Aging of the Population

The number of persons 65 years of age and over increased from about 31 million to about 34 million between 1990 and 2000. The percentage of the population aged 65 and over remained fairly constant during this period—about 12.4 percent (chart 3). The number of the oldest old, aged 85 and over, increased from about 3 million to over 4 million in 2000, or from 1.2 percent to 1.5 percent. In short, although the number of elderly increased during this decade, it did not increase at a very rapid rate (19). Baby boomers are still under age 65, but as they age, both the number and percentage of elderly in the United States will begin to accelerate rapidly. However, baby boomers are currently in their forties and fifties and are beginning to experience the onset of chronic conditions such as diabetes and heart disease.

Aging is associated with an increase in functional limitation and in the prevalence of chronic conditions. As people age, they tend to use more hospital services and prescription medicines. In 1999, people over the age of 65 years experienced nearly three times as many hospital days per thousand than the general population. This ratio goes up to nearly four times for people over the age of 75 (20).

However, the relationship between aging (or any correlate of utilization) and overall health care utilization is not a direct one. Increased longevity can be a result of the postponement of disease onset or a steady rate of functional loss (10–13). The elderly do have a higher rate of many procedures and are prescribed more drugs, but the increase in the use of some drugs may reduce the prevalence of some other conditions and their associated utilization. For example, increased use of glucose-lowering and antihypertensive drugs may reduce complications of diabetes and associated care for some elderly, but it also may be associated with increased utilization of physicians’ services. There is also some evidence that the rate of acute care, in general, decreases with advanced age because of co-morbid conditions or unwillingness to perform invasive or traumatic therapies on the very old (21). The independent effect of aging of the population on health services utilization, therefore, is not immediately apparent.