The Oldest Old

The health status of the very old is also a matter of considerable interest, especially given that a significant share of their health-care expenses is paid with public funds. The proportion of the population with one or more limitations in the activities of daily living (ADL) tends to rise sharply with age. While nearly nine in ten persons aged sixty-five to sixty-nine reported no problems with ADLs, this was true for only about 40 percent of the oldest old. A closely related issue is the extent to which the oldest old population resides in a nursing home or similar institution, a living arrangement strongly conditioned by the health and marital status of the individual (persons with a surviving spouse are far less likely to be nursing home residents than are the widowed). Fewer than one tenth of Americans aged eighty to eighty-four resided in a nursing home when the 1990 census was taken, but the incidence of institutionalization was sharply higher among oldest Americans; for those age eighty-five and older, nearly one in four were in a long-term care environment. This issue is of great import to policy makers at the federal and state levels, since many nursing home costs are paid through the jointly funded Medicaid program.