Older Americans are living longer and are generally, in better health than two decades ago. Nonetheless, long-term care expenditures are a major component of health care cost for the elderly, in particular because of the tripling of the oldest-old population age 85 years and older. We propose to define demographic trends in the health and disability composition of nursing home residents in recent years from 1991 to 2001 using information collected by National Nursing Home Surveys (NNHS) conducted in the interval. Nine items concerning activities of daily living, mobility, incontinence, and sight and hearing losses will be used to construct a hierarchy of disability (Grade of Membership analysis). The size of the identified disability groups, their demographic composition, and trends over time will be described. Census data will be employed to define trends in the use of nursing homes over time for the U.S. elderly population. The proposed work builds on and extends work already completed for years 1973 to 1997. A more detailed picture of recent trends is needed for projection into the near-term future. These descriptive and analytic results may also be employed to examine the recent decline in disability among the aged as well as trends in the overall pattern of morbidity in the aged population. This proposal includes work that effectively extends analyses of a repeating cross sectional survey of extraordinary duration through a period when living arrangements and disability levels are undergoing rapid, apparent change. Both the National Long Term Care Survey (NLTCS) and the Medicare Current Beneficiary Survey (MCBS) show evidence of a disability decline over the period. Continuity of NNHS analyses is essential for understanding the nature and distribution of the observed recent disability decline among the aged.
