Disability among the elderly has declined markedly in the United States in the past two decades. In 1984, 25 percent of the elderly population reported difficulty with activities associated with independent living. By 1999, the share had fallen to 20 percent, a decline of one-fifth. Although these basic facts are well known, the interpretation of these facts is not clear. Is the reduction in disability a result of improved medical care, individual behavioral changes, or environmental modifications that allow the elderly to better function by themselves? Will the trend continue, or is it time limited? What does the reduction in disability mean for years of healthy life and labor force participation? We explore these issues in this paper.
To make progress, we focus on disability caused by a specific set of medical conditions: cardiovascular disease. Focusing on one condition is helpful because it allows us to analyze health shocks and their sequellae in some detail. Cardiovascular disease is a natural condition to pick because it is the most common cause of death in the US (and most other developed countries), and more is spent on cardiovascular disease than any other condition. further
Thus, this is a case where medical care could really matter. Our analysis has three parts. In the first part, we examine basic trends in disability associated with cardiovascular disease. We show that reduced disability for people with cardiovascular disease incidents is a major part of reductions in overall disability, accounting for between one-fifth and one-third of the total reduction in disability. The second part of the paper considers the role of advances in medical care in reducing disability from cardiovascular disease.
We show that medical technology in the treatment of cardiovascular disease is a major factor in reduced disability. We estimate that use of recommended treatments for heart attacks, including prescriptions of beta-blockers, aspirin and ace-inhibitors at discharge, as well as use of reperfusion and other surgical procedures increased the probability that elderly patients survive an acute cardiovascular event in a non-disabled state by 13 to 22 percent between 1984 and 1994. The third part of the paper considers the long-run health and financial impacts of improved care for people with cardiovascular disease.