disease
















59.7
57.6
61.3
54.7
65.4
67.7
56.8
63.2
 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 two years, by
           characteristics, selected years 1987-2010
                                                                                                        selected

Women age 40 and over
Age group
40-49
50-64
65 and over
65-74
75 and over
Women age 65 and over
Race and Hispanic origin
White, not Hispanic or Latino
Black, not Hispanic or Latino
Hispanic or Latino
Poverty
Below 100%
100%-199%
200%-399%
400% or more
Education
No high school diploma or GED
High school diploma or GED
Some college or more

Women age 40 and over
Age group
40-49
50-64
65 and over
65-74
75 and over
Women age 65 and over
Race and Hispanic origin
White, not Hispanic or Latino
Black, not Hispanic or Latino
Hispanic or Latino
Poverty
Below 100%
100%-199%
200%-399%
400% or more
Education
No high school diploma or GED
High school diploma or GED
Some college or more
7987


31.9
31.7
22.8
26.6
17.3


24.0
14.1
*

13.1
19.9
27.7
34.7

16.5
25.9
32.3
7999

67.2
76.5
66.8
73.9
58.9


66.8
68.1
67.2

57.6
60.2
70.0
76.7

56.6
68.4
77.1
7990


55.1
56.0
43.4
48.7
35.8


43.8
39.7
41.1

30.8
38.6
47.4
61.2

33.0
47.5
56.7
2000

64.3
78.7
67.9
74.0
61.3


68.3
65.5
68.3

54.8
60.3
71.1
81.9

57.4
71.8
74.1
7997


55.6
60.3
48.1
55.7
37.8


49.1
41.6
40.9

35.2
41.8
55.9
63.0

37.7
54.0
57.9
2003

64.4
76.2
67.7
74.6
60.6


68.1
65.4
69.5

57.0
62.8
72.3
73.0

56.9
69.7
75.1
7993


59.9
65.1
54.2
64.2
41.0


54.7
56.3
35.7

40.4
47.6
60.3
71.3

44.2
57.4
64.8
2005

63.5
71.8
63.8
72.5
54.7


64.7
60.5
63.8

52.3
56.1
68.6
72.6

50.7
64.3
73.0
7994


61.3
66.5
55.0
63.0
44.6


54.9
61.0
48.0

43.9
48.8
61.0
73.0

45.6
59.1
64.3
2008

61.5
74.2
65.4
72.6
57.9


66.1
66.4
59.0

49.1
59.4
65.0
78.3

49.2
65.7
75.6
7998


63.4
73.7
63.8
69.4
57.2


64.3
60.6
59.0

51.9
57.8
69.5
71.1

54.7
66.8
71.3
2070

62.3
72.6
64.4
71.9
55.7


65.0
60.9
65.2

50.6
55.5
67.2
74.5

54.1
62.5
70.9






















1
fir














* Estimate is considered unreliable.
NOTE: Questions concerning the use of mammography differed slightly on the National Health Interview Survey across the years for which data are shown. For details,
Health, United States 2011, Appendix II. The poverty categories shown here differ from previous versions of Older Americans.
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 diet scores,3 population age 65 and over, by age group, 2007-2008

Total Healthy Eating lndex-2005 score
Dietary adequacy components'3
Total fruit
Whole fruit
Total vegetables
Dark green and orange vegetables and legumes
Total grains
Whole grains
Milk
Meat and beans
Oils
Dietary moderation components0
Saturated fat
Sodium
Calories from solid fats, alcoholic beverages, and added sugars

65 and over
67

90
100
84
36
100
34
60
100
75

60
33
59
Age group (Years)
65-74
66

86
100
86
36
100
32
58
100
77

59
32
59

75 and over
67

94
100
82
35
100
37
63
100
73

63
35
59
 a Scores are Healthy Eating lndex-2005 scores.
 b Higher scores reflect higher intakes.
 c Higher scores reflect lower intakes.
 NOTE: The Healthy Eating lndex-2005 (HEI-2005) has 12 components, and a higher score indicates a higher quality diet. Intakes equal to or better than the standards set
 for each component are assigned a maximum score of 100 percent. For the nine adequacy components (e.g., total fruit), no intake gets 0 percent, and scores increase up to
 100 percent of the standard. The three moderation components (e.g., sodium) are scored in reverse; that is, excessively high intakes getO percent and as intakes decrease
 towards the standard, scores increase up to 100 percent. Scores are averages across all adults and reflect long-term dietary intake.
 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, 2007-2008 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 participating in leisure-time aerobic and muscle-
              strengthening activities that meet the 2008 Federal physical activity guidelines, by age group, 1998-2010
Year
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
45-64
11.4
11.9
12.8
13.1
14.2
14.6
14.0
14.4
13.8
15.0
16.3
16.9
17.8
65 and over
5.5
5.9
6.9
6.7
7.1
7.6
7.8
7.9
7.5
7.9
9.5
10.0
10.5
65-74
7.0
7.7
8.4
7.7
8.8
9.2
9.7
10.5
9.1
9.5
11.3
12.8
13.6
75-84
3.9
4.5
5.7
6.1
5.8
6.7
6.4
5.7
6.5
6.6
9.3
7.9
7.3
85 and over
2.0
0.9
1.9
3.1
2.1
2.9
3.5
3.0
3.0
4.1
2.3
2.8
4.0
 NOTE: This measure of physical activity differs from previous editions of Older Americans. The measure reflects the 2008 Federal Physical Activity Guidelines for Americans
 (available from: http://vvww.health.gov/PAGuidelines/). The 2008 Federal guidelines recommend that for substantial health benefits, adults perform at least 150 minutes (2
 hours and 30 minutes) a week of moderate-intensity,  or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination
 of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should  be spread throughout the
 week. The 2008 guidelines also recommend that adults perform muscle-strengthening activities that are moderate or high intensity and involve all major muscle groups on two
 or more days a week, because these activities provide additional health benefits. The measure shown here presents the percentage of people who fully met both the aerobic
 activity and muscle-strengthening guidelines.
 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 participating in leisure-time aerobic and muscle-
              strengthening activities that meet the 2008 Federal physical activity guidelines, by sex and race and
              ethnicity, 2010


Both sexes
Men
Women

All
10.5
13.6
8.0

White, not Hispanic or Latino
11.5
14.6
9.0
Aerobic activity only
Black, not Hispanic or Latino
5.2
7.8
3.6

Hispanic or Latino
5.6
9.0
3.0
 NOTE: This measure of physical activity differs from previous editions of Older Americans. The measure reflects the 2008 Federal Physical Activity Guidelines for Americans
 (available from: http://www.health.gov/PAGuidelines/). The 2008 Federal guidelines recommend that for substantial health benefits, adults perform at least 150 minutes (2
 hours and 30 minutes) a week of moderate-intensity,  or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination
 of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should  be spread throughout the
 week. The 2008 guidelines also recommend that adults perform muscle-strengthening activities that are moderate or high intensity and involve all major muscle groups on two
 or more days a week, because these activities provide additional health benefits. The measure shown here presents the percentage of people who fully met both the aerobic
 activity and muscle-strengthening guidelines.
 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.
                                                                                                                     I
                                                                                                                     fir

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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 1976-2010
Sex and age group 1976-1980 1988-1994 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010
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


— 60.1
57.2 64.1
— 53.9

— 64.4
54.2 68.5
— 56.5

— 56.9
59.5 60.3
— 52.3


— 22.2
17.9 25.6
— 17.0

— 20.3
13.2 24.1
— 13.2

— 23.6
21.5 26.9
— 19.2


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


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


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


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


71.2
73.7
68.3

77.0
78.7
75.0

66.8
69.8
63.7


32.1
36.8
26.7

33.5
39.7
25.9

31.1
34.6
27.3


72.8
77.5
66.2

74.6
76.6
71.3

71.3
78.2
62.7


37.8
44.2
29.0

36.9
42.9
27.3

38.6
45.4
30.2
— 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 glossary for the definition of BMI. Some data for 2007-2008 have been revised and differ from previous editions of Older Americans.
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 people age 45 and over who are current cigarette smokers, by selected characteristics, selected
         years 1965-2010
Sex and 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
2009
2010

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
24.5
23.2
Total
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
9.5
9.7
White
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
24.0
22.6
65 and over

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
9.3
9.6
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
28.9
31.8
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 C
14.0 Jj"
10.0 g
See notes at end of table.

-------
INDICATOR 26
Cigarette Smoking
 Table 26a.  Percentage of people age 45 and over who are current cigarette smokers, by selected characteristics, selected
             years 1965-2010—continued
Sex and 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
2009
2010

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
19.5
19.1
Total
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
9.5
9.3
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
19.4
19.5
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
9.6
9.4
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
22.7
19.8
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
11.5
9.4
 * Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error of 20 to 30 percent.
 f The value for all women includes other races who may have very low rates of cigarette smoking. Thus, the weighted average for all women is lower than that for the race
 groups shown in the table.
 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 data sources 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.
 Table 26b.  Cigarette smoking status of people age 18 and over, by sex and age group, 2010
Sex and age group All current smokers Every day smokers Some day smokers Former smokers Non-smokers
Both sexes
Men
18-44
45-64
65 and over
Women
18-44
45-64
65 and over
19.4

23.9
23.2
9.7

19.1
19.1
9.3
15.1

17.3
19.5
8.4

14.6
15.6
7.6
4.2

6.6
3.7
1.3

4.5
3.6
1.7
21.7

14.9
28.9
52.5

10.6
22.5
29.3
59.0

61.2
47.9
37.8

70.3
58.4
61.4
 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 27
Air Quality
 Table 27a.  Percentage of people age 65 and over living in counties with "poor air quality," 2000-2010
Pollutant measures
Participate Matter (PM 2.5)
8hr Ozone
Any standard
2000
40.5
51.7
64.2
2001
38.8
55.1
63.3
2002
37.9
54.3
62.2
2003
32.6
54.4
60.7
2004
23.3
34.8
50.1
2005
35.1
52.0
60.4
2006
21.1
49.8
55.9
2007
23.6
47.8
54.3
2008
10.7
36.1
41.8
2009
9.5
16.6
23.7
2010
4.8
31.6
36.3
 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. Data for previous years have been computed using the new
 daily PM 2.5 standard of 35 micrograms/m3 to enable comparisons overtime. This results in percentages that are not comparable to previous publications of Older Americans.
 Measuring concentrations above the level of a standard is not equivalent to violating the standard. The level of a standard may be exceeded on multiple days before the
 exceedance is considered a violation of the standard.
 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, 2000-2010.
                                                                                                                                                  I
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INDICATOR 27
Air Quality
Table 27b. Counties with "poor air quality" for any standard in 2010
State
Alabama
Alabama
Alabama
Alaska
Alaska
Arizona
Arizona
Arizona
Arizona
Arizona
Arizona
Arkansas
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
California
Colorado
Colorado
Colorado
County
Jefferson County
Mobile County
Pike County
Fairbanks North Star Borough
Matanuska-Susitna Borough
Gila County
Maricopa County
Pima County
Pinal County
Santa Cruz County
Yuma County
Crittenden County
Butte County
Calaveras County
Contra Costa County
El Dorado County
Fresno County
Imperial County
Inyo County
Kern County
Kings County
Los Angeles County
Madera County
Mariposa County
Merced County
Mono County
Nevada County
Placer County
Plumas County
Riverside County
Sacramento County
San Bernardino County
San Diego County
San Joaquin County
San Luis Obispo County
Santa Clara County
Stanislaus County
Tehama County
Tulare County
Ventura County
Alamosa County
Archuleta County
Douglas County
State
Colorado
Colorado
Colorado
Colorado
Connecticut
Connecticut
Connecticut
Connecticut
Connecticut
Delaware
Delaware
Delaware
District of Columbia
Florida
Florida
Georgia
Georgia
Georgia
Georgia
Georgia
Hawaii
Idaho
Idaho
Illinois
Illinois
Illinois
Illinois
Indiana
Indiana
Indiana
Indiana
Indiana
Indiana
Indiana
Indiana
Iowa
Iowa
Iowa
Iowa
Kansas
Kentucky
Kentucky
Kentucky
County
Jefferson County
La Plata County
Larimer County
Mesa County
Fairfield County
Hartford County
Middlesex County
New Haven County
Tolland County
Kent County
New Castle County
Sussex County
District of Columbia
Hillsborough County
Nassau County
Chatham County
Cobb County
Fulton County
Henry County
Rockdale County
Hawaii County
Franklin County
Shoshone County
Cook County
Lake County
Madison County
Tazewell County
Clark County
Daviess County
Delaware County
Floyd County
Marion County
Morgan County
Vigo County
Wayne County
Black Hawk County
Linn County
Muscatine County
Pottawattamie County
Saline County
Campbell County
Jefferson County
Oldham County
See notes at end of table.

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INDICATOR 27
Air Quality
Table 27b. Counties with "poor air quality" for any standard in 2010—continued
State
Louisiana
Louisiana
Louisiana
Louisiana
Louisiana
Louisiana
Louisiana
Louisiana
Louisiana
Louisiana
Maine
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Maryland
Massachusetts
Massachusetts
Massachusetts
Massachusetts
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Minnesota
Minnesota
Mississippi
Missouri
Missouri
Missouri
Missouri
Missouri
Missouri
Missouri
Missouri
Missouri
Montana
County
Ascension Parish
Bossier Parish
Caddo Parish
Calcasieu Parish
East Baton Rouge Parish
Jefferson Parish
Livingston Parish
St. Bernard Parish
St. Tammany Parish
West Baton Rouge Parish
Hancock County
AnneArundel County
Baltimore County
Calvert County
Carroll County
Cecil County
Charles County
Frederick County
Garrett County
Harford County
Montgomery County
Prince George's County
Washington County
Barnstable County
Bristol County
Dukes County
Hampshire County
Chippewa County
Ionia County
Macomb County
Muskegon County
St. Clair County
Wayne County
Dakota County
Ramsey County
DeSoto County
Clay County
Clinton County
Greene County
Iron County
Jefferson County
Lincoln County
Perry County
St. Charles County
St. Louis County
Lewis and Clark County
State
Montana
Montana
Nebraska
Nevada
New Hampshire
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 Jersey
New Jersey
New Jersey
New Mexico
New Mexico
New York
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 Dakota
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
County
Silver Bow County
Yellowstone County
Cass County
Clark County
Hillsborough County
Merrimack County
Atlantic County
Bergen County
Camden County
Cumberland County
Essex County
Gloucester County
Hudson County
Hunterdon County
Mercer County
Middlesex County
Monmouth County
Morris County
Ocean County
Passaic County
Warren County
Dona Ana County
Luna County
Chautauqua County
Dutchess County
Jefferson County
Putnam County
Queens County
Richmond County
Rockland County
Suffolk County
Forsyth County
Guilford County
Mecklenburg County
New Hanover County
Rowan County
Williams County
Ashtabula County
Butler County
Clinton County
Cuyahoga County
Franklin County
Geauga County
Hamilton County
Jefferson County
Lake County
See notes at end of table.
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INDICATOR 27
Air Quality
 Table 27b.  Counties with "poor air quality" for any standard in 2010—continued
State
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Ohio
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Rhode Island
South Carolina
South Carolina
Tennessee
Tennessee
Tennessee
Tennessee
Tennessee
Tennessee
Tennessee
Tennessee
Tennessee
Texas
Texas
Texas
Texas
Texas
Texas
County
Meigs County
Montgomery County
Morgan County
Stark County
Summit County
Trumbull County
Warren County
Washington County
Allegheny County
Armstrong County
Beaver County
Berks County
Bucks County
Chester County
Clearfield County
Dauphin County
Delaware County
Greene County
Indiana County
Lancaster County
Lehigh County
Mercer County
Monroe County
Montgomery County
Northampton County
Philadelphia County
Warren County
Westmoreland County
York County
Washington County
Lexington County
Spartanburg County
Blount County
Bradley County
Hamilton County
Jefferson County
Loudon County
Sevier County
Shelby County
Sullivan County
Sumner County
Bexar County
Brazoria County
Collin County
Dallas County
Denton County
El Paso County
State
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Texas
Utah
Utah
Utah
Utah
Utah
Utah
Utah
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Washington
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
Wisconsin
Wisconsin
Wisconsin
Wisconsin
Wisconsin
Wisconsin
Wisconsin
Wisconsin
Wisconsin
Wisconsin
Wisconsin
Wisconsin

County
Galveston County
Gregg County
Harris County
Hood County
Jefferson County
Johnson County
Montgomery County
Orange County
Tarrant County
Box Elder County
Cache County
Davis County
Salt Lake County
Uintah County
Utah County
Weber County
Arlington County
Charles City County
Chesterfield County
Fairfax County
Hanover County
Henrico County
Loudoun County
Stafford County
Alexandria City
Hampton City
Skagit County
Berkeley County
Brooke County
Hancock County
Marshall County
Monongalia County
Ohio County
Wood County
Brown County
Door County
Kenosha County
Kewaunee County
Manitowoc County
Milwaukee County
Oneida County
Outagamie County
Ozaukee County
Racine County
Sheboygan County
Waukesha 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. Measuring concentrations above the level of a standard is not
 equivalent to violating the standard. The level of a standard may be exceeded on multiple days before the exceedance is considered a violation of the standard.
 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, 2000-2010.

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INDICATOR 28
Use of Time
Table 28a. Average number of hours per day and percentage of day that people age 55 and over spent doing selected
           activities on an average day, by age group, 2010

Average
hours
Selected activities per day
Sleeping 8.5
Leisure activities 5.2
Work and work-related activities 3.8
Household activities 2.1
Caring for and helping others 0.4
Eating and drinking 1 .3
Purchasing goods and services 0.8
Grooming 0.7
Other activities 1 .2
55-64
Percent
of day
35.4
21.8
16.0
8.6
1.6
5.4
3.5
2.7
4.8
NOTE: "Other activities" includes activities such as educational activities; organizational, civ
work at all.

Average
hours
per day
8.8
6.9
1.2
2.4
0.4
1.4
0.9
0.6
1.4
ic and religious
65-74
Percent
of day
36.6
28.6
4.8
10.0
1.8
5.9
3.9
2.7
5.9
activities; and telephone
75 and over

Average
hours Percent
per day
9.3
7.7
0.2
2.3
0.2
1.5
0.7
0.6
1.4
of day
38.8
32.0
1.0
9.6
0.7
6.4
3.1
2.6
5.9
calls. Table includes people who did not
Reference population: These data refer to the civilian noninstitutionalized population.
SOURCE: Bureau of Labor Statistics, American Time Use Survey.
Table 28b. Average number of hours and percentage of total leisure time that people age 55
selected leisure activities on an average day, by age group, 2010

Average
hours
Selected leisure activities per day
Socializing and communicating 0.6
Watching TV 3.0
Participation in sports, exercise,
and recreation 0.3
Relaxing and thinking 0.3
Reading 0.4
Other leisure activities 0.7
55-64
Percent of
leisure time
11.3
57.8
4.9
5.2
7.1
13.7

Average
hours
per day
0.7
3.8
0.3
0.5
0.6
0.8
65-74
Percent of
leisure time
10.3
55.6
4.3
7.8
9.5
12.2
and over spent doing
75 and over


Average
hours Percent of
per day leisure time
0.6
4.4
0.2
0.7
0.9
0.8
8.0
57.7
3.0
8.6
12.2
10.6
 NOTE: "Other leisure activities" includes activities such as playing games, using the computer for leisure, arts and crafts as a hobby, arts and entertainment (other than sports),
 and related travel.
 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, 1992-2009

                                                        Utilization measure
Year
Hospital Skilled nursing Physician visits
stays facility stays and consultations
Home health Average length
care visits of hospital stay
Rate per thousand
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
306
300
331
336
341
351
354
365
361
364
361
359
353
350
343
336
331
320
28
33
43
50
59
67
69
67
67
69
72
74
75
79
80
81
82
80
—
—
—
—
—
—
—
11,395
11,490
11,546
12,232
12,662
12,730
13,302
13,193
13,505
13,897
15,437
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
3,609
3,864
Days
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
5.6
5.4
— Data not available.
NOTE: 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 data base used to generate rates of physician visits and consultations in previous Older American reports is no longer available. This table uses
a different data base that begins with 1999 data and yields slightly different rates. Therefore, this table uses the new data base to estimate rates of physician visits and
consultations for all years between 1999 and 2009 to get a consistently defined trend. 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.
SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
 Table 29b.  Use of Medicare-covered home health care and skilled nursing facility services by Medicare enrollees age 65
             and over, by age group, 2009
 Utilization measure
                                                            65-74
                                                                                             75-84
                                                                                                                       85 and over
                                                                                      Rate per thousand
 Skilled nursing facility stays
 Home health care visits
                              33
                           1,896
   94

4,768
  222

8,974
 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 2008 dollars, by age group,
            1992-2008
Age
Total
65-74
75-84
85 and over
Age
Total
65-74
75-84
85 and over
7992
$9,850
7,330
10,779
19,052
2007
$13,522
10,281
15,037
22,560
7993
$10,557
7,658
12,067
19,750
2002
$14,510
11,184
15,757
23,522
7994
$11,377
8,406
12,601
21,321
2003
$14,645
11,090
16,367
23,013
7995
$11,903
8,661
13,025
22,516
2004
$14,878
11,059
16,202
24,971
7996
$12,039
8,714
13,551
22,042
2005
$15,753
11,893
17,411
24,997
7997
$12,304
8,693
13,669
22,293
2006
$16,105
12,053
17,999
25,270
7998
$12,011
8,403
13,362
22,440
2007
$15,956
11,927
17,893
25,414
7999
$12,347
9,374
13,093
21,683
2008
$15,709
11,793
18,160
23,693
2000
$12,816
9,544
13,970
22,095





 NOTE: Data include both out-of-pocket costs and costs covered by insurance. Dollars are inflation-adjusted to 2008 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.
Table 30b.  Major components of health care costs among Medicare enrollees age 65 and over, 1992 and 2008
Cost component
Total
Inpatient hospital
Physician/outpatient hospital
Nursing home/long-term institution
Home health care
Prescription drugs
Other (short-term institution/hospice/dental)
7992
Average dollars
$6,551
2,107
2,071
1,325
244
522
282

Percent
100
32
32
20
4
8
4
2008
Average dollars
$15,709
3,778
5,630
1,899
524
2,530
1,349

Percent
100
24
36
12
3
16
9
 NOTE: 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: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
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INDICATOR 30
Health Care Expenditures
Table 30c.  Average annual health care costs among Medicare enrollees age 65 and over, by selected characteristics,
            2008
 Characteristics
                                                                                                                   Cost
Total
   Race and ethnicity
     Non-Hispanic White
     Non-Hispanic Black
     Hispanic
     Other
   Institutional status
     Community
     Institution
   Annual income
     Under $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
                                                                                 $15,708

                                                                                  15,526
                                                                                  19,839
                                                                                  15,362
                                                                                  12,746

                                                                                  13,150
                                                                                  61,318

                                                                                  21,924
                                                                                  17,845
                                                                                  14,930
                                                                                  13,149

                                                                                   5,520
                                                                                  10,363
                                                                                  17,876
                                                                                  24,658

                                                                                  14,791
                                                                                  15,762
 NOTE: Data include both out-of-pocket costs and costs covered by insurance. See data sources 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: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.

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INDICATOR 30
Health Care Expenditures
Table 30d.  Major components of health care costs among Medicare enrollees age 65 and over, by age group, 2008
Cosf component
Total
Inpatient hospital
Physician/outpatient hospital
Nursing home/long-term institution
Home health care
Prescription drugs
Other (short-term institution/hospice/dental)

65-74
$11,793
2,895
4,870
526
292
2,471
738
Age
75-84
$18,160
4,661
6,731
1,916
605
2,748
1,499

85 and over
$23,693
4,866
5,768
6,594
1,142
2,203
3,120
 NOTE: Data include both out-of-pocket costs and costs covered by insurance.
 Reference population: These data refer to Medicare enrollees.
 SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 30e.  Percentage of noninstitutionalized Medicare enrollees age 65 and over who reported problems with access to
            healthcare, 1992-2007

Difficulty obtaining care
Delayed getting care due
to cost

Difficulty obtaining care
Delayed getting care due
to cost
1992
3.1
9.8
2000
2.9
4.8
7993
2.6
9.1
2001
2.8
5.1
1994
2.6
7.6
2002
2.5
6.1
7995
2.6
6.8
2003
2.3
5.3
7996
2.3
5.5
2004
2.3
5.3
1997
2.4
4.8
2005
2.5
4.8
7998
2.4
4.4
2006
2.8
5.3
7999
2.8
4.7
2007
2.7
4.6
 Reference population: These data refer to noninstitutionalized Medicare beneficiaries.
 SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.1
 1 MCBS Project. (2011). Health and Health Care of the Medicare Population: Data from the 2007 Medicare Current Beneficiary Survey (prepared under contract to the Centers
 for Medicare and Medicaid Services). Rockville, MD: Westat.
                                                                                                                                I
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INDICATOR 31
Prescription  Drugs
Table 31a.  Average prescription drug costs and sources of payment among noninstitutionalized Medicare enrollees age
            65 and over, 1992-2008


Total
Out-of-pocket
Private
Public

Total
Out-of-pocket
Private
Public
7992

$649
390
165
94
2007
$1,877
750
653
474
7993

$861
500
216
145
2002
$2,082
822
759
502
7994

$914
497
251
166
2003
$2,238
839
851
547
7995
Average
$959
503
283
173
2004
$2,402
870
923
609
7996
7997
7998
7999
2000
cosf in dollars
$1,034
514
344
177
2005
$2,795
994
1,146
655
$1,130
560
368
202
2006
$2,720
799
871
1,050
$1,307
605
457
245
2007
$2,758
677
684
1,397
$1 ,464
644
512
308
2008
$2,834
663
672
1,499
$1 ,675
703
583
389





 NOTE: Dollars have been inflation-adjusted to 2008 using the Consumer Price Index (Research Series). Reported costs have been adjusted to account for underreporting of
 prescription drug use. The adjustment factor changed in 2006 with the initiation of the Medicare Part D prescription drug program. Public programs include Medicare, Medicaid,
 Department of Veterans Affairs, and other State and Federal programs.
 Reference population: These data refer to Medicare enrollees.
 SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 31b. Distribution of annual prescription drug costs among noninstitutionalized Medicare enrollees age 65 and over,
            2008
 Cosf in dollars
                                                                                                         Percent of enrollees
Total
   $0
   1-499
   500-999
   1,000-1,499
   1,500-1,999
   2,000-2,499
   2,500-2,999
   3,000-3,499
   3,500-3,999
   4,000-4,499
   4,500-4,999
   5,000 or more
                                                                                       100.0
                                                                                          6.1
                                                                                         13.9
                                                                                         10.5
                                                                                         10.2
                                                                                         10.2
                                                                                          8.3
                                                                                          7.4
                                                                                          6.2
                                                                                          4.9
                                                                                          3.9
                                                                                          3.1
                                                                                         15.1
 NOTE: Reported costs have been adjusted to account for underreporting of prescription drug use.
 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
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 October 2011
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
October 2011
40,752,219
23,832,723

14,325,499
9,507,224

6,392,018
17,440,705
5,850,214
11,069,282
 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, 2004, and 2008
 Characteristics
                                                            2000
                                                                                Average cost in dollars
                                                                                         2004
                                                                                                                       2008
Chronic conditions
0
1-2
3-4
5 and over
Annual income
Under $10,001
$10,001 -$20,000
$20,001 -$30,000
$30,001 and over

$628
1,314
2,314
3,159

1,577
1,598
1,790
1,733

$912
1,985
3,243
4,402

2,209
2,371
2,437
2,495

$1 ,230
2,276
3,653
5,299

3,530
2,898
2,759
2,666
 NOTE: Dollars have been inflation-adjusted to 2008 using the Consumer Price Index (Research Series). Reported costs have been adjusted 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.
 Reference population: These data refer to Medicare enrollees.
 SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
                                                                                                      I
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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, 1991-2009
Type of insurance
Private (employer- or
union-sponsored)
Private (Medigap)*
HMO/health plans
Medicaid
TRICARE
Other public
No supplement
1991
40.7
44.8
6.3
8.9
—
4.0
11.3
7992
41.0
45.0
5.9
9.0
—
5.3
10.4
7993
40.8
45.3
7.7
9.4
—
5.8
9.7
7994
40.3
45.2
9.1
9.9
—
5.5
9.3
7995
39.1
44.3
10.9
10.1
—
5.0
9.1
7996
37.8
38.6
13.8
9.5
—
4.8
9.4
7997
37.6
35.8
16.6
9.4
—
4.7
9.2
7998
37.0
33.9
18.6
9.6
—
4.8
8.9
7999
35.8
33.2
20.5
9.7
—
5.1
9.0
2000
35.9
33.5
20.4
9.9
—
4.9
9.7
                            2007
                                       2002
                                                  2003
                                                             2004
                                                                        2005
                                                                                  2006
                                                                                             2007
                                                                                                        2008
                                                                                                                   2009
Private (employer- or
union-sponsored)
Private (Medigap)*
HMO/health plans
Medicaid
TRICARE
Other public
No supplement
36.0
34.5
18.0
10.6
—
5.4
10.1
36.1
37.5
15.5
10.7
—
5.5
12.3
36.1
34.3
14.8
11.6
4.5
5.7
9.1
36.6
33.7
15.6
11.3
4.2
5.2
9.7
36.1
34.6
15.5
11.8
5.1
5.6
8.9
34.9
32.5
20.7
11.9
5.2
4.3
9.4
35.3
31.5
21.5
11.9
5.1
4.0
10.5
34.2
29.5
23.2
11.7
5.4
3.9
10.5
32.5
27.8
28.1
11.7
5.2
3.6
9.4
 * Includes people with private supplement of unknown sponsorship.
 — Not available.
 NOTE: HMO/health plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and private fee-for-service plans (PFFS). 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 3 percent of enrollees). Medicaid coverage was determined from both survey responses and Medicare administrative records.
 TRICARE coverage was added to Medicare Current Beneficiary Survey Access to Care files beginning in 2003. Previous versions of Older Americans did not include data on
 TRICARE coverage. Adding TRICARE coverage to the table changes the percentage of enrollees in the  "No supplement" group.
 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, 2010

                                                                                  Poverty threshold
Type of insurance
Private
Medicaid
Medicare
Other coverage
Uninsured
Total
71.8
6.5
4.4
4.5
12.8
Below 100 percent
19.0
35.5
8.3
6.2
31.0
100-199 percent
38.2
13.0
12.0
6.1
30.7
200 percent or more
84.6
1.8
2.5
4.0
7.2
 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, and 2000-2009
Age group
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
1977
83.3
81.9
81.6
82.6
83.4
83.8
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
2001
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
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
2007
94.3
89.5
88.7
91.9
93.2
95.3
95.6
2008
95.0
90.1
89.0
93.0
94.3
95.7
95.8
2009
94.3
88.5
88.6
88.3
93.8
94.8
95.1
NOTE: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Data for 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.
                                                                                                                     I
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INDICATOR 33
Out-of-Pocket Health Care Expenditures
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, and 2000-2009
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
Health Status Category
Poor or fair health
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
Excellent, very good, or good health
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
7977

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


9.5
8.7
8.8
8.6
8.7
11.3
8.9

6.1
3.9
3.9
4.1
5.3
7.5
7.6
7987

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


11.0
8.5
9.0
7.6
10.0
12.4
12.2

7.1
4.6
4.5
4.9
5.4
9.7
11.8
7996

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
*

5.6
3.2
2.9
3.8
4.9
6.3
7.8


11.7
13.0
11.8
15.9
10.7
11.8
*

6.6
5.0
4.1
7.3
6.3
7.2
6.4
2000

9.1
7.0
6.1
9.3
8.1
10.4
10.1


22.6
29.9
28.1
*
24.4
22.9
17.6

6.3
3.4
3.1
4.3
5.6
6.9
7.6


13.1
14.1
12.8
17.4
11.8
14.6
13.8

6.7
4.0
3.5
5.6
6.2
7.5
7.1
2007

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


13.9
13.6
12.9
15.2
13.5
14.7
13.2

7.6
5.2
4.8
6.6
6.2
9.1
10.6
2002

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


14.6
13.3
12.8
14.7
14.4
15.2
13.5

8.4
4.6
4.4
5.6
7.1
9.6
11.9
2003

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


16.0
13.3
12.4
15.9
13.8
17.5
19.5

8.9
5.0
4.9
5.4
6.9
10.7
13.9
See notes at end of table.

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INDICATOR  33
Out-of-Pocket Health  Care Expenditures
 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, and 2000-2009—continued
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
Health Status Category
Poor or fair health
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
Excellent, very good, or good health
65 and over
55-64
55-61
62-64
65-74
75-84
85 and over
2004

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


15.2
13.8
13.5
14.7
14.3
15.4
17.9

9.4
5.0
4.5
6.4
8.9
9.3
12.8
2005

10.9
7.1
6.7
8.2
9.2
12.5
13.0


27.6
27.7
27.9
27.3
26.2
28.6
28.6

7.4
4.2
3.9
5.3
6.2
8.8
8.2


15.5
12.7
11.8
15.3
14.3
17.1
14.5

8.1
4.9
4.6
5.6
6.6
9.2
11.9
2006

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


12.9
13.2
12.9
14.0
13.1
13.0
12.2

8.2
4.8
4.3
6.3
7.1
8.8
12.2
2007

8.6
6.0
5.8
6.6
7.2
10.0
10.1


21.9
23.3
24.1
21.2
20.2
24.5
20.0

5.6
3.8
3.5
4.5
4.9
6.1
7.2


11.3
10.0
9.8
10.5
11.3
11.3
11.2

7.0
4.4
4.3
5.0
5.3
9.2
9.2
2008

8.4
6.2
5.8
7.3
7.0
9.5
10.7


19.4
24.3
24.2
24.4
19.4
18.3
21.6

5.9
3.8
3.4
4.9
4.8
7.2
7.4


11.8
11.3
10.9
12.2
11.4
11.2
14.4

6.4
4.1
3.9
4.8
5.0
8.3
7.9
2009

8.1
6.2
5.8
7.4
7.0
9.3
9.4


22.4
26.1
25.1
28.5
23.3
21.5
22.5

5.2
3.4
3.2
4.0
4.3
6.2
6.4


10.5
9.8
10.2
8.8
9.6
11.9
10.0

6.8
4.8
4.1
6.8
5.7
7.8
9.0
 * 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 age 65 and over in 1977, and 4.5 percent of the population age 65 and over 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.
                                                                                                                                               I
                                                                                                                                               fir

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INDICATOR 33
Out-of-Pocket Health Care Expenditures
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, 2000-2009
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
2005
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

5.4
11.4
15.3
57.8
10.1
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

12.2
19.6
15.7
45.9
6.5
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

12.8
19.6
16.3
44.7
6.7
62-64

*
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

10.8
19.9
14.3
49.0
6.1
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

5.1
11.4
19.4
57.9
6.2
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

5.7
12.3
12.6
59.1
10.4
85 and
over

8.6
6.0
9.6
48.0
27.9

*
6.0
8.3
45.1
*

5.1
7.8
6.2
65.5
15.4

5.1
5.4
9.5
59.8
20.2

*
5.3
7.5
51.9
29.5

5.4
8.7
9.8
53.3
22.7
See notes at end of table.

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INDICATOR 33
Out-of-Pocket  Health  Care Expenditures
 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, 2000-2009—continued
Type of health care service, by year
2006
Hospital care
Office-based medical provider services
Dental services
Prescription drugs
Other health care
2007
Hospital care
Office-based medical provider services
Dental services
Prescription drugs
Other health care
2008
Hospital care
Office-based medical provider services
Dental services
Prescription drugs
Other health care
2009
Hospital care
Office-based medical provider services
Dental services
Prescription drugs
Other health care
65 and
over

7.2
12.3
16.2
51.1
13.2

*
13.7
18.5
47.3
11.6

6.3
15.0
19.6
42.0
17.1

10.6
15.8
18.7
41.3
13.6
55-64

*
19.8
13.9
43.2
5.5

12.4
22.1
21.1
38.8
5.6

14.2
23.1
19.9
35.9
6.8

16.0
23.2
21.6
32.2
7.0
55-61

9.4
20.9
15.4
48.5
5.8

12.6
21.7
21.3
38.8
5.7

14.7
24.0
19.8
35.8
5.8

13.3
24.6
23.0
32.2
6.9
62-64

*
17.4
10.6
32.0
4.9

11.9
23.1
20.7
38.7
5.5

13.3
21.4
20.2
36.3
8.8

*
20.3
18.6
32.1
7.1
65-74

6.6
14.1
19.7
51.5
8.1

4.4
15.5
21.4
49.5
9.2

7.3
17.3
21.4
44.8
9.2

6.4
18.8
23.0
44.2
7.7
75-84

5.9
11.0
15.3
53.2
14.7

*
12.7
16.4
45.4
10.2

5.9
14.9
19.8
41.2
18.2

14.5
14.0
15.4
40.2
15.9
85 and
over

12.2
9.5
7.6
45.2
25.5

*
10.4
14.9
45.3
21.6

4.5
9.3
14.2
35.9
36.1

12.7
11.8
15.0
36.1
24.4
 * Estimate not shown due to a relative standard error 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. Estimates 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. Average cost and percentage of sources of payment for health care services for Medicare enrollees age 65
           and over, by type of service, 2008
Type of service
All
Hospice
Inpatient hospital
Home health care
Short-term institution
Physician/medical
Outpatient hospital
Prescription drugs
Dental
Long-term care facility
Average cost
$15,710
260
3,780
520
690
4,170
1,460
2,530
390
1,900
Total
100
100
100
100
100
100
100
100
100
100
Medicare
60
100
87
92
81
63
69
45
1
0
Medicaid
7
0
1
1
2
2
2
1
0
52
OOP
18
0
4
5
8
19
10
22
76
41
Other
15
0
8
2
9
16
19
33
22
7
 NOTE: "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: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
Table 34b. Average cost and percentage of sources of payment for health care services for Medicare enrollees age 65
           and over, by income, 2008
Income
All
Under $10,000
$10,000-$20,000
$20,001 -$30,000
$30,001 and over
Average cost
$15,710
21 ,920
17,850
14,930
13,150
Total
100
100
100
100
100
Medicare
60
61
62
62
57
Medicaid
7
21
10
3
1
OOP
18
12
16
20
20
Other
15
7
12
16
22
 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: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.

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INDICATOR 3 5
Veterans' Health Care
Table 35.  Total number of veterans age 65 and over who are enrolled in or are receiving health care from the Veterans
        Health Administration, 1990-2011
Year

1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
— Data not available.
Veteran population
Number (in
7.9
8.3
8.7
9.0
9.2
9.4
9.7
9.8
9.9
10.0
10.0
9.9
9.9
9.8
9.6
9.5
9.4
9.3
9.2
9.2
9.2
9.4

VA enrollees
millions)
—
—
—
—
—
—
—
—
—
1.9
2.2
2.8
3.2
3.3
3.4
3.5
3.5
3.5
3.4
3.6
3.7
3.8

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
2.4
2.5
2.6

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, including those who received care but were not enrolled in VA. Death Master File from the Social Security
Administration (SSA) is 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 Projections; Office of the Assistant Deputy Under Secretary for Health for Policy and Planning, Fiscal 2011 Year-
end Enrollment file linked with VHA Vital Status data (including data from 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, 2009
 Residential setting
                                                    65 and over
                                                                                   65-74
                                                                                                             75-84
                                                                                                                                85 and over
All settings
 Total
 Traditional community
 Community  housing with services
 Long-term care facilities
                     34,200
                      100.0
                        93.0
                         2.7
                         4.2
Numbers (in thousands)
     16,900                  12,400
         Percent
      100.0
        97.4
         1.1
         1.5
100.0
 93.3
   2.9
   3.8
                         4,900
100.0
 77.8
   8.1
 14.2
 NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senio
 retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations, AND who
 more of the following services through their place of residence: meal preparation, cleaning or housekeeping services, laundry services, o
 were asked about access to these services, but not whether they actually used the services. A residence (or unit) is considered a long-te
 Medicare or Medicaid; or has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least one pe
 hour, 7-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.
                                                                           citizen housing, continuing care
                                                                          eported they had access to one or
                                                                           help with medications. Respondents
                                                                          m care facility if it is certified by
                                                                          sonal care service; or provides 24-
 Table 36b.  Percentage of Medicare enrollees age 65 and over with functional limitations, by residential setting, 2009
 Functional status
                          Traditional
                         community
                                                                                     Community housing
                                                                                             with services
                                                    Long-term
                                                 care facilities
 Total
 No functional limitations
 IADL limitation only
 1-2 ADL limitations
 3 or more ADL limitations
                               100.0
                                61.0
                                12.7
                                18.2
                                 8.1
                       100.0
                         35.3
                         14.2
                         34.5
                         16.1
                         100.0
                            5.2
                           10.4
                           16.3
                           68.0
 NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senio
 retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations, AND who
 more of the following services through their place of residence: meal preparation, cleaning or housekeeping services, laundry services, o
 were asked about access to these services, but not whether they actually used the services. A residence (or unit) is considered a long-te
 Medicare or Medicaid; or has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least one pe
                                                                           citizen housing, continuing care
                                                                          eported they had access to one or
                                                                           help with medications. Respondents
                                                                          m care facility if it is certified by
                                                                          sonal care service; or provides
 24-hour, 7-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, or 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, or 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.  Percent availability of specific services among Medicare enrollees age 65 and over residing in community
              housing with services, 2009
/Access to
                                                                                                                                    Percent
 Prepared meals
 Housekeeping, maid, or cleaning services
 Laundry services
 Help with medications
                                                                                                    84.3
                                                                                                    80.0
                                                                                                    73.1
                                                                                                    47.9
 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 carefacilities/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
 Table 36d.  Percent distribution of annual income of Medicare enrollees age 65 and over, by residential setting, 2009
Income
Total
Under $10,000
$10,001 -$20,000
$20,001 -$30,000
$30,001 and over
Community housing
Traditional community with services
100.0
11.4
22.4
19.7
46.5
100.0
16.9
27.1
19.7
36.3
Long-term care
facilities
100.0
41.1
34.2
10.8
13.9
 NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senio
 retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations, AND who
 more of the following services through their place of residence: meal preparation, cleaning or housekeeping services, laundry services, o
 were asked about access to these services, but not whether they actually used the services. A residence (or unit) is considered a long-te
 Medicare or Medicaid; or has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least one pe
                                                                         citizen housing, continuing care
                                                                         eported they had access to one or
                                                                         help with medications. Respondents
                                                                         m care facility if it is certified by
                                                                         sonal care service; or provides 24-
 hour, 7-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, 2009
 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

                                                                                                  37.6
                                                                                                  51.7

                                                                                                  10.7
                                                                                                100.0

                                                                                                  53.3

                                                                                                  46.7
 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, or 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.  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 1992-2009

Personal assistance only
Equipment only
Personal assistance and equipment
None
7992
9.2
28.3
20.9
41.6
7997
5.6
34.2
21.4
38.8
2007
6.3
36.3
22.0
35.3
2005
6.6
36.3
21.9
35.2
2007
6.0
37.6
22.1
34.3
2009
6.4
38.4
23.4
31.9
 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.  Percent distribution of noninstitutionalized Medicare enrollees age 65 and over who have limitations in
             activities of daily living (ADLs), by type of assistance and sex, 2009
                                                                                    Men
                                                                                                                             Women
 Personal assistance only
 Equipment only
 Personal assistance and equipment
 None
                                                   6.0
                                                  36.4
                                                  22.4
                                                  35.2
 6.6
39.7
24.0
29.7
 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 37c.  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 1992-2009

65 and over
65-74
75-84
85 and over
7992
61.6
58.9
63.2
69.2
7997
63.6
61.8
63.2
71.1
2007
65.2
60.9
66.5
73.7
2005
66.4
62.7
67.4
74.0
2007
66.3
65.4
66.0
69.7
2009
66.2
64.8
67.3
67.6
 NOTE: I ADL 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 I ADLs.
 SOURCE: Centers for Medicare and Medicaid Services, Medicare Current Beneficiary Survey.
 Table 37d.  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 and sex, 2009
                                                                                    Men
                                                                                                                             Women
 65-74
 75-84
 85 and over
                                                  60.8
                                                  73.2
                                                  70.1
66.5
64.1
66.4
 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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SPECIAL FEATURE
End of Life
Table EL1.  Percentage of Medicare decedents age 65 and over who used hospice or intensive care unit/coronary care
            unit services in their last 30 days of life, selected years 1999-2009

Hospice
Intensive care unit/coronary care unit
7999
19.2
22.0
2007
24.3
22.8
2003
29.4
23.8
2005
34.3
24.5
2007
39.3
25.5
2009
42.6
27.1
NOTE: Table is based on a 5 percent sample of deaths occurring between February and December of each year.
Reference population: These data refer to Medicare enrollees in fee-for-service.
SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
Table EL2.  Percentage of Medicare decedents age 65 and over who used hospice services in their last 30 days of life, by
            age, sex, and race, 2009
Total
Age and sex
Both Sexes
65-74
75-84
85 and over
Men
65-74
75-84
85 and over
Women
65-74
75-84
85 and over
Number
71,400
14,200
24,600
32,600

7,700
10,900
9,600

6,400
13,700
23,000
Percent
42.6
34.7
41.4
47.0

32.3
38.8
43.5

37.5
43.5
48.5
White
Number
62,400
11,800
21,300
29,400

6,400
9,500
8,700

5,300
11,800
20,600
Percent
44.0
36.1
42.9
47.9

33.4
40.2
44.5

39.4
45.1
49.4
Black
Number
6,000
1,700
2,200
2,100

910
910
500

800
1,200
1,600
Percent
34.3
27.8
32.9
41.1

27.8
32.0
35.4

27.9
33.6
42.9
Other
Number
3,000
680
1,200
1,200

400
540
430

290
650
740
Percent
31.3
27.4
29.3
35.6

25.9
25.2
32.6

29.4
32.6
37.3
NOTE: Table is based on a 5 percent sample of deaths occurring between February and December of 2009.
Reference population: These data refer to Medicare enrollees in fee-for-service.
SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
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SPECIAL FEATURE
End  of Life
Table ELS.  Percentage of Medicare decedents age 65 and over who used intensive care unit/coronary care unit services
             in their last 30 days of life, by age, sex, and race, 2009
Total
Age and sex
Both Sexes
65-74
75-84
85 and over
Men
65-74
75-84
85 and over
Women
65-74
75-84
85 and over
Number
71,400
14,200
24,600
32,600

7,700
10,900
9,600

6,400
13,700
23,000
Percent
27.1
32.7
30.9
21.8

31.7
31.3
25.8

33.9
30.6
20.2
White
Number
62,400
11,800
21,300
29,400

6,400
9,500
8,700

5,300
11,800
20,600
Percent
26.4
32.2
30.2
21.3

31.6
30.8
25.4

32.9
29.7
19.5
Black
Number
6,000
1,700
2,200
2,100

910
910
500

810
1,200
1,600
Percent
32.1
36.0
34.5
26.2

31.9
31.6
28.2

40.5
36.6
25.5
Other
Number
3,000
680
1,200
1,200

400
540
430

290
650
740
Percent
32.8
33.5
37.2
27.9

32.7
39.1
31.0

34.6
35.7
26.1
NOTE: Table is based on a 5 percent sample of deaths occurring between February and December of 2009.
Reference population: These data refer to Medicare enrollees in fee-for-service.
SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
Table EL4.  Number and percent distribution of lengths of stay in hospice among Medicare decedents age 65 and over,
             1999 and 2009
Length of stay
                                                                           1999
                                                                                                                       2009
Number
Total
   1-7 days
   8-14 days
   15-30 days
   31-60 days
   61-90 days
   91-180 days
   181 days or more
                                 15,500
                                  100.0
                                   31.5
                                   17.0
                                   18.1
                                   14.3
                                    6.5
                                    7.9
                                    4.8
30,400
 100.0
  34.1
  15.3
  15.1
  11.7
   6.0
   8.3
   9.6
NOTE: Table is based on a 5 percent sample of deaths occurring between February and December of each year. Length of hospice stay consists of continuous enrollment in
hospice ending within 30 days of death. Length of stay was not available for 126 cases in 1999 and 79 cases in 2009.
Reference population: These data refer to Medicare enrollees in fee-for-service.
SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.
Table ELS.  Percent distribution of primary diagnoses related to hospice among Medicare decedents age 65 and over who
             used hospice services in their last 30 days of life, 1999 and 2009
Primary diagnosis
Number
Total
Neoplasms
Diseases of the circulatory system
Diseases of the respiratory system
Diseases of the nervous system and sense organs
Symptoms, signs, and ill-defined conditions
Diseases of the genitourinary system
Diseases of the digestive system
Other
ICD-9-CM


1 40-208, 230-234
390-459
460-51 9
320-389
780-799
580-629
520-579

7999
15,600
100.0
53.4
17.2
6.6
5.5
5.3
3.2
1.6
7.2
2009
30,300
100.0
31.5
19.2
8.5
7.8
16.8
3.5
1.4
11.4
NOTE: Table is based on a 5 percent sample of deaths occurring between February and December of each year. For each decedent the table reflects the most frequent first-
listed diagnosis appearing on hospice claims. Table excludes 124 cases for which a diagnosis could not be determined.
Reference population: These data refer to Medicare enrollees in fee-for-service.
SOURCE: Centers for Medicare and Medicaid Services, Medicare claims and enrollment data.

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SPECIAL FEATURE
End  of Life
Table EL6.  Percent distribution of decedents age 65 and over by place of death, 1989-2009
Place of death
Hospital — inpatient
Nursing home/long-term care facilities
Residence
Other

Hospital — inpatient
Nursing home/long-term care facilities
Residence
Other

Hospital — inpatient
Nursing home/long-term care facilities
Residence
Other
7989
48.7
21.3
15.2
14.9
7996
40.9
26.3
20.7
12.1
2003
38.3
28.4
22.2
11.2
7990
49.3
21.4
16.4
12.9
1997
41.3
27.2
20.9
10.6
2004
37.2
28.3
22.8
11.7
7997
48.2
21.6
17.7
12.5
7998
40.9
27.6
20.9
10.7
2005
36.6
28.5
22.9
12.0
7992
47.0
22.30
18.3
12.4
7999
40.7
27.8
20.8
10.7
2006
35.9
28.2
23.5
12.4
7993
44.9
23.8
19.0
12.3
2000
40.0
28.2
21.2
10.7
2007
35.3
27.9
23.7
13.1
7994
43.3
24.8
19.7
12.1
2007
39.6
28.3
21.3
10.8
2008
34.4
27.3
23.5
14.8
7995
41.9
25.7
20.3
12.2
2002
38.9
28.5
21.6
11.0
2009
32.4
26.7
24.3
16.6
NOTE: Other includes hospital outpatient or emergency department, including dead on arrival, inpatient hospice facilities, and all other places and unknown. Beginning in 2003,
the term "long-term care facilities" was added to the nursing home check box on the death certificate.
Reference population: These data refer to the resident population.
SOURCE: National Vital Statistics System. Mortality public use data files, 1989-2009.
Table EL7.  Percent distribution of decedents age 65 and over by place of death and sex, 2009
Place of death
                                                                     Male
                                                                                                                     Female
Hospital—inpatient
Nursing home/long-term care facilities
Residence
Other
                             34.8
                             21.2
                             26.5
                             17.5
30.5
31.3
22.4
15.8
NOTE: Other includes hospital outpatient or emergency department, including dead on arrival, inpatient hospice facilities, and all other places and unknown.
Reference population: These data refer to the resident population.
SOURCE: National Vital Statistics System. Mortality public use data files, 2009.
I
fir

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SPECIAL FEATURE
End  of Life
Table ELS.  Percent distribution of decedents age 65 and over by place of death and age group, 2009
Place of death
                                                                    65-74
                                                                                             75-84
                                                                                                                85 and over
Hospital—inpatient
Nursing home/long-term care facilities
Residence
Other
                              38.6
                              12.4
                              29.6
                              19.4
35.3
22.6
25.3
16.8
26.6
38.0
20.5
14.9
NOTE: Other includes hospital outpatient or emergency department, including dead on arrival, inpatient hospice facilities, and all other places and unknown.
Reference population: These data refer to the resident population.
SOURCE: National Vital Statistics System. Mortality public use data files, 2009.
Table ELS.  Percent distribution of decedents age 65 and over by place of death and race and ethnicity, 2009
Non-Hispanic Non-Hispanic
Place of death White Black
Hospital — inpatient
Nursing home/long-term care facilities
Residence
Other
31.1
28.4
24.3
16.2
38.2
18.8
21.3
21.7
American Indian Asian or
Hispanic or Alaska Native Pacific Islander
41.1
15.8
28.4
14.8
40.5
19.4
26.5
13.5
43.6
17.2
24.4
14.8
NOTE: Other includes hospital outpatient or emergency department, including dead on arrival, inpatient hospice facilities, and all other places and unknown.
Reference population: These data refer to the resident population.
SOURCE: National Vital Statistics System. Mortality public use data files, 2009.

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Data Sources

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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, Outreach and Information Division,
located in Research Triangle Park, NC.

For more information, contact:
David Mintz
U.S. Environmental Protection Agency
Phone: 919-541-5224
Web site: http://www.epa.gov/ttn/airs/airsaqs

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 60 metropolitan surveys and is
designed to collect data from the same housing
units for each survey. The national survey, a
representative sample of approximately 85,000
housing units beginning in 2011 (60,000 in prior
years), is conducted biennially in odd-numbered
years; the metropolitan surveys, representative
samples of 4,500 housing units, are conducted
in odd-numbered years on a 4-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; and demographic data on family
composition, income, education, and race and
ethnicity. Information on neighborhood quality,
walkability, public transportation and recent
movers; the health and safety aspects of a home;
accommodations for older and disabled household
members; doubling up of households; working
from home; and energy efficiency are collected
in rotating supplements to the survey.

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

For more information, contact:
Carolyn Lynch
U.S. Department of Housing and Urban
Development
E-mail: Carolyn.Lynch@hud.gov
Phone: 202-708-1060
Web site: http://www.census.gov/housing/ahs

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 spend 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.

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For more information, contact:
American Time Use Survey Staff
E-mail: atusinfo@bls.gov
Phone: 202-691-6339
Web site: http://www.bls.gov/tus

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 characteristics of the consumer
unit, which is similar to a household, 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
Web site: 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 base 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: CPS respondents
are asked to identify themselves as belonging to
one or more of six racial groups (White, Black,
American Indian and Alaska Native, Asian,
Native Hawaiian and other Pacific Islander,
and Some Other Race). 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. 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: cpsinfo@bls.gov
Phone: 202-691-6378
Web site: http://www.bls.gov/cps
Additional Web site: http://www.census.gov/cps


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Decennial Census

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. For most
data collections, Census Day was April 1st of the
respective year.

For the 2010 Census, the Bureau devised a short-
form questionnaire that asked for the age, sex,
race, and ethnicity (Hispanic or non-Hispanic)
of each household resident, his or her relationship
to the person filling out the form, and whether the
housing unit was rented or owned by a member
of the household. The census long form, which
for decades collected detailed socioeconomic and
housing data from a sample of the population
on education, housing, jobs, etc., was replaced
by the American Community Survey (ACS), an
ongoing survey of about 250,000 households per
month that gathers largely the same data as its
predecessor.

Race and Hispanic origin:  Starting in Census
2000, and continuing in the 2010 Census,
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 in Census 2000 and the 2010
Census, these data are not directly comparable
with data from the 1990 or  earlier censuses.

As in earlier censuses, the 2010 Census included a
separate question on Hispanic origin. In the 2010
Census, people of Spanish/Hispanic/Latino origin
could identify themselves as Mexican, Mexican
American or Chicano, Puerto Rican, Cuban,  or
Another Hispanic, Latino, or Spanish origin.
People of Hispanic origin may be of any  race.

For more information, contact:
Age and Special Populations Branch
Phone: 301-763-2378
Web site: http://2010.census.gov/2010census/
Health and Retirement Study

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). The HRS steady-state desig.
calls for the addition of a new 6-year cohort of
Americans entering their 50s every 6 years. So,
the Early Boomer birth cohort (1948-1953) was
added in 2004, the Mid "Baby Boomer" birth
cohort (1954-1959) was added in 2010, and
the Late "Baby Boomers" (1960-1965) will be
added in 2016. The 2010 wave also included an
expansion of the minority sample of Early and
Mid "Baby Boomers". Telephone follow-ups
are conducted every second year, with proxy
interviews after death. Beginning in 2006, one-
half of the 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)
supplements the HRS with the  specific aim
of conducting a population-based study of
dementia. A genome-wide scan is being
completed on approximately 20,000 HRS
participants by the end of 2012 that can
support genetic and genomic studies.

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 intended to provide data for
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

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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; 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: hrsquest@isr.umich.edu
Phone:734-936-0314
Web site: http://hrsonline.isr.umich.edu/

Intercensal Population
Estimates: 2000  to 2010

Intercensal population estimates are produced
for the years between two decennial censuses
when both the beginning and ending populations
are known. They are produced by adjusting the
existing time series of postcensal estimates for the
entire decade to smooth the transition from one
decennial census count to the next.  They differ
from the annually released postcensal estimates
because they rely on mathematical formulae that
redistribute the difference between the April 1
postcensal estimate and April 1 census count
for the end of the decade across the postcensal
estimates for that decade. For dates when both
postcensal and intercensal estimates are available,
intercensal estimates are preferred.

The 2000-2010 intercensal estimates reconcile
the postcensal estimates with the 2010 Census
counts and provide  a consistent time series of
population estimates that reflect the 2010 Census
results. The 2000-2010 intercensal  estimates were
produced for the nation, states, and counties by
demographic characteristics (age, sex, race and
Hispanic origin).
For a more detailed discussion of the methods
used to create the intercensal estimates, see
http://www.census.gov/popest/data/intercensal/
index.html.

For more information, contact:
Population Estimates Branch
Phone:301-763-2385
Web site: http://www.census.gov/popest/index.
html

International Data Base

The U.S. Census Bureau produces the
International Data Base (IDE), which includes
regularly updated population estimates and
projections for over 200 countries and areas.
The series of estimates and projections provide
a consistent set of demographic indicators,
including population size and growth, mortality,
fertility, and net migration. The IDE is accessible
via the internet at www.census.gov/population/
international/data/idb.

For more information, contact:
Eurasia Branch, International Programs Center
for Demographic and Economic Studies
Phone:301-763-1360
Web site: http://www.census.gov/population/
international/data/

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 MCBS
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


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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 four 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 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: MCBS@cms.hhs.gov
Web site: http://www.cms.hhs.gov/mcbs

The Research Data Assistance Center
E-mail: resdac@umn.edu
Phone: 888-973-7322
Web site: http://www.resdac.umn.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).

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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 (CAHPS®;
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:
MEPS Web site: http://www.meps.ahrq.gov/
mepsweb

National Health Interview
Survey

The National Health Interview Survey (NHIS),
conducted by the National Center for Health
Statistics since 1960, is a continuing nationwide
sample survey in which data are collected during
personal household interviews. NHIS is the
principal source of information on the health
of the civilian, noninstitutionalized, household
population of the United States. A major strength
of this survey lies in the ability to analyze
health measures by many demographic and
socioeconomic characteristics. Sampling and
interviewing are continuous throughout each
year. The sampling plan follows a multistage area
probability design that permits the representative
sampling of households and noninstitutional
group quarters (e.g., college dormitories).
The sampling plan is redesigned after every
decennial census. The current NHIS sample
design oversamples Asian Americans, African
Americans, and Hispanics.

Interviewers collect data on illnesses, injuries,
impairments, and chronic conditions; activity
limitation caused by chronic conditions;
utilization of health services; and other
health topics. Information is also obtained on
personal, social, economic, and demographic
characteristics, including race and ethnicity
and health insurance status. The survey is
reviewed each year, core questionnaire items are
revised every 10-15 years (with major revisions
occurring in 1982 and 1997), and special topics
are added or deleted annually.

NHIS data are used to monitor trends in illness
and disability, to track progress toward achieving
national health objectives, to link behaviors to
health outcomes, and  to identify new health
risks. NCHS has conducted a mortality linkage
of NHIS with death certificate records from the
National Death Index (NDI) to allow researchers
to investigate the association of a variety of
health factors with mortality, using the richness
of the NHIS questionnaires.  The NHIS Early
Release Program publishes a periodic report on
15 Early Release measures prior to final data
editing and final weighting to provide access to
the most recent information. These estimates are
then updated as each new quarter of NHIS data
becomes available.  In addition to these reports,
preliminary microdata files containing selected
NHIS variables are produced as part of the Early
Release Program.

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: nhis@cdc.gov
Phone: 301-458-4901
       301-458-4001
Web site: 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 a combination of
health interviews, physical examinations, and


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laboratory tests. The health interviews are
conducted in respondent's homes and health
measurements are performed in specially-
designed and equipped mobile examination
centers, which travel to locations throughout
the country. The study team consists of a
physician, medical and health technicians, as
well as dietary and health interviewers. Many of
the study staff are bilingual (English/Spanish).
All health information gathered is held in strict
confidentiality. 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 began in the early 1960s
and has been conducted as a series of surveys
focusing on different population groups or
health topics and 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 became a continuous, annual
survey, which allows increased flexibility in
survey content. Since April 1999, NHANES has
collected data every year from a representative
sample of the civilian noninstitutionalized U.S.
population, newborns and older. To produce
reliable statistics, NHANES over-samples
persons 60 and older, Asian Americans, African
Americans, and Hispanics.

Information collected from the current survey
is comparable with information collected in
previous surveys. This allows health planners
to detect the extent various health problems
and risk factors have changed in the U.S.
population overtime. NHANES has collected
data on chronic disease prevalence and conditions
(including undiagnosed conditions) and on
risk factors such as obesity, smoking,  elevated
serum cholesterol levels, hypertension, diet
and nutritional status, immunization status,
infectious disease prevalence, health insurance,
and measures of environmental exposures. Other
topics addressed include hearing, vision, mental
health, anemia, diabetes, cardiovascular disease,
osteoporosis, oral health, pharmaceuticals and
dietary supplements used, and physical fitness.
Results from the survey allow scientists to
determine the prevalence of major diseases
and risk factors for diseases, assess nutritional
status and its association with health promotion
and disease prevention, and produce national
references for such measurements as height,
weight, and blood pressure.

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: cdcinfo@cdc.gov
Phone: 800-232-4636
Web site: 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, fetal 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. By law, the registration of deaths
is the responsibility of the funeral director. The
funeral director obtains demographic data for
the death certificate from an informant. The
physician in attendance at the death is required
to certify the cause of death. Where death is  from
other than natural causes, a coroner or medical
examiner may be required to examine the body
and certify the cause  of death. 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

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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.

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

For more information, contact:
Mortality Statistics Branch
E-mail: cdcinfo@cdc.gov

Phone: 800-232-4636
Web site: http://www.cdc.gov/nchs/nvss.htm

Population Projections

The 2008 National Population Projections
provide projections of resident population and
demographic components of change (births,
deaths, and net international migration) through
2050. Population projections are available by age,
sex, race and Hispanic origin. The projections
do not precisely agree with population estimates
available elsewhere on the U.S. Census Bureau
website for various reasons.  For example, the
2008 National Projections are based on, and
move forward from, Census 2000, whereas the
estimates are updated annually. Where both
estimates and projections are available for a
given time reference, we recommend use of
the population estimates as the measure of the
current population. Below we provide a general
description of the methods used to produce the
2008 National Population Projections.

The projections originate with a base population
from Census 2000 and are produced using
a cohort-component method. Many of the
characteristics of the U.S. resident population,
as measured by Census  2000, are preserved
as demographic patterns that work their way
through the projection period. Using the cohort-
component method, the  components of population
change (births, deaths, and net international
migration) are projected for each birth cohort
(persons born in a given year). For each passing
year, we advance the population one year of age.
We update the new age  categories using survival
rates and levels of net international migration
projected for the passing year. A new birth  cohort
is added to form the population under one year
of age by applying projected age-specific fertility
rates to the female population aged 15 to 49,
and updating the new cohort for the effects of
mortality and net international migration.

The assumptions for the components  of change
are based on time series analysis. Because of
limited information about racial characteristics
in the fertility and mortality historical series,
the assumptions were first developed  for three
mutually exclusive and exhaustive groups:
Hispanic origin (any race), non-Hispanic Black
alone, and non-Hispanic all other races. These
assumptions were then applied to their respective
detailed racial and ethnic categories to project
the population, which allows us to present the
race categories described above.

For more information see:
http://www.census.gov/population/www/
projections/2008projections.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 a representative
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:
Brad Trenkamp
E-mail: brad.trenkamp@ssa.gov
Phone:202-358-6116
Web site: http://www.socialsecurity.gov


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Survey of Consumer Finances

The Survey of Consumer Finances (SCF) is a
triennial, cross-sectional, national survey of
non-institutionalized Americans conducted by
the Federal Reserve Board with the cooperation
of the Statistics of Income Division of the Internal
Revenue Service. It includes data on household
assets and debts, use of financial  services, income,
demographics, and labor force participation.
The survey is considered one of the best sources
for wealth measurement because  of its detailed
treatment of assets and debts and because it
oversamples wealthy households.55-56 The data
for the panels of SCF used in this study were
collected by the National Opinion Research
Center at the University  of Chicago. The SCF
uses a dual-frame sample consisting of both
a standard random sample and a  special over-
sample of wealthier households in order to
correct for the under-representation of high
income families in the survey. It uses multiple
imputation techniques to deal with missing
data, which procedure results in the creation
of five data sets called "implicates". There are
five implicates for every  record. In the SCF,
a household unit is divided into a "primary
economic unit" (PEU)—the family—and
everyone else in the household. The PEU is
intended to be the economically dominant
single person or couple (whether married or
living together as partners) and all other
persons in the household who are financially
interdependent with the economically dominant
person or couple."57 The Indicator 10 data
represent the  PEU which we call  households
in the chart and discussion.

Race and Hispanic origin: Data in this report
are shown for race is white or race is black for
the head of the primary economic unit. Data
are not shown by Hispanic origin.

For more information, contact:
Chris Angelov
E-mail: chris.angelov@ssa.gov
Phone: 202-358-6300

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 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:
Brad Trenkamp
E-mail: brad.trenkamp@ssa.gov
Phone:202-358-6116
Web site:  http://www.socialsecurity.gov

Survey of Veteran Enrollees'
Health and Reliance Upon VA,
2010

The 2010 Survey of Veteran Enrollees' Health and
Reliance Upon VA (Survey of Enrollees) is the
eighth in a series of surveys of Veteran enrollees
conducted by the Veterans Health Administration
(VHA) within the Department of Veterans Affairs
(VA), under multiyear Office of Management
and Budget authority. Previous surveys of VHA-
enrolled Veterans were conducted in 1999, 2000,
2002, 2003, 2005, 2007, and 2008. All eight
VHA Surveys of Enrollees consisted of telephone
interviews with stratified random samples
of enrolled Veterans. Overtime, the survey
instrument has been modified to reflect
VA management's need for specific data on
enrolled Veterans.

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As with the other surveys in the series, the 2010
Survey of Enrollees sample was stratified by
Veterans Integrated Service Network, enrollment
priority, and type of enrollee (new or past user).
Beginning in 2008, Operation Enduring Freedom/
Operation Iraqi Freedom/Operation New Dawn
enrollees were oversampled in order to provide
more data about this group of Veterans.

Information gathered from the survey includes
socioeconomic characteristics of the enrollee
population, public and private insurance coverage,
pharmaceutical use, tobacco use, health status
measures, and future use of VA health care
services by the Veteran enrollee population.
The 2010 survey included a series of questions
regarding Activities of Daily Living/Instrumental
Activities of Daily Living. The survey includes
these questions periodically, and these questions
were last included in the 2005 Survey of Enrollees.

Telephone interviews averaged 18 minutes
in length. In the 2010 survey, interviews were
conducted beginning on May 28, 2008, over a
course of 12 weeks. Of the approximately 7.8
million eligible enrollees as of September 30,
2009, 42,920 completed interviews in the 2010
telephone survey.

The VHA Survey of Enrollees provides 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 survey is to provide critical inputs into
the VA Enrollee Health Care Projection Model
enrollment, patient, and expenditure projections,
and the Secretary's enrollment level decision
processes. Data from the surveys are also useful
into a variety of strategic analysis areas related
to budget, policy, or legislation.

Race and Hispanic origin: The report displays
ethnicity and race data from this survey at the
national level.

For more information, contact:
Marybeth Matthews
E-mail: Marybeth.Matthews@va.gov
Phone: 414-384-2000, ext. 42359
Web site: http://www4.va.gov/
HEALTHPOLICYPLANNING/reports 1 .asp
Veteran Population Estimates
and Projections
VA Office of the Chief Actuary (OACT) provided
veteran population projection by key demographic
characteristics such as age and gender as well as
geographic  areas. VetPop2007 was last updated
using Census 2000 data, VA administrative data,
and Department of Defense data. VetPop2011
will be released in Summer 2012.

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

For more information, contact the Office of the
Chief Actuary:
Lijia Guo
Office of the Chief Actuary
E-mail: lijia.guo@va.gov
Phone: 202-461-1049


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Glossary

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Activities of daily living (ADLs): 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: 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.

Assistive 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 (BMI): This is a measure of
body weight adjusted for height that 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 a BMI equal to
25 or greater; and obese is defined as having a
BMI equal to 30 or greater. To calculate your own
body mass index, go to 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."58

Cause of death: 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. In addition to the underlying
cause, all other conditions reported on the death
certificate are captured and coded and are referred
to as multiple causes of death. Cause of death is
coded according to the appropriate revision of the
International Classification of Diseases (I CD).
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 overtime. These discontinuities
are measured using comparability ratios.
These measures of discontinuity are essential
to the interpretation of mortality trends. For
further discussion, see the "Mortality Technical
Appendix" available at http://www.cdc.gov/nchs/
data/statab/techap99 .pdf.

Cause-of-death ranking: 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 "Cancer") 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).

Cigarette smoking: 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 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,

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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. 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 26aand 26b.

Current smoker: There are two categories of
current smokers: people who smoke every day
and people  who smoke only on some days.

Former smoker: This category includes people
who have smoked at least 100 cigarettes in their
lifetimes but currently do not smoke at all.

Nonsmoker: This category includes people who
have never smoked at least 100 cigarettes in their
lifetime.

Civilian population: See Population.

Civilian noninstitutionalized population: See
Population.

Death rate: 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.
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.

Earnings: Earnings are considered money
income reported in the Current Population Survey
from wages or salaries and net income from self-
employment (farm and nonfarm).
Emergency room services: 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.

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

Group quarters: A group quarters is a place
where people live or stay, in a group living
arrangement that is owned or managed by an
entity or organization providing housing and/
or services for the residents. This is not a typical
household-type  living arrangement. These
services may include custodial or medical care  as
well as other types of assistance, and residency
is commonly restricted to those receiving these
services. People living in group quarters are
usually not related to each other. The group
quarters definitions used in the 2010 Census are
available in Appendix B at: http://www.census.
gov/prod/cen2010/doc/sf 1 .pdf.

Head of household: The Survey of Consumer
Finances (SCF) estimates wealth for the "Primary
Economic Unit" which  is similar to the Census
Bureau's Household. The "Primary Economic
Unit" is the economically dominant single person
or couple (whether married or living together as
partners) and all other persons in the household
who are financially interdependent with the
economically dominant person or couple. If a
couple is economically  dominant in the PEU,
the head is the male in a mixed sex couple or the
older person in a same-sex couple. If a single
person is economically  dominant, that person is
designated as the family head in this report.

Health care expenditures: In the Consumer
Expenditure Survey (Indicator 12), health care
expenditures include out-of-pocket expenditures
E
cT

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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.

Health maintenance organization (HMO):
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).

Hispanic origin: See specific data source
descriptions.

Home health care/services/visits: Home health
care is care provided to individuals and families
in their places of residence for promoting,
maintaining, or restoring health or for minimizing
the effects of disability and illness, including
terminal  illness. In the Medicare Current
Beneficiary Survey and Medicare claims data
(Indicators 29, 30, and 34), home health care
refers to  skilled nursing care, physical therapy,
speech language pathology services, occupational
therapy, and home health aide services provided
to homebound patients. In the Medical
Expenditure Panel Survey (Indicator 33), home
health care  services are classified into the "Other
health care" category and are considered any paid
formal care provided by home health agencies
and independent home health providers. Services
can include visits by professionals including
nurses, doctors, social workers, and therapists, as
well as home health aides, homemaker services,
companion services, and home-based hospice
care. Home care provided free of charge (informal
care by family members) is not included.

Hospice care/services: 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
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.

Hospital care: 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.

Hospital inpatient services: 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,
as well as 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

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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.

Hospital outpatient services: 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.

Hospital stays: Hospital stays in the Medicare
claims data (Indicator 29) refers to admission
to and discharge from a short-stay acute care
hospital.

Housing cost burden: In the American
Housing Survey, housing cost burden is defined
as expenditures on housing and utilities in excess
of 30 percent of household reported income.

Housing expenditures: 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.

Incidence: 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.

Income: 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, Supplemental Security Income, interest,
dividends, and other income sources are included.

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, or 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 Poverty Indicator 33: Out-of-Pocket Health
Care Expenditures.

Income fifths: 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.
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Inpatient hospital: See Hospital impatient
services.

Institutions: For the 2010 Census, the Census
Bureau denned institutions as adult correctional
facilities, juvenile facilities, skilled-nursing
facilities, and other institutional facilities such
as mental (psychiatric) hospitals and in-patient
hospice facilities. See Population.

Institutionalized population: See Population.

Instrumental  activities of daily living (lADLs):
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.

Long-term  care facility: 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, 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: Mammography is an X-ray
image of the breast used to detect irregularities
in breast tissue.

Mean: The mean is an average of n numbers
computed by adding the numbers and dividing
by n.

Median: The median is a measure of central
tendency, the point on the scale that divides a
group into two parts.

Medicaid: This nationwide health insurance
program is operated and administered by the
states with Federal financial participation.
Within certain broad, federally determined
guidelines, 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.

Medicare: 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.

Medicare Advantage: See Medicare Part C.

Medicare Part A: 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.

Medicare Part B: Medicare Part B (Medical
Insurance) covers doctor's 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.

Medicare Part C: With the passage of the
Balanced Budget Act of 1997, Medicare
beneficiaries were given the option to receive
their Medicare benefits through private health
insurance  plans, instead of through the original
Medicare plan (Parts A and B). These plans were
known as  "Medicare+Choice" or "Part C" plans.
Pursuant to the Medicare  Prescription Drug,
Improvement, and Modernization Act of 2003, the
types of plans allowed to contract with Medicare
were expanded, and the Medicare Choice program
became known as "Medicare Advantage." In
addition to offering comparable coverage to Part

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A and Part B, Medicare Advantage plans may
also offer Part D coverage.

Medicare Part D: 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.

Medigap: See Supplemental health insurance.

National population adjustment matrix: 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.

Noninstitutional group quarters: For the
2010 Census, the Census Bureau defined
noninstitutional group quarters as facilities that
house those  who are primarily eligible, able,
or likely to participate in the  labor force while
resident. The noninstitutionalized population lives
in noninstitutional group quarters such as college/
university student housing, military quarters,
and other noninstitutional group quarters such as
emergency and transitional shelters for people
experiencing homelessness and group homes.
For more information on noninstitutional group
quarters, please see Appendix B at http://www.
census .gov/prod/cen2010/doc/sf 1 .pdf.

Obesity: See Body mass index.

Office-based medical provider services: In the
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.

Other health care: 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,
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: 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.

Outpatient hospital: See Hospital outpatient
services.

Out-of-pocket health care costs: These
are health care costs that are not covered by
insurance.

Overweight: See Body  mass index.

Pensions: 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.

Physician/Medical services: 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.
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Physician/Outpatient hospital: In the Medicare
Current Beneficiary Survey (Indicator 30), this
term refers to "physician/medical services"
combined with "hospital outpatient services."

Physician visits and consultations: 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.

Population: 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.

Resident population: 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
State sovereignty or jurisdiction (principally
American Samoa, Guam, Virgin Islands  of
the United States and the Commonwealth
of the Northern Mariana Islands). An area's
resident population consists of those persons
"usually resident" in that particular area  (where
they live and sleep most of the time). The
resident population includes people living in
housing units, nursing homes, and other  types
of institutional settings. People whose usual
residence is outside of the United States, such as
the U.S. military and civilian  personnel as well as
private U.S. citizens living overseas, are excluded
from the resident population.

Resident noninstitutionalizedpopulation: The
resident noninstitutionalized population  is the
resident population residing in noninstitutional
group quarters. See also the definitions of Resident
population and Noninstitutional group quarters.

Civilian population: The civilian population is
the U.S. resident population not in the active-
duty Armed Forces.

Civilian noninstitutionalized population:
This population includes all U.S. civilians
residing in noninstitutional group quarters. See
also the definitions of Civilian population and
Noninstitutional group quarters.
Institutionalized population: For the 2010
Census, the Census Bureau defined institutional
group quarters as facilities that house those who
are primarily ineligible, unable, or unlikely to
participate in the labor force while resident.
The institutionalized population is the population
residing in institutional group quarters such as
adult correctional facilities, juvenile facilities,
skilled-nursing facilities, and other institutional
facilities such as mental (psychiatric) hospitals
and in-patient hospice facilities. People living
in noninstitutional group quarters are the
noninstitutionalized population. For more
information on institutional and noninstitutional
group quarters, please see Appendix B at http://
www.census.gov/prod/cen2010/doc/sfl.pdf

Poverty: The official measure of poverty is
computed each year by the U.S. Census Bureau
and is defined as having income less than 100
percent of the poverty threshold (i.e., $10,458
for one person age 65  and over in 2010).59
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 size
and the 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,"
"Indicator 32: Sources of Health Insurance,"
and "Indicator 33: Out-of-Pocket Health Care
Expenditures" using the official U.S. Census
Bureau definition for the corresponding year.
In addition, the following income-to-poverty
categories are used in  this report.

Indicator 8: Income:  The income categories
are derived from the ratio of the family's money
income (or an unrelated individual's money
income) to the poverty threshold. Being in
poverty is having income less than 100 percent
of the poverty threshold. Low income is income
between 100  percent and 199 percent of the
poverty threshold (i.e., $10,458  and $20,915 for
one person age 65 and over in 2010). Middle
income is income between 200 percent and 399
percent of the poverty threshold (i.e., between
$20,916 and $41,831 for one person age 65 and
over in 2010). High income is income 400 percent
or more of the poverty threshold.

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Indicator 22: Mammography: Below poverty is
defined as having income less than 100 percent
of the poverty threshold. Above poverty is
grouped into 3 categories: (1) income between
100 percent and 199 percent of the poverty
threshold (2) income between 200 percent and
399 percent of the poverty threshold and (3)
income equal to or greater than 400 percent of the
poverty threshold.

Indicator 32: Sources of Health Insurance:
Below poverty is defined as having income
less than 100 percent of the poverty threshold.
Above poverty is grouped into two categories: (1)
income between  100 percent and  199 percent of
the poverty threshold and (2) income equal to or
greater than 200 percent of the poverty threshold.

Indicator 33: Out-of-Pocket Health Care
Expenditures: 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. The 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). The other
income category includes people  in families with
income greater than or equal to 125 percent of the
poverty line. See Income, household.

Prescription  drugs/medicines: 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.

Prevalence: Prevalence is the number of cases
of a disease, infected people, or people with some
other attribute present  during a particular interval
of time. It is often expressed as a  rate (e.g., the
prevalence of diabetes per 1,000 people during a
year). See Incidence.
Private supplemental health insurance: See
Supplemental health insurance.

Public assistance: 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.

Quintiles: See Income fifths.

Race: See specific data source descriptions.

Rate: A rate is a measure of some event, disease,
or condition in relation to a unit of population,
along with some specification of time.

Reference population: The reference population
is the base population from which a sample
is drawn at the time of initial sampling. See
Population.

Respondent-assessed health status:  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.

Retiree Drug Subsidy: The Retiree Drug
Subsidy is designed to encourage employers to
continue providing retirees with prescription drug
benefits. Under the program,  employers may
receive a subsidy of up to 28  percent of the
costs of providing the prescription drug benefit.

Short-term  institution: 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: 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).
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Skilled nursing facility: A skilled nursing facility
(SNF) as denned 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: Social Security benefits
include money income reported in the Current
Population Survey from Social Security old-age,
disability, and survivors' benefits.

Standard population: This is 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:  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 or through 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: 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: TRICARE for Life is
TRICARE's Medicare wraparound coverage
(similar to traditional Medigap coverage)
for Medicare-eligible uniformed services
beneficiaries and their eligible family members
and survivors.

Veteran: 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 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 1923-2012
                           1923 Cohort
                            5 years old
             1933 Cohort
1943 Cohort
Year

 1923



 1928



 1933



 1938



 1943



 1948



 1953



 1958



 1963



 1968



 1973



 1978



 1983



 1988



 1993



 1998



 2003



 2008
                                                                         Historical Events
                                                                                                                         Legislative Events
                                                           1929 - Stock market crashes
                                                           1941 - Pearl Harbor; United States enters WWII
                                                           1945- Yalta Conference; Cold War begins
                                                           1946 - Baby boom begins
                                                           1950 - United States enters Korean War
                                                           1955 - Nationwide polio vaccination program begins
                                                           1964 - United States enters Vietnam War;
                                                                 baby boom ends
                                                           1969 - First man on the moon
                                                           1980 - First AIDS case is reported to the Centers for
                                                                 Disease Control and Prevention
                                                           1989- Berlin Wall falls
                                                           1990- United States enters Persian Gulf War
                                                           2001 - 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
                                                                                                           1934- Federal Housing Administration created by
                                                                                                                  Congress; 1935- Social Security Act passed;
                                                                                                                  1937- U.S. Housing Act passed, establishing
                                                                                                                  Public Housing
1956- Women age 62-64 eligible for reduced Social
      Security benefits; 1957- Social Security
      Disability Insurance implemented; 1959-
      Section 202 of the Housing Act established,
      providing assistance to older adults with low
      income;  1961 - Men age 62-64 eligible for
      reduced Social Security benefits; 1962-
      Self-Employed Individual Retirement Act
      (Keogh Act) passed; 1964 - Civil Rights Act
      passed;  1965- Medicare and Medicaid
      established; Older Americans Act passed;
      •/967-Age Discrimination  in Employment Act
      passed
                                                                                                            1972 - Formula for Social Security cost-of-living
                                                                                                                  adjustment established; Social Security
                                                                                                                  Supplemental Security Income legislation
                                                                                                                  passed; 1974 - Employee Retirement Income
                                                                                                                  Security Act (ERISA) passed; IRAs established;
                                                                                                                  •/975-Age Discrimination Act passed; 1978-
                                                                                                                  401 (k)s established
1983 - Social Security eligibility age increased for
      full benefits; 1984 - Widows entitled to pension
      benefits if spouse was vested
1986 - Mandatory retirement eliminated for most
      workers; 1987- Reverse mortgage market
      created by the HUD Home Equity Conversion
      Program
1990- Americans with Disabilities Act passed
1996 - Veterans' Health Care Eligibility Reform Act
      passed, creating access to community based
      long-term care for all enrollees; 1997-
      Balanced Budget Act passed changing
      Medicare payment policies; 2000- Social
      Security earnings test eliminated for full
      retirement age; 2003 - Medicare Modernization
      Act passed


2005 - Deficit Reduction Act passed realigning
      Medicaid incentives to provide noninstitution-
      alized long-term care; 2006- Medicare
      presciption drug benefit implemented;
      Pension Protection Act passed
2010- Patient Protection and Affordable Care Act
      passed

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