The economic cost of dependency at older ages is large and projected to grow rapidly as the number of older adults increases in the coming decades, and reduced well-being for individuals facing loss of functioning and their families, who provide the bulk of uncompensated care, also is an important societal concern. The purpose of this report is to describe disability and care needs of the United States population over the age of 65 using baseline (2011) measures from the National Health and Aging Trends Study, a new study designed to support understanding of both trends and trajectories in health and disability in later life. To provide a context for framing policy discussions of disability and care needs of older adults, we investigate two overarching topics: (a) the extent of activity limitations and use of assistance by older adults; and (b) care resources available to and used by older adults and the extent of unmet need in the population with care needs.
This report shows that late-life care needs are significant--nearly one-half of all adults in the United States over age 65, or 18 million people, have difficulty or receive help with daily activities. (This is for the total population over age 65, but disability increases with age. The percentage is lower for those aged 65-75 and higher for those over age 85.) At the same time, potential care networks among those receiving help are substantial--nearly 98% of older adults receiving help with daily activities have at least one close family member, household member, or close friend--and on average most older adults have four potential informal network members. Moreover, levels of informal assistance, primarily from family caregivers, are substantial not only for older adults in the community but also for those living in assisted living and other supportive care settings. Nearly all of those receiving help (irrespective of setting) receive informal care, and about three in ten receive some paid care. Those receiving assistance from paid, non-staff caregivers have especially high risk for adverse consequences related to unmet needs--nearly 60% had an adverse consequence in the last month.
We also find a substantial proportion of the population--7% or nearly 3 million--receiving assistance with three or more self-care or mobility activities in settings other than nursing homes, exceeding the level of need typically associated with eligibility for benefits under either private insurance or public program eligibility. A disproportionate share of older persons at this level of assistance is in the lowest income quartile. Although publicly and privately paid care continues to be an important source of assistance to older adults with extensive needs, the higher level of adverse consequences linked to unmet need among those receiving paid care warrants further investigation. As individual preferences and public programs continue to support the shift of the locus of long-term care from nursing homes to the community and alternative residential care settings, a better understanding of unmet need can inform policies to promote safety and maximized functioning in the community and the well-being of older adults and their families.