The reduction in disability among the elderly

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Abstract
As the population lives longer, is it living in more or less healthy states? Manton and Gu (1) tackled this question in a recent issue of PNAS. Understanding whether the population is healthier or not is vitally important to individuals and to society as a whole. People value longevity improvements more when the quality of life of the additional years is high. Living longer but with severe disability is nowhere near as enjoyable as living longer with good health. The social consequences of an aging population also depend on average health. Disabled people use significantly more medical resources than do nondisabled people. If the elderly population is increasingly healthy, the impact of overall population aging on medical care needs will be smaller than if the surviving population is increasingly frail. Further, policies to encourage additional work effort among the elderly will only be successful if the elderly have the physical capacity to perform the work. Reduced disability will not solve the aging problem for the public sector—medical spending is increasing too rapidly for that—but it can ameliorate the magnitude of the problem. There has been a longstanding debate concerning whether the elderly are more or less healthy over time. Demographers examining the issue in the 1970s concluded that the elderly were increasingly less healthy (2). The data used were not of high quality, however, and they afforded multiple interpretations (3). The National Long-Term Care Survey (NLTCS), first conducted in 1982, was designed in part to rectify this difficulty. The NLTCS asks detailed questions about disability in a consistent manner over time. It samples from all of the elderly population, not just community dwellers. And it now has nearly 20 years of data from a consistent questionnaire, asked in 1982, 1984, 1989, 1994, and 1999. In a recent issue of PNAS, …