Seeman et. al.'s enlightening article1 concludes that older Americans face increased disability. This increase, revealed by data from the National Health and Nutrition Examination Surveys, particularly affected adults aged 60–69 years, with no significant trends among adults aged 70–79 years, and a lower prevalence among those aged 80 years and older. These findings are confirmed by another survey series, the National Mortality Followback Surveys of 1986 and 1993, conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention.2,3
The National Mortality Followback Surveys made inquiries of the next of kin of a representative sample of all adult decedents in the United States in 1986 and 1993. Questions were asked as to whether the decedent needed help or used special equipment in walking, eating, bathing, dressing, or using the toilet (Table 1). On all but the last of these questions about activities of daily life, the affirmative responses regarding adults aged 65–74 were greater in 1993 than they were in 1986. Among those aged 75–84 years, no such trend was observed. Among those aged 85 years and older there was a decrease in disability.
TABLE 1.
Percentage of Adults With Affirmative Response to Questions on Needing Help With Activities of Daily Life: National Mortality Followback Survey, 1986 and 1993
| Age 65–74 Years |
Age 75–84 Years |
Age 85 Years and Older |
|||||||
| Function | 1986, % | 1993, % | % Differencea | 1986, % | 1993, % | % Differencea | 1986, % | 1993, % | % Differencea |
| Walking | 44.5 | 59.4 | 14.9 | 54.9 | 59.9 | 5.0 | 71.6 | 68.4 | −3.2 |
| Eating | 31.4 | 35.5 | 3.9 | 37.3 | 49.7 | 3.6 | 49.7 | 40.4 | −9.3 |
| Bathing | 50.8 | 53.0 | 2.2 | 60.6 | 58.2 | −2.4 | 79.1 | 71.0 | −8.1 |
| Dressing | 45.0 | 46.6 | 1.6 | 53.5 | 50.3 | −3.2 | 68.7 | 61.5 | −7.2 |
| Use of toilet | 44.9 | 44.6 | −0.3 | 53.2 | 47.3 | −5.9 | 67.2 | 58.0 | −9.2 |
Statistically significant at the 95% confidence level.
The observation by Seeman et. al. that their conclusions have significant and sobering implications for the US health care system and health care costs is strengthened by these confirming findings in another series of national surveys.
Acknowledgments
Teresa E. Seeman is a niece of the author of this letter, but the two reports on the surveys were prepared completely independently of each other.
References
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