Health Problems Mount Rapidly for the Less Educated

For 39 years, the Bureau of Labor Statistics has tracked the labor force experience of a cohort of Baby Boomers as they aged from their teens and twenties into their fifties and sixties. The National Longitudinal Survey of Youth was first fielded in 1979, when a nationally representative sample of young adults aged 14 to 22 answered a battery of questions. This cohort has been surveyed repeatedly for decades, the latest being in 2018–19, when these late Boomers (born from 1957 to 1964) were aged 53 to 62. 

One of the survey questions has asked respondents whether their health limits the kind or amount of work they can do. Not surprisingly, a growing share of respondents reported health limitations as they aged. Only 3.5 percent said their health was a limiting factor at age 24. The figure grew slightly to 4.9 percent at age 34, then more than doubled to 10.3 percent at age 44. By age 54, a substantial 19.9 percent of the cohort reported limitations in their work due to health issues. 

No characteristic plays a bigger role in determining the health status of aging Boomers than educational attainment...

Percent at specified age who said their health limits their work, by educational attainment

	at 54	at 44	at 34	at 24
Total cohort	19.9%	10.3%	4.9%	3.5%
Bachelor's degree+	8.5	4.7	3.6	3.1
Some college/associate's degree	19.7	10.3	5.9	3.2
High school graduate only	23.9	12.2	5.1	3.8
No high school diploma	46.9	23.0	5.8	5.1

By age 54, nearly half (46.9 percent) of those without a high school diploma were limited in their work because of health issues. Among those with a bachelor's degree or more education, only 8.5 percent reported such limitations. The college graduates at age 54 were healthier than every other educational attainment group had been at age 44. 

Source: Bureau of Labor Statistics, Number of Jobs, Labor Market Experience, Marital Status, and Health: Results from a National Longitudinal Survey Summary

Nearly Half the 75-Plus Population Has a Disability

Forty-one million Americans have a disability, according to the Census Bureau's 2018 American Community Survey—12.6 percent of the total population. The percentage of people with a disability rises with age, from less than 1 percent of children under age 5 to nearly half the population aged 75 or older.

Percent of Americans with a disability by type and age, 2018

	all ages	75-plus
Any disability	12.6%	47.5%
Hearing difficulty	3.6	21.7
Vision difficulty	2.4	9.0
Cognitive difficulty	5.1	13.1
Ambulatory difficulty	6.8	31.0
Self care difficulty	2.6	12.8
Independent living difficulty	5.8	23.4

Note: Ambulatory difficulty is serious difficulty walking or climbing stairs. Self care difficulty is difficulty dressing or bathing. Independent living difficulty is difficulty doing errands such as visiting a doctor or shopping.

Source: Census Bureau, Disability Characteristics, 2018 American Community Survey

Standing, Stooping Are the Most Common Physical Difficulties

What are the physical functions Americans have the most trouble performing? Surprisingly, it's not walking a quarter mile or climbing stairs. Instead, the most difficult physical tasks for the largest share of the public are standing for two hours and stooping, bending, and kneeling. Overall, 9 percent of people aged 18 or older—nearly one in 10—say it would be very difficult or impossible for them to stand for two hours. The same percentage say they are not be able to stoop, bend, or kneel.

Overall, 14.9 percent of the public reports having at least one of these difficulties in physical functioning...

Among people aged 18 or older, percent saying it would be very difficult or impossible to...
Stand for two hours: 9.0%
Stoop, bend, kneel: 9.0%
Walk a quarter mile: 7.1%
Push/pull large objects: 5.9%
Climb 10 steps without resting: 4.9%
Lift or carry 10 pounds: 4.1%
Sit for two hours: 3.0%
Reach overhead: 2.3%
Grasp small objects: 1.7%

With age, physical difficulties increase. Only 5 percent of 18-to-44-year-olds report any difficulty in physical functioning. The share rises to 49 percent among people aged 75 or older. Among the oldest Americans, 33 percent say they would find it very difficult or impossible to stand for two hours, 29 percent could not stoop, bend, or kneel, 28 percent could not walk a quarter of a mile, and 20 percent could not climb 10 steps without resting.

Source: National Center for Health Statistics, National Health Interview Survey, Tables of Summary Health Statistics

50% of People Aged 75-Plus Have a Disability

Thirty-nine million Americans have a disability—13 percent of the population, according to the 2012–16 American Community Survey. The percentage with a disability rises with age...

Percent with a disability
Under age 5: 0.8%
Aged 5 to 17: 5.4%
Aged 18 to 34: 6.0%
Aged 35 to 64: 12.9%
Aged 65 to 74: 25.4%
Aged 75-plus: 50.0%

Among those aged 75 or older with a disability, 33 percent have difficulty walking, 25 percent have difficulty living independently, 23 percent have hearing problems, 14 percent have a cognitive deficit, 14 percent have trouble with self-care, and 10 percent have vision problems.

Source: Census Bureau, American Factfinder, Disability Characteristics

Older Adults Who Become Disabled Have Less Wealth

When older Americans become disabled and need long-term care services and supports (LTSS), their wealth plummets. Long-term care insurance would help to conserve this wealth. Yet only 11 percent of people aged 65 or older have purchased a policy. An Urban Institute study examines whether policies to encourage more Americans to buy long-term care insurance would be successful.

Using Health and Retirement Study data, the Urban Institute's Richard W. Johnson tracked adults without disabilities from 1992 (when they were aged 51 to 59) until 2012 (when they were 71 to 79) to determine whether those who became disabled and in need of care during the time period differed in some way from those who remained disability free. He found big differences in wealth between the two groups. Among adults who developed disabilities, median household wealth was just $139,200 in 2012. Among those who remained disability free, median wealth was 61 percent higher at $224,600.

Older adults who became disabled over the 20-year time period had much less wealth than those who remained disability free—and the wealth gap existed years before they developed disabilities. Thus, adults at high risk of becoming disabled are at an economic disadvantage and unlikely to be able to afford long-term care insurance. Consequently, concludes Johnson, "proposed policies designed to encourage people to pre-fund future LTSS expenses may have limited impact because they will be unable to target those with the highest expenses."

Source: Urban Institute, Later-Life Household Wealth before and after Disability Onset

Difficulties in Physical Functioning, 2015

Among Americans aged 65 or older in 2015, a substantial 37 percent reported having great difficulty performing at least one of nine physical tasks, according to the National Center for Health Statistics. The 37 percent figure is a bit higher than the 35 percent of people aged 65 or older who reported having great difficulty with these tasks in 2002, the first year the question was asked.

Percent of 65-plus who say physical task would be very difficult or impossible
Standing for two hours: 24.9%
Stooping, bending, or kneeling: 22.5%
Walking a quarter mile: 19.2%
Pushing or pulling large objects: 15.1%
Climbing 10 steps without resting: 14.5%
Lifting or carrying 10 pounds: 11.5%
Reaching over head: 5.6%
Sitting for two hours: 4.9%
Grasping or handling small objects: 4.6%

Source: National Center for Health Statistics, National Health Interview Survey

How Many Households Are Home to the Disabled?

A substantial 22 percent of American households include someone with a disability, according to the 2015 American Housing Survey. The percentage of households with a disabled member rises from just 8 percent of households headed by people under age 35 to the 55 percent majority of households headed by people aged 75 or older...

Percentage of households with a disabled member
Total households: 22.2%
Under age 35: 7.8%
Aged 35 to 44: 11.3%
Aged 45 to 54: 16.9%
Aged 55 to 64: 25.7%
Aged 65 to 74: 33.9%
Aged 75-plus: 55.2%

Source: Census Bureau, 2015 American Housing Survey

Percent Who Need Help Doing Errands

Percentage of adults who say they have difficulty doing errands by themselves, by age...

Men
Aged 18 to 64: 3.1%
Aged 65 to 74: 6.4%
Aged 75 to 84: 12.9%
Aged 85-plus: 26.2%

Women
Aged 18 to 64: 3.9%
Aged 65 to 74: 9.4%
Aged 75 to 84: 20.7%
Aged 85-plus: 45.0%

Source: National Center for Health Statistics, Health, United States, 2015

The Three Stages of Old Age

Old age has three stages: the Go-Go years, the Slow-Go years, and the No-Go years. A Census Bureau analysis of the disability status of Americans aged 65 or older, based on data from the American Community Survey, confirms this reality.

• The Go-Go elderly are aged 65 to 74. Only 26.4 percent are disabled. 
• The Slow-Go elderly are aged 75 to 84, when a larger 45.0 percent are disabled.
• The No-Go elderly are aged 85 or older. Fully 72.5 percent are disabled. 

Among the disabled elderly, the most common problem is difficulty walking or climbing stairs, experienced by two out of three.

Source: Census Bureau, Older Americans with a Disability: 2008-2012

Trends in Healthy Life Expectancy

Older Americans are living longer than ever, but are they enjoying those years in good health? That question is posed by a National Bureau of Economic Research study, which measured the health status of the elderly in the years prior to death based on data from the Medicare Current Beneficiary Survey.

There is good news to report: life expectancy at age 65 is growing, and so are years of healthy life. The average 65-year-old in 2003-05 could expect to live an additional 18.2 years in total, up from 17.5 years for their counterparts in 1991-93. Of those 18.2 years of life, 10.4 years are lived free of disability, up from 8.8 disability-free years for 65-year-olds in 1991-93. The number of years of expected life lived with a disability fell from 8.7 years in the earlier time period to 7.8 years in the 2000s.

But the findings are different if healthy life is defined as one without disease rather than disability. Disease-free life expectancy has increased, but so has life expectancy with a major disease (defined as cancer, Alzheimer's, Parkinson's, pulmonary disease, heart attack, heart disease, stroke, broken hip, arthritis, or diabetes). Of the 18.2 years of total life expectancy for 65-year-olds in 2003-05, 8.6 years are lived free of disease, up from 8.0 disease-free years for their counterparts in 1991-93. But the number of years of expected life lived with a major disease also climbed, from 9.5 years in the earlier time period to 9.7 years in the 2000s.

Source: National Bureau of Economic Research, Evidence for Significant Compression of Morbidity in the Elderly U.S. Population, NBER Working Paper 19268

Can You Hear Me Now?

Sixteen percent of Americans aged 18 or older have trouble hearing when not using a hearing aid or other listening device. Here is the percentage with hearing trouble by age...

Aged 18 to 44: 6%
Aged 45 to 64: 19%
Aged 65 to 74: 30%
Aged 75-plus: 47%

Source: National Center for Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2011

Millions Are Disabled

One in five Americans aged 15 or older and half aged 65 or older have a disability, according to the Census Bureau. Difficulty walking is one of the most widespread problems, reported by 10 percent of people aged 15 or older and 31 percent of people aged 65 or older.

When asked what accounts for their disability, the most common causes are arthritis (25 percent), back problems (25 percent), diabetes (10 percent), and heart trouble (10 percent).

Of the 51 million people aged 15 or older with a disability, only 12 million require help from others. Eighty-nine percent get that help for free--mostly from family members.

Source: Census Bureau, Americans with Disabilities: 2010

The Limited

Percentage of adults who are limited in their activities because of physical, mental, or emotional problems, by age...

18 to 24: 10.3%
25 to 34: 12.7%
35 to 44: 15.2%
45 to 54: 23.1%
55 to 64: 28.8%
65-plus:  33.1%

Source: CDC, Behavioral Risk Factor Surveillance System, 2010 data

Are We Eating Ourselves into Disability?

A look at the latest disability statistics reveals a disturbing figure: nearly one in ten Americans has trouble walking or using stairs, according to the new report on disability released by the Census Bureau. A substantial 11 percent of people aged 15 or older have difficulty with these basic physical tasks. Among people aged 25 to 64, who cannot claim age as an excuse for their disability, a still substantial 8 percent—or nearly one in 12—has trouble walking or using stairs.

Difficulties walking and climbing stairs are the most common disabilities, and Americans' growing girth certainly plays a role in turning these basic functions into daily challenges. With apparently no end in sight to the American weight gain, these difficulties are likely to have a growing impact on shopping malls, theme parks, museums, public transportation, and disaster preparedness.

The End of Retirement

"The years 1965–1999 were the closest thing to economic 'golden years' ever seen by this nation for those moving into retirement, and they will likely never be matched again for the bulk of the population unless savings behavior changes radically."

Those chilling words were issued last month by Dallas Salisbury, president of the nonpartisan Employee Benefit Research Institute, in support of the PBS Frontline documentary "Can You Afford to Retire?" The documentary examined how prepared baby boomers are for retirement (answer: NOT) as defined benefit pension plans become scarce and savings remain shockingly low for the minority who participate in defined contribution plans such as 401(k)s. If you haven't seen the Frontline show yet, you can watch it online through the PBS website.

The documentary concludes with the ominous warning that the retirement of the baby-boom generation is, in fact, the end of retirement because most boomers will find they cannot retire and maintain any semblance of their middle-class standard of living. Consequently, most will be forced to work to make ends meet. What are the political implications of the impending downward spiral of today's comfortable middle class? What will happen when disability overtakes working boomers in old age? How will younger generations respond to the growing destitution of their aging parents?

Stay tuned, because that appears to be the next installment in the boomer narrative.

Ten Million Need Help, Most Get It

Ten million Americans aged 15 or older not living in nursing homes or other institutions need help from others to live independently, according to a new report on disability from the Census Bureau. Getting around inside the house, eating, dressing, preparing meals, going outside alone, and walking are some of the tasks they cannot do themselves.

Among those needing help, the 63 percent majority get help only from relatives, 20 percent receive help from both relatives and nonrelatives, 15 percent from nonrelatives only, and 2 percent have no helpers. Fully 89 percent of those receiving help pay nothing for the service.