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Objective Despite cross-sectional evidence that persons living with dementia receive disproportionate hours of care, studies of how care intensity progresses over time and differs for those living with and without dementia have been lacking. Method We used the 2011–2018 National Health and Aging Trends Study to estimate growth mixture models to identify incident care hour trajectories ("classes") among older adults (N = 1,780). Results We identified 4 incident care hour classes: "Low, stable," "High, increasing," "24/7 then high, stable," and "Low then resolved." The high-intensity classes had the highest proportions of care recipients with dementia and accounted for nearly half of that group. Older adults with dementia were 3–4 times as likely as other older adults to experience one of the 2 high-intensity trajectories. A substantial proportion of the 4 in 10 older adults with dementia who were predicted to be in the "Low, stable" class lived in residential care settings. Discussion Information on how family caregiving is likely to evolve over time in terms of care hours may help older adults with and without dementia, the family members, friends, and paid individuals who care for them, as well as their health care providers assess and plan for future care needs. [ABSTRACT FROM AUTHOR]

An increase in the number of elderly people may place a substantial burden on the health care system. It is estimated that 20% of the American population will be elderly by the year 2030, up from 13% in 2000. An analysis of data from Medicare, the National Mortality Followback Survey and the National Medical Expenditure Survey show that total expenditures increase considerably from the age of 65 until death. Much of this increase is a result of long-term care in nursing homes. However, this effect will be magnified by the increased number of people who survive to the age of 65 and beyond.

The underwriting of private long-term care insurance is studied based on data from the National Mortality Followback Survey. Results show that if the population applied for private long-term care insurance at age 65, about 12% to 23% of applicants will be rejected due to poor health. The number will increase to 20% to 31% for applicants aged 75. Long-term care insurance underwriting criteria also vary depending on the risks perceived by the insurers.

Recent proposals to increase access to health insurance suggest the need to know what the magnitude of responses would be if the one in five nonelderly persons uninsured for all or part of the year were to become insured. This paper finds that an additional commitment of resources to hospital and ambulatory care on the order of $26 billion (in 1989 dollars), or about 4% of total national health care spending, would be required if those now uninsured were to use these services on a par with the privately insured. The primary inputs to this result are new, estimates of the impact of being uninsured which indicate a substantial potential response to insurance, particularly by adults.

In this paper data from the National Mortality Followback Survey and the National Nursing Home Survey are used to estimate the lifetime cost of nursing home care. The expected discounted cost for persons turning 65 in 1990 is $27,600. However, variation around this average is high. The 9% of persons expected to use at least 5 years of nursing home care will account for 64% of aggregate cost for the cohort; the 68% using less than 3 months of care will account for only about 1% of cost. The percentage of costs covered under alternative financing strategies also varies widely. An entitlement covering the first 3 months of care subject to 30% coinsurance would cover 5% of aggregate cost; an entitlement with a 2-year deductible and the same coinsurance would cover 41% of cost.

Objectives We provide national estimates of caregiving networks for older adults with and without dementia and examine how these networks develop over time. Most prior research has focused on primary caregivers and rarely on change over time. Method We identify a cohort of older adults continuously followed in the National Health and Aging Trends Study between 2011 and 2015 and receiving help from family members or unpaid caregivers in 2015 (n = 1,288). We examine differences by dementia status in network size, types of assistance and task sharing, and composition—differentiating between "specialist" and "generalist" caregivers helping in one versus multiple activity domains. Multinomial regression is used to estimate change over time in network task sharing and composition. Results In 2015, older adults with dementia had larger caregiving networks involving more task sharing than those without dementia and more often relied on generalist caregivers, especially the subset assisting with medical, household, and mobility or self-care activities. Uniformly greater reliance over time on these more intensely engaged generalist caregivers chiefly accounts for larger dementia networks. Discussion Findings lend support to the need for caregiver training on managing multiple task domains and—for dementia caregivers in particular—task-sharing skills. More generally, the design of new approaches to better support older adults and their caregivers should consider the complexity, heterogeneity, and change over time in caregiving networks. [ABSTRACT FROM AUTHOR]

Objectives Studies have reported decreasing dementia prevalence in recent decades in the United States. We explore with a new national data source whether declines have occurred since 2011, whether trends are attributable to shifts in dementia incidence or mortality, and whether trends are related to shifts in population composition or subgroup prevalence. Methods We use the 2011–2015 National Health and Aging Trends Study (N = 27,547) to examine prevalence of probable dementia among the 70 and older population. To minimize the influence of potential learning effects on prevalence rates, we require individuals to meet probable dementia criteria at two consecutive rounds. Results: Prevalence of probable dementia declines over this period by 1.4% to 2.6% per year. Declines are concentrated among women, non-Hispanic white and black groups, and those with no vascular conditions or risk factors. The latter group also has experienced declines in dementia incidence. Declines in prevalence are largely attributable to age- and education-related shifts in population composition. Discussion Given the role of age and educational composition in short-term declines, the United States is likely to continue to experience short-term declines in dementia prevalence. However, persistently high rates among minority groups, especially of Hispanic origin, are concerning, and, barring new treatments, long-run trends may reverse course. [ABSTRACT FROM AUTHOR]

Understanding long-range trends in longevity and disability is useful for projecting the likely impact of the baby-boom generation on long-term care utilization and spending. We examine changes in active life expectancy in the United States from 1982 to 2011 for white and black adults ages sixty-five and older. For whites, longevity increased, disability was postponed to older ages, the locus of care shifted from nursing facilities to community settings, and the proportion of life at older ages spent without disability increased. In contrast, for blacks, longevity increases were accompanied by smaller postponements in disability, and the percentage of remaining life spent active remained stable and well below that of whites. Older black women were especially disadvantaged in 2011 in terms of the proportion of years expected to be lived without disability. Public health measures directed at older black adults--particularly women--are needed to offset impending pressures on the long-term care delivery system as the result of population aging. [ABSTRACT FROM AUTHOR]

Considers an integrated income and disability annuity as an alternative framework for long-term care financing and shows that pooling disability and mortality risks can reduce the need for medical underwriting. Annuity approach to financing long-term care; Results from a study simulating the implications of combining an immediate income annuity and a cash disability policy for the potential size of the market and for adverse selection in both types of insurance.

When private resources are defined broadly to include informal care as well as private expenditures, 73 percent of the elderly long term care population rely entirely on private resources for their care. The emphasis of current programs on institutional care directs public resources toward those with more serious disability and less family to care for them. Among those with four or five disabilities in ADLS, 35 percent of those without a spouse or children currently receive no public support, compared with nearly 80 percent of those with both spouse and chiidren. Thus, even if restricted to seriously disabled persons, a new program expanding public long term care financing would increase eligibiity for public benefits disproportionately among those with greater informal care resources. [ABSTRACT FROM PUBLISHER]

A correction to the article "Change OverTime in Caregiving Networks for Older Adults With and Without Dementia," by Brenda C. Spillman, Vicki A. Freedman, Judith D. Kasper, and Jennifer L. Wolff, which was published in a 2019 issue of the journal is presented.

Private insurance is one strategy for financing the large and growing cost of long-term care. Little is known, however, about the extent to which medical underwriting may limit the potential of private insurance to cover nursing home care, or whether the underwriting criteria used in this relatively new market successfully identify high-cost groups. Data from the National Mortality Followback Survey are used to address these two questions. It is estimated that between 12 and 23 percent of the population would be rejected from private long-term care insurance because of their health if everyone applied at 65. These figures rise to between 20 and 31 percent at age 75. The simulation results suggest that long-term care insurance underwriting criteria identify individuals who vary substantially in the financial risk they pose to insurers. In most cases, whether a criterion identifies a high-cost group is sensitive to the policy individuals are assumed to buy. [ABSTRACT FROM AUTHOR]

The number of US adults ages sixty-five and older who are living with dementia is substantial and expected to grow, raising concerns about the demands that will be placed on family members and other unpaid caregivers. We used data from the 2011 National Health and Aging Trends Study and its companion study, the National Study of Caregiving, to investigate the role of dementia in caregiving. We found that among family and unpaid caregivers to older noninstitutionalized adults, one-third of caregivers, and 41 percent of the hours of help they provide, help people with dementia, who account for about 10 percent of older noninstitutionalized adults. Among older adults who receive help, the vast majority in both community and residential care settings other than nursing homes rely on family or unpaid caregivers (more than 90 percent and more than 80 percent, respectively), regardless of their dementia status. Caregiving is most intense, however, to older adults with dementia in community settings and from caregivers who are spouses or daughters or who live with the care recipient. [ABSTRACT FROM AUTHOR]