Nber Working Paper Series Coping with Chronic Disease? Chronic Disease and Disability in Elderly American Population 1982-1999

It is well known that disability rates among the American elderly have declined over the past decades. The cause of this decline is less well established. In this paper, we test one important possible explanation--that the decline in disability occurred because of chronic disease prevention efforts among the elderly. For this purpose we analyze data from the National Long Term Care Survey and from the National Health and Interview Survey. Our findings suggest that primary prevention, as reflected in decreased disease prevalence, was not responsible for advances made in elderly functioning between 1980 and 2000. We found a broad decline in less severe forms of disability that is unlikely to have resulted from improved disease management. Instead, these measured improvements in functioning may reflect environmental, technological, and/or socioeconomic changes. Improvements in the more severe forms of disability were modest and were restricted to those suffering from particular illnesses, which make improved and/or more aggressive management a plausible explanation and one that might increase costs should the trend persist. Gabriel Aranovich Department of Psychiatry, UCSF 401 Parnassus Avenue, Box 0984-ADM San Francisco, CA 94143-0984 [email protected] Jay Bhattacharya 117 Encina Commons Center for Primary Care and Outcomes Research Stanford University Stanford, CA 94305-6019 and NBER [email protected] Alan M. Garber PCOR/CHP 117 Encina Commons Stanford, CA 94305-6019 and NBER [email protected] Thomas E. MaCurdy Department of Economics Stanford University Stanford, CA 94305-6072 and NBER [email protected]