Discuss the specific public health issue you chose (OBESITY- SEE ABOVE). Make sure to have a short summary and do not go into clinical details of specific issues.

Locate the U.S. National Library of Medicine’s MedlinePlus webpage- explore it. Use Older Americans 2020: Key Indicators of Well-Being. Review Health Risks and Behaviors (PAGE 34). Indicator 26 Obesity (Page 40). Find table 26 (Page 114) <<<<< Research topic!

Assess the presented data. Write an op-ed journal article (see “Supplemental” section) addressing the following issues:

Discuss the specific public health issue you chose (OBESITY- SEE ABOVE). Make sure to have a short summary and do not go into clinical details of specific issues. Your discussion needs to be centered around social policies promoting the issue, the country/state expenditure directed to prevent, treat, and address the individual but, more importantly, the public consequences of the matter. Remember about epidemiological indicators, workforce and business losses, informal caregiving, and social consequences for the families and state.

Evaluate the stakeholders interested in addressing this public health issue. Remember to discuss the governance bodies as well as community partners. Define specific role in public health efforts directed toward this matter (epi markers and expenditure) reduction.

Assess the collaborative efforts among the stakeholders and identify gaps (or excellence) in the partnerships/collaborative efforts between the stakeholders. Make sure to offer supportive evidence to demonstrate either.

Assess the status of the existing social policies directed to minimize the damage to the individual and community as well as offer 1-2 new (different) social policies to be introduced and directed to minimize the negative behaviors and public health outcomes. Make sure to provide evidence supporting your ideas.

Define the communication and leadership tools and strategies useful in convincing the public and the Governance bodies in considering the policies you recommended. Explain why you recommended these tools and who your audience is for each.

Try not to exceed 10 pages plus the title and reference pages. All evidence must be cited and referenced in APA 7th Edition. A minimum of 6 references.

Supplemental:

Ten simple rules for writing scientific op-ed articles – https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1008187

How to Write a Perspective and Opinion Article – https://jle.hse.ru/pop

Myths and Truths About Publishable Journal Articles – https://www.insidehighered.com/advice/2019/07/18/how-write-publishable-journal-article-opinion

Requirements: 8 pages

2020Older AmericansKey Indicators of Well-Being

Federal Interagency Forum on Aging-Related StatisticsThe Federal Interagency Forum on Aging-Related Statistics (Forum) was founded in 1986 to foster collaboration among Federal agencies that produce or use statistical data on the older population. Forum agencies as of September 2020 are as follows: Consumer Product Safety Commissionhttps://www.cpsc.gov/Department of CommerceU.S. Census Bureauhttps://www.census.gov/Department of Health and Human ServicesAdministration for Community Livinghttps://acl.gov/Agency for Healthcare Research and Qualityhttps://www.ahrq.gov/Centers for Medicare & Medicaid Serviceshttps://www.cms.gov/National Center for Health Statisticshttps://www.cdc.gov/nchs/National Institute on Aginghttps://www.nia.nih.gov/Office of the Assistant Secretary for Planning and Evaluationhttps://aspe.hhs.gov/Substance Abuse and Mental Health Services Administrationhttps://www.samhsa.gov/Department of Housing and Urban Developmenthttps://www.hud.gov/Department of LaborBureau of Labor Statisticshttps://www.bls.gov/Employee Benefits Security Administrationhttps://www.dol.gov/agencies/ebsaDepartment of Veterans Affairshttps://www.va.gov/Environmental Protection Agencyhttps://www.epa.gov/Office of Management and BudgetOffice of Statistical and Science Policyhttps://www.whitehouse.gov/omb/Social Security AdministrationOffice of Research, Evaluation, and Statisticshttps://www.ssa.gov/Copyright information: All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. Recommended citation: Federal Interagency Forum on Aging-Related Statistics. (2020). Older Americans 2020: Key indicators of well-being. Washington, DC: U.S. Government Printing Office. Report availability: Single copies of this report are available at no charge through the Government Printing Office, 8660 Cherry Lane, Laurel, MD 20707, [email protected]. This report is also available at https://agingstats.gov.

Older Americans 2020Key Indicators of Well-Being

 

iiiForewordOlder Americans (those age 65 and over) are a vibrant and growing part of our Nation. They also experience unique challenges to their economic well-being, health, and independence. To inform decisions regarding the support and well-being of older Americans, robust statistics reflecting these experiences are needed. Although many Federal agencies provide statistics on aspects of older Americans’ lives, it can be difficult to fit the pieces together into a comprehensive representation. Thus, it is important for policymakers and the general public to have an accessible, easy-to-understand portrait of how older Americans fare.Older Americans 2020: Key Indicators of Well-Being (Older Americans 2020) provides a comprehensive, easy-to-understand picture of our older population. Older Americans 2020 is the eighth report prepared by the Federal Interagency Forum on Aging-Related Statistics (Forum). It provides readers with an accessible compendium of indicators drawn from the most reliable and recent official statistics. The indicators are categorized into six broad groups: Population, Economics, Health Status, Health Risks and Behaviors, Health Care, and Environment. Recognizing that Federal agencies will continue to collect and report data on older Americans over time, these metrics will broaden to address current knowledge gaps and emerging information needs. Measurement and reporting will improve to enhance the quality and utility of information. The statistics reported in this volume, while the most recent available, are based on data collected prior to the COVID-19 pandemic. Although many of these data collection systems have adapted to accommodate the emerging information needs related to the pandemic, COVID-19-related data were not available for inclusion in this report. However, provisional data show that the onset of COVID-19 has disproportionately impacted older Americans, resulting in higher mortality because older Americans are more likely to have chronic conditions that contribute to an increased risk of death. As of September 23, 2020, 79 percent (148,737/188,470) of deaths involving COVID-19, based on death certificate data received and coded by the National Center for Health Statistics, occurred among people age 65 and over.1Established in 1986, the goal of the Federal Interagency Forum on Aging-Related Statistics (Forum) is to bring together Federal agencies that share a common interest in improving aging-related data. As the population of older Americans continues to grow, the Forum continues its collaborative effort to provide reliable and relevant information on this vital component of our society. The Forum plays a key role in critically evaluating existing data resources and limitations, stimulating new database development, encouraging cooperation and data sharing among Federal agencies, and preparing collaborative statistical reports (https://www.agingstats.gov/about.html). The Forum appreciates users’ requests for greater detail for many existing indicators. We also extend an invitation to all readers and partners to let us know what else we can do to make our reports more accessible and useful. Please send any comments to [email protected] Older Americans reports reflect the Forum’s commitment to advancing our understanding of where older Americans stand today and what challenges they may face tomorrow. This work would not be possible without the continued cooperation of millions of American citizens who willingly provide the data that are summarized and analyzed by Federal agency staff for the American people. Office of the Chief Statistician, U.S. Office of Management and Budget

ivAcknowledgmentsOlder Americans 2020 is a report of the Forum. This report was prepared by the Forum’s planning committee and reviewed by its principal members, which include Vicki Gottlich and Susan Jenkins, Administration for Community Living (ACL); Joel W. Cohen, Agency for Healthcare Research and Quality (AHRQ); Dorinda Allard, Bureau of Labor Statistics (BLS); Roberto Ramirez, U.S. Census Bureau; Debra Reed-Gillette, Centers for Medicare & Medicaid Services (CMS); Steve Hanway, U.S. Consumer Product Safety Commission; Joseph Piacentini and Anja Decressin, Employee Benefits Security Administration (EBSA); Jennifer Madans and Julie Weeks, National Center for Health Statistics (NCHS); John Phillips and Georgeanne Patmios, National Institute on Aging (NIA); Gavin Kennedy and William Marton, Office of the Assistant Secretary for Planning and Evaluation (ASPE), Department of Health and Human Services; Nancy Potok (retired), Office of Management and Budget (OMB); Elizabeth Lopez and Beth Han, Substance Abuse and Mental Health Services Administration (SAMHSA); Katherine Bent and Natalie Lu, Social Security Administration (SSA); and Tom Garin and Melissa Chiu, Department of Veterans Affairs (VA).The Forum’s planning committee and contributing staff members include Traci Cook, Forum Staff Director; Caryn Bruyere, ACL; David Kashihara, AHRQ; Emy Sok, BLS; Wan He and Andrew Roberts, U.S. Census Bureau; Katherine Giuriceo and Nic Schluterman, CMS; Meena Bavan and Barry Steffen, Department of Housing and Urban Development (HUD); Bobbie Joyeux and Lynn Pearce, EBSA; Ellen Kramarow, NCHS; Georgeanne Patmios, NIA; Helen Lamont, ASPE; Anthony Nerino Jr. and Margo Schwab, OMB; Beth Han and Jennifer Solomon, SAMHSA; Brad Trenkamp, SSA; Hazel Hiza, Department of Agriculture (USDA); and Tom Garin and Maggie Heimann, VA.In addition to the 16 agencies of the Forum, the USDA was invited to contribute to this report. The Forum greatly appreciates the efforts of Hazel Hiza, Center for Nutrition Policy and Promotion, USDA, in providing valuable information from their agency. Other staff members of Federal agencies who provided data and assistance include Jennifer Klocinski, ACL; Rachel Krantz-Kent and Geoffrey Paulin, BLS; William Dean, Maria Diacogiannis, Chris McCormick, Maggie Murgolo, Joseph Regan, Laura Saffron, and Marina Vornovitsky, CMS; David Mintz, Environmental Protection Agency; Carolyn Lynch, HUD; Elizabeth Arias, Nazik Elgaddal, Cynthia L. Ogden, Manisha Sengupta, and Ashley Woodall, NCHS; Chris Tamborini, SSA; and Peter Ahn, VA. Member agencies of the Forum provided funds and valuable staff time to produce this report. NCHS and its contractor, the American Institutes for Research (AIR), facilitated the production, printing, and dissemination of this report. Susan Armstrong, Mandy Dean, Anita Lederer, Katie Mallory, Ashley Roberts, and Max Wylie managed the report’s production process and designed the layout; Richard Devens, First XV Communications, provided consultation and editing services.

vAbout This ReportIntroductionOlder Americans 2020 marks 20 years since the first key indicators describing the overall condition of the U.S. population age 65 and over were released by the Forum. It is the eighth in a series of reports published by the Forum. The reports use data from more than a dozen national data sources to construct broad indicators of well-being for the older population and monitor changes over time. The data trends in these reports present information and opportunities that can improve the lives of older Americans.In 2016, the Forum conducted a conceptual and methodological review of report indicators and format according to established indicator selection criteria (see “Selection Criteria for Indicators”). This review ensures that the report continues to feature the most current topics and the most reliable, accurate, and accessible statistics.This report is intended to stimulate relevant and timely public discussions, encourage exchanges between the data and policy communities, and foster improvements in Federal data collection on older Americans. By examining a broad range of indicators, researchers, policymakers, and service providers can better understand the areas of well-being that are improving for older Americans as well as the areas that require more attention.Structure of the ReportBy presenting data in a nontechnical, user-friendly format, Older Americans 2020 complements other more technical and comprehensive reports from the individual Forum agencies. The report includes indicators grouped in six sections: Population, Economics, Health Status, Health Risks and Behaviors, Health Care, and Environment. Each indicator includes the following:• A paragraph describing the relevance of the indicator to the well-being of the older population.• One or more charts that illustrate important aspects of the data. • Bulleted data highlights. The data used in the indicators are presented in tables in the back of the report. Data source descriptions and a glossary are in the back matter. A timeline of selected historical events is also included on the back inside cover. For more detailed information on the practices and parameters for developing consistency in data reported across the report indicators, the Forum’s Operations and Practices and Parameters for Publications, Products, and Activities are available on the Forum’s website at https://agingstats.gov.Selection Criteria for IndicatorsThe Forum chose these indicators because they meet the following criteria:• Easy to understand by a wide range of audiences.• Based on reliable, nationwide data sponsored, collected, or disseminated by the Federal government.• Objectively based on substantial research that connects the indicator to the well-being of older Americans.• Balanced so that no single section dominates the report. • Measured periodically (but not necessarily annually) so that they can be updated, making possible the description of trends over time.• Representative of large segments of the aging population, rather than one particular group.Considerations When Examining the IndicatorsThe data in Older Americans 2020 usually describe the U.S. population age 65 and over. More specific age groups (e.g., ages 65–74, 75–84, and 85 and over) are reported whenever possible.Data availability and analytical relevance may factor into the determination of the age groups presented in an indicator. For example, data for the age range 85 and over may not appear in an indicator because small survey sample sizes resulted in statistically reliable data for that age range not being available. On the other hand, data for the population younger than age 65 are sometimes included in an indicator if the inclusion allows for a more comprehensive interpretation of the indicator’s content. For example, to show trends in the amount of savings reserved for retirement by the entire population, data on public and private retirement assets are included for the total population in Indicator 10: Net Worth. In Indicator 11: Participation in Labor Force, a comparison with a younger population provided an opportunity for an enhanced interpretation of labor force trends among people age 65 and over.

viTo standardize the age distribution of the population age 65 and over across years, some estimates have been age adjusted by multiplying age-specific rates by time-constant weights. If an indicator has been age adjusted, this will be stated in the note under the chart(s) as well as under the corresponding table(s).The reference population (the base population sampled at the time of data collection) for each indicator is labeled under each chart and table and is defined in the Glossary. Whenever possible, the indicators include data on the U.S. resident population (both people living in the community and people living in institutions). However, many indicators show data only for the civilian noninstitutionalized population. Because the older population residing in nursing homes (and other long-term care institutional settings) is not included in samples based on the noninstitutionalized population, use caution when attempting to generalize the findings from these data sources to the entire population age 65 and over. This is especially true for the older age groups. In 2018, 10 percent of the population age 85 and over was not included in the civilian noninstitutionalized population as defined by the U.S. Census Bureau. For example, the reference population for Indicator 19: Dementia in this year’s report has not changed from Older Americans 2016—both show the community (noninstitutionalized) population only. The prevalence of dementia in the institutionalized (nursing home) population is higher than in the community population and is not reflected in the indicator chart.100Percent80604020065 and over65–7475–8485 and over98999790Civilian noninstitutionalized population as a percentage of the total resident population, by age: July 1, 2018SOURCE: U.S. Census Bureau, Population Estimates, July 1, 2018.Survey YearsThe reader should be aware that the range of years presented in each chart varies because data availability is not uniform across the data sources. Accuracy of the EstimatesMost estimates in this report are based on a sample of the population and are therefore subject to sampling error. Standard tests of statistical significance have been used to determine whether differences between populations exist at generally accepted levels of confidence or whether they occurred by chance. Unless otherwise noted, only differences that are statistically significant at the p ≤ 0.05 level are discussed in the text. To indicate the reliability of the estimates, standard errors for selected estimates in the report can be found on the Forum’s website at https://agingstats.gov.Where possible, data estimates have been obtained from the true unrounded value of the original data. Data are rounded to one decimal place in the data tables and appear as whole numbers in the report text unless a finer breakdown is needed to show a significant difference between two estimates that would otherwise round to the same number. Although charts display rounded numbers, the charts are created using unrounded estimates.Finally, the data in some indicators may not sum to totals because of rounding.Sources of DataThe data used to create the charts are provided in the tables in the back of the report, along with data described in the bullets below each chart. The source of the data for each indicator is noted below the chart.Descriptions of the data sources can be found in the back matter. Additional information about these data sources and contact information for the agency providing the data are available on the Forum’s website at https://agingstats.gov.Data NeedsThis year, the Forum assessed data needs related to sources of income for older Americans. It was determined that a better data source is needed to accurately measure the retirement income components of the income sources for older Americans. To address these concerns, the Sources of Income indicator (Indicator 9 in Older Americans 2016) is not included in this report because of changes in data collection and reporting; however, the indicator will return in future Older Americans reports.

viiMissionThe Forum’s mission is to encourage cooperation and collaboration among Federal agencies to improve the quality and utility of data on the aging population. The specific goals of the Forum are as follows:• Widen access to information on the aging population through periodic publications and other means.• Promote communication among data producers, researchers, and public policymakers.• Coordinate the development and use of statistical databases among Federal agencies.• Identify information gaps and data inconsistencies.• Investigate questions of data quality. • Encourage cross-national research and data collection on the aging population.• Address concerns regarding collection, access, and dissemination of data.For Further InformationThe Forum’s website (https://www.agingstats.gov) contains data tables (with standard errors, when available); links to previous reports; the Forum’s Charter, Operations and Practices, and Parameters for Publications, Products, and Activities; agency contacts; and additional information about the Forum. Follow the Forum on Twitter @agingstats for selected highlights from Older Americans 2020. For more information about Older Americans 2020 or other Forum activities, contact the Forum as follows:Traci CookStaff DirectorFederal Interagency Forum on Aging-Related Statistics3311 Toledo RoadHyattsville, MD 20782Phone: 301-458-4082Fax: 301-458-4192Email: [email protected]: https://agingstats.govAdditional Online ResourcesAdministration for Community Living Profile of Older Americanshttps://acl.gov/aging-and-disability-in-america/data-and-research/profile-older-americansAGing, Independence, and Disability (AGID) Program Data Portalhttps://agid.acl.gov/Default.aspxACL Program Evaluations and Related Reportshttps://acl.gov/programs/program-evaluations-and-reportsAgency for Healthcare Research and Quality Research Tools and Datahttps://www.ahrq.gov/research/index.htmlBureau of Labor StatisticsBureau of Labor Statistics Datahttps://www.bls.gov/dataU.S. Census BureauAge Datahttps://www.census.gov/topics/population/age-and-sex.htmlStatistical Abstract of the United Stateshttps://www.census.gov/library/publications/time-series/statistical_abstracts.htmlLongitudinal Employer-Household Dynamicshttps://lehd.ces.census.govCenters for Medicare & Medicaid ServicesCMS Research, Statistics, Data, and Systemshttps://www.cms.gov/research-statistics-data-and-systems/research-statistics-data-and-systems.htmlDepartment of Housing and Urban DevelopmentPolicy Development and Research Reports and Information Serviceshttps://www.huduser.govDepartment of Veterans AffairsVeteran Data and Informationhttps://www.va.gov/vetdataEmployee Benefits Security AdministrationEBSA’s Researchhttps://www.dol.gov/agencies/ebsa/researchersNational Center for Health StatisticsHealth, United Stateshttps://www.cdc.gov/nchs/hus.htmWashington Group on Disability Statisticshttp://www.washingtongroup-disability.com/

viiiNational Institute on AgingNIA Centers on the Demography of Aginghttps://agingcenters.org/National Archive of Computerized Data on Aginghttps://www.icpsr.umich.edu/NACDAPublicly Available Datasets for Aging-Related Secondary Analysis in the Behavioral and Social Scienceshttps://www.nia.nih.gov/research/dbsr/publicly-available-databases-aging-related-secondary-analyses-behavioral-and-socialOffice of the Assistant Secretary for Planning and Evaluation, HHSOffice of Behavioral Health, Disability, and Aging Policyhttps://aspe.hhs.gov/bhdapOffice of Management and BudgetFederal Committee on Statistical Methodologyhttps://nces.ed.gov/fcsm/Social Security AdministrationSocial Security Administration Statistical Informationhttps://www.ssa.gov/policySubstance Abuse and Mental Health Services AdministrationCenter for Behavioral Health Statistics and Qualityhttps://www.samhsa.gov/dataCenter for Mental Health Serviceshttps://www.samhsa.gov/about-us/who-we-are/offices-centers/cmhsOther ResourcesData and Statistics About the United Stateshttps://www.usa.gov/statisticsData.govhttps://www.data.gov

ixTable of ContentsForeword ……………………………………………………………………………………………………………………………………………iiiAcknowledgments ………………………………………………………………………………………………………………………………..ivAbout This Report ………………………………………………………………………………………………………………………………..vList of Tables ……………………………………………………………………………………………………………………………………….xiHighlights …………………………………………………………………………………………………………………………………………xviPOPULATIONIndicator 1: Number of Older Americans ………………………………………………………………………………………..2Indicator 2: Racial and Ethnic Composition …………………………………………………………………………………….4Indicator 3: Marital Status …………………………………………………………………………………………………………….5Indicator 4: Educational Attainment ……………………………………………………………………………………………….6Indicator 5: Living Arrangements …………………………………………………………………………………………………..8Indicator 6: Older Veterans ……………………………………………………………………………………………………………9ECONOMICSIndicator 7: Poverty ……………………………………………………………………………………………………………………12Indicator 8: Income ……………………………………………………………………………………………………………………13Indicator 9: Social Security Beneficiaries ………………………………………………………………………………………..14Indicator 10: Net Worth ……………………………………………………………………………………………………………..16Indicator 11: Participation in Labor Force ……………………………………………………………………………………..18Indicator 12: Housing Problems …………………………………………………………………………………………………..20Indicator 13: Total Expenditures …………………………………………………………………………………………………..22HEALTH STATUSIndicator 14: Life Expectancy ………………………………………………………………………………………………………24Indicator 15: Mortality ……………………………………………………………………………………………………………….25Indicator 16: Chronic Health Conditions ………………………………………………………………………………………26Indicator 17: Oral Health ……………………………………………………………………………………………………………27Indicator 18: Respondent-Assessed Health Status ……………………………………………………………………………28Indicator 19: Dementia……………………………………………………………………………………………………………….29Indicator 20: Depressive Symptoms ………………………………………………………………………………………………30Indicator 21: Functional Limitations …………………………………………………………………………………………….32HEALTH RISKS AND BEHAVIORSIndicator 22: Vaccinations …………………………………………………………………………………………………………..36Indicator 23: Cancer Screenings ……………………………………………………………………………………………………37Indicator 24: Diet Quality …………………………………………………………………………………………………………..38Indicator 25: Physical Activity ……………………………………………………………………………………………………..39Indicator 26: Obesity ………………………………………………………………………………………………………………….40Indicator 27: Cigarette Smoking …………………………………………………………………………………………………..41

xHEALTH CAREIndicator 28: Use of Health Care Services ………………………………………………………………………………………44Indicator 29: Health Care Expenditures …………………………………………………………………………………………46Indicator 30: Prescription Drugs …………………………………………………………………………………………………..48Indicator 31: Sources of Health Insurance………………………………………………………………………………………50Indicator 32: Out-of-Pocket Health Care Expenditures ……………………………………………………………………51Indicator 33: Sources of Payment for Health Care Services ……………………………………………………………….52Indicator 34: Veterans’ Health Care ………………………………………………………………………………………………53Indicator 35: Residential Services ………………………………………………………………………………………………….54Indicator 36: Personal Assistance and Equipment ……………………………………………………………………………56Indicator 37: Long-Term Care Providers ………………………………………………………………………………………..58ENVIRONMENTIndicator 38: Use of Time ……………………………………………………………………………………………………………62Indicator 39: Air Quality …………………………………………………………………………………………………………….64Indicator 40: Transportation ………………………………………………………………………………………………………..66References …………………………………………………………………………………………………………………………………………67Tables ……………………………………………………………………………………………………………………………………………….71Data Sources ……………………………………………………………………………………………………………………………………141Glossary ………………………………………………………………………………………………………………………………………….153

xiList of TablesIndicator 1: Number of Older AmericansTable 1a. Number of people (in millions) age 65 and over and age 85 and over, selected years, 1900–2018, and projected years, 2020–2060 ……………………………………………………………………………………………………………72Table 1b. Percentage of people age 65 and over and age 85 and over, selected years, 1900–2018, and projected years, 2020–2060 ………………………………………………………………………………………………………………….73Table 1c. Population of countries or areas with at least 10 percent of their population age 65 and over, 2019…….74Table 1d. Percentage of the population age 65 and over, by state, 2018 ……………………………………………………….76Table 1e. Percentage of the population age 65 and over, by county, 2018 …………………………………………………….77Table 1f. Number and percentage of people age 65 and over and age 85 and over, by sex, 2018 ………………………77Indicator 2: Racial and Ethnic CompositionTable 2. Population age 65 and over, by race and Hispanic origin, 2018 and projected 2060…………………………..78Indicator 3: Marital StatusTable 3. Marital status of the population age 65 and over, by age group and sex, 2018 …………………………………..78Indicator 4: Educational AttainmentTable 4a. Educational attainment of the population age 65 and over, selected years 1965–2018 ………………………79Table 4b. Educational attainment of the population age 65 and over, by sex and race and Hispanic origin, 2018…………………………………………………………………………………………………………………………………………………79Indicator 5: Living ArrangementsTable 5a. Living arrangements of the population age 65 and over, by sex and race and Hispanic origin, 2018 ……80Table 5b. Percentage of population age 65 and over living alone, by sex and age group, selected years, 1970–2019………………………………………………………………………………………………………………………………………..80Indicator 6: Older VeteransTable 6a. Percentage of population age 65 and over who are veterans, by age group and sex, selected years 2000–2018, and projected 2020 and 2030 …………………………………………………………………………………………….81Table 6b. Number of veterans age 65 and over, by age group and sex, selected years 2000–2018, and projected, 2020 and 2030 ……………………………………………………………………………………………………………………81Indicator 7: PovertyTable 7a. Poverty rate by age, by official poverty measure and Supplemental Poverty Measure, 1966–2018 ……….82Table 7b. Percentage of the population age 65 and over living in poverty, by selected characteristics, 2018 ………..84Indicator 8: IncomeTable 8a. Income distribution of the population age 65 and over, 1974–2018 ………………………………………………84Table 8b. Median income of householders age 65 and over, in current and in 2018 dollars, 1974–2018 …………..86Indicator 9: Social Security BeneficiariesTable 9a. Percentage distribution of people who began receiving Social Security benefits in 2018, by age and sex ……………………………………………………………………………………………………………………………………88Table 9b. Percentage distribution of female Social Security beneficiaries age 62 and over, by type of benefit received, selected years 1960–2018 ………………………………………………………………………………………………………..88

xiiIndicator 10: Net WorthTable 10a. Median household net worth, in 2016 dollars, by selected characteristics of head of household, selected years 1989–2016 …………………………………………………………………………………………………………………….89Table 10b. Percent holding and median household financial assets held in retirement investment accounts, in 2016 dollars, by selected characteristics of head of household, selected years 1989–2016 ……………………………89Table 10c. Amount of funds (in millions of dollars) held in retirement assets, by sector and type of plan, 1975–2018………………………………………………………………………………………………………………………………………..91Indicator 11: Participation in Labor ForceTable 11. Labor force participation rates (annual averages) of persons age 55 and over, by sex and age group, 1963–2019………………………………………………………………………………………………………………………………………..92Indicator 12: Housing ProblemsTable 12a. Prevalence of housing problems among older owner/renter households, by type of problem, selected years, 2013–2017 ……………………………………………………………………………………………………………………94Table 12b. Prevalence of housing problems among older-member households, by type of problem, selected years, 2013–2017 ……………………………………………………………………………………………………………………94Table 12c. Prevalence of housing problems among all U.S. households except those households with one or more persons age 65 and over, by type of problem, selected years, 2013–2017 ……………………………………95Table 12d. Prevalence of housing problems among older owner/renter intergenerational households,by type of problem, selected years, 2013–2017 ………………………………………………………………………………………..95Table 12e. Prevalence of housing problems among older-member intergenerational households, by type of problem, selected years, 2013–2017 ………………………………………………………………………………………..96Table 12f. Prevalence of housing problems among all older households: householder, spouse, or member(s) age 65 and over, by type of problem, selected years, 2013–2017 …………………………………………………………………96Indicator 13: Total ExpendituresTable 13. Percentage distribution of total household annual expenditures, by age of reference person, 2018 ………97Indicator 14: Life ExpectancyTable 14. Life expectancy at ages 65 and 85, by race and Hispanic origin and sex, 2006–2018 ……………………….98Indicator 15: MortalityTable 15a. Death rates among people age 65 and over, by selected leading causes of death, 2000–2018 ……………99Table 15b. Number of deaths and age-adjusted death rates among people age 65 and over, by selected leading causes of death and sex, 2018 ………………………………………………………………………………………………….100Indicator 16: Chronic Health ConditionsTable 16a. Percentage of people age 65 and over who reported having selected chronic health conditions, by sex and race and Hispanic origin, 2018…………………………………………………………………………………………….101Table 16b. Percentage of people age 65 and over who reported having selected chronic health conditions, 1997–2018………………………………………………………………………………………………………………………………………101Indicator 17: Oral HealthTable 17a. Percentage of people age 65 and over who had dental insurance, had a dental visit in the past year, or had no natural teeth, by age group, 2018 ……………………………………………………………………………102Table 17b. Percentage of people age 65 and over who had dental insurance, had a dental visit in the past year, or had no natural teeth, by sex and race and Hispanic origin, 2018 …………………………………………….102

xiiiIndicator 18: Respondent-Assessed Health StatusTable 18. Percentage of people age 65 and over with respondent-assessed health status, by race and Hispanic origin, sex, and age group, 2018 …………………………………………………………………………………………….103Indicator 19: DementiaTable 19a. Number and percentage of the non-nursing home population age 65 and over with dementia, by age group, 2011 and 2015 ……………………………………………………………………………………………………………..104Table 19b. Number and percentage of the non-nursing home population age 65 and over with dementia, by sex and age group, 2011 and 2015 …………………………………………………………………………………………………..104Table 19c. Number and percentage of the non-nursing home population age 65 and over with dementia, by sex and educational attainment, 2011 and 2015 ………………………………………………………………………………..104Table 19d. Number and percentage of the non-nursing home population age 65 and over with dementia, by age group and educational attainment, 2011 and 2015 ……………………………………………………………………….105Table 19e. Number and percentage of the non-nursing home population age 65 and over with dementia, by race and Hispanic origin, 2011 and 2015 …………………………………………………………………………………………105Indicator 20: Depressive SymptomsTable 20a. Percentage of people age 55 and over with clinically relevant depressive symptoms, by age group and sex, selected years 1998–2018 ………………………………………………………………………………………………106Table 20b. Percentage of people age 55 and over with clinically relevant depressive symptoms, by age group and sex, 2018 ………………………………………………………………………………………………………………………….106Indicator 21: Functional LimitationsTable 21a. Percentage of people age 65 and over with a disability, by sex and functional domain, 2010–2018 ….107Table 21b. Percentage of people age 65 and over with a disability, by age group and functional domain, 2018 …107Table 21c. Percentage of people age 65 and over with a disability, by race and Hispanic origin and functional domain, 2018 …………………………………………………………………………………………………………………………………..108Table 21d. Percentage of Medicare beneficiaries age 65 and over who have limitations in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or who are in a long-term care facility, 1992–2017………………………………………………………………………………………………………………………………………108Table 21e. Percentage of Medicare beneficiaries age 65 and over who have limitations in performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or who are in a long-term care facility, by sex and age group, 2017 ……………………………………………………………………………………………….109Indicator 22: VaccinationsTable 22a. Percentage of people age 65 and over who reported having been vaccinated against influenza and pneumococcal disease, by race and Hispanic origin, 1997–2018 ………………………………………………………..110Table 22b. Percentage of people age 65 and over who reported having been vaccinated against influenza and pneumococcal disease, by selected characteristics, 2018 …………………………………………………………………….110Indicator 23: Cancer ScreeningsTable 23. Percentage of women ages 50–74 who had breast cancer screening and percentage of people ages 50–75 who had colorectal cancer screening, by sex and age group, selected years, 2000–2018 ………………..111Indicator 24: Diet QualityTable 24. Average diet quality scores using the Healthy Eating Index-2015 for the population age 65 and over, by age group, 2015–2016 ……………………………………………………………………………………………………..112

xivIndicator 25: Physical ActivityTable 25a. Percentage of people age 65 and over who reported participating in leisure-time aerobic and muscle-strengthening activities that meet the Physical Activity Guidelines for Americans, by age group, 1998–2018………………………………………………………………………………………………………………………………………113Table 25b. Percentage of people age 65 and over who reported participating in leisure-time aerobic and muscle-strengthening activities that meet the Physical Activity Guidelines for Americans, by sex and race and Hispanic origin, 2018 ……………………………………………………………………………………………………………113Indicator 26: ObesityTable 26. Percentage of people age 65 and over overweight and with obesity, by sex and age group, selected years, 1976–2018 ………………………………………………………………………………………………………………….114Indicator 27: Cigarette SmokingTable 27a. Percentage of people age 65 and over who are current cigarette smokers, by sex and race and Hispanic origin, selected years, 1965–2018 …………………………………………………………………………………….115Table 27b. Percentage of people age 65 and over who are current cigarette smokers, by sex and poverty status, 2018 ……………………………………………………………………………………………………………………………………..116Indicator 28: Use of Health Care ServicesTable 28a. Use of Medicare-covered health care services per 1,000 Medicare beneficiaries age 65 and over, 1992–2017………………………………………………………………………………………………………………………………………117Table 28b. Use of Medicare-covered home health care and skilled nursing facility services per 1,000 Medicare beneficiaries age 65 and over, by age group, 2017 ……………………………………………………………………..117Indicator 29: Health Care ExpendituresTable 29a. Average annual health care costs, in 2017 dollars, for Medicare beneficiaries age 65 and over, by age group, 1992–2017 …………………………………………………………………………………………………………………..118Table 29b. Total amount and percentage distribution of annual health care costs among Medicare beneficiaries age 65 and over, by major cost component, 2008, 2012, and 2017 …………………………………………118Table 29c. Average annual health care costs among Medicare beneficiaries age 65 and over, by selected characteristics, 2017 ………………………………………………………………………………………………………………………….119Indicator 30: Prescription DrugsTable 30a. Average prescription drug costs, in 2017 dollars, among noninstitutionalized Medicare beneficiaries age 65 and over, by sources of payment, 1992–2017 …………………………………………………………….120Table 30b. Percentage distribution of annual prescription drug costs among noninstitutionalized Medicare beneficiaries age 65 and over, 2017 ………………………………………………………………………………………………………120Table 30c. Number of Medicare beneficiaries age 65 and over who enrolled in Part D prescription drug plans or who were covered by retiree drug subsidy payments, 2006 and 2017 …………………………………………….121Indicator 31: Sources of Health InsuranceTable 31a. Percentage of noninstitutionalized Medicare beneficiaries age 65 and over with supplemental health insurance, by type of insurance, 1991–2017 ………………………………………………………………………………..122Table 31b. Percentage of people ages 55–64 with health insurance coverage, by poverty status and type of insurance, 2018 …………………………………………………………………………………………………………………………….122Indicator 32: Out-of-Pocket Heath Care ExpendituresTable 32a. Percentage of people age 55 and over with out-of-pocket expenditures for health care service use, by age group, 1977, 1987, 1996, and 2000–2017 ………………………………………………………………………………….123Table 32b. Percentage of household income per person attributable to out-of-pocket health care expenditures among people age 55 and over, by selected characteristics, 1977, 1987, 1996, 2000, and 2005–2017 …………….123

xvTable 32c. Percentage distribution of total out-of-pocket health care expenditures among people age 55 and over, by age group and type of health care service, 2000–2017 …………………………………………………………..125Indicator 33: Sources of Payment for Health Care ServicesTable 33. Average cost per beneficiary and percentage distribution of sources of payment for health care services for Medicare beneficiaries age 65 and over, by type of service, 2017 ……………………………………………….128Indicator 34: Veterans’ Health CareTable 34. Total number of veterans age 65 and over who are enrolled in Veterans Health Administration, by age group, 2003–2018 and projected 2023–2038 ………………………………………………………………………………128Indicator 35: Residential ServicesTable 35a. Percentage distribution of Medicare beneficiaries age 65 and over residing in selected residential settings, by age group, 2017 ………………………………………………………………………………………………..129Table 35b. Percentage distribution of Medicare beneficiaries age 65 and over with limitations in performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs), by residential setting, 2017……………………………………………………………………………………………………………………………………………….129Indicator 36: Personal Assistance and EquipmentTable 36a. Percentage distribution of noninstitutionalized Medicare beneficiaries age 65 and over who have limitations in performing activities of daily living (ADLs), by type of assistance, 1992–2017 ………………………..130Table 36b. Percentage distribution of noninstitutionalized Medicare beneficiaries age 65 and over who have limitations in performing activities of daily living (ADLs), by type of assistance, age group, and sex, 2017 ………130Table 36c. Percentage of noninstitutionalized Medicare beneficiaries age 65 and over who have limitations in performing instrumental activities of daily living (IADLs) and who receive personal assistance, by age group, 1992–2017 ……………………………………………………………………………………………………………………………131Table 36d. Percentage of noninstitutionalized Medicare beneficiaries age 65 and over who have limitations in performing instrumental activities of daily living (IADLs) and who receive personal assistance, by sex and age group, 2017 ………………………………………………………………………………………………………………………….131Indicator 37: Long-Term Care ProvidersTable 37a. Number of users of long-term care services, by sector and age group, 2015 and 2016 …………………..132Table 37b. Percentage of users of long-term care services needing any assistance with activities of daily living (ADLs), by sector and activity, 2015 and 2016 ………………………………………………………………………………………132Indicator 38: Use of TimeTable 38a. Average number of hours per day and percentage of day that people age 55 and over spent doing selected activities on an average day, by age group, 2018 …………………………………………………………………………133Table 38b. Average number of hours and percentage of total leisure time that people age 55 and over spent doing selected leisure activities on an average day, by age group, 2018 ……………………………………………………….133Indicator 39: Air QualityTable 39a. Percentage of people age 65 and over living in counties with “poor air quality,” by selected pollutant measures, 2000–2018…………………………………………………………………………………………………………..134Table 39b. Counties with “poor air quality” for any standard in 2018 ……………………………………………………….134Indicator 40: TransportationTable 40. Percentage of noninstitutionalized Medicare beneficiaries age 65 and over who made a change in transportation mode because of a health or physical problem, by age group and type of change, 2017 ………..140

xviHighlightsOlder Americans 2020 is one in a series of periodic reports to the Nation on the condition of older adults in the United States. In this report, 40 indicators depict the well-being of older Americans in the areas of Population, Economics, Health Status, Health Risks and Behaviors, Health Care, and Environment. Selected highlights from each section of the report follow.Population• In 2018, 52 million people age 65 and over lived in the United States, accounting for 16 percent of the total population. The older population in 2030 is projected to be more than twice as large as in 2000, growing from 35 million to 73 million and representing 21 percent of the total U.S. population (Indicator 1: Number of Older Americans).• The older population is projected to become increasingly diverse, reflecting the demographic changes in the U.S. population as a whole during the last several decades. In 2018, 77 percent of the population was non-Hispanic White alone, 9 percent non-Hispanic Black alone, 5 percent non-Hispanic Asian alone, and 8 percent Hispanic (of any race). By 2060, it is projected that this will change to 55 percent non-Hispanic White alone, 13 percent non-Hispanic Black alone, 8 percent non-Hispanic Asian alone, and 21 percent Hispanic (of any race; Indicator 2: Racial and Ethnic Composition).• In general, the older population is less likely to be married, and more likely to be widowed, at older ages. Marital status also varies by sex, such that older men were more likely than older women to be married (71 percent versus 46 percent) and less likely to be widowed (11 percent versus 32 percent; Indicator 3: Marital Status).• In 2018, 86 percent of the population age 65 and over were high school graduates or more, and 29 percent had a bachelor’s degree or more (Indicator 4: Educational Attainment).• In 2019, older men were more likely to live with a spouse than were older women. About 67 percent of older men lived with a spouse while less than half (47 percent) of older women did. In contrast, older women were more likely than older men to live alone (31 percent versus 19 percent; Indicator 5: Living Arrangements).• In 2010, there were 9.2 million veterans age 65 and over in the United States. This number is expected to drop to 7.5 million by 2030, an expected decrease of about 18.5 percent (Indicator 6: Older Veterans).Economics• Among the older population, increased age is associated with higher rates of poverty (9 percent for ages 65–74 compared with 14 percent for age 85 and older). Poverty rates also vary greatly by sex and by race and ethnicity, with the lowest poverty rates seen among the non-Hispanic White alone population and men age 65 and over (Indicator 7: Poverty).• Between 1974 and 2018, there was a decrease in the proportion of older people with an income below poverty (from 15 percent to 10 percent) and with low income (from 35 percent to 20 percent), and there was an increase in the proportion of people with high income (from 18 percent to 40 percent; Indicator 8: Income).• The type of Social Security benefits received by older women changed between 1960 and 2018. The percentage receiving spouse-only benefits decreased from 33 percent to 8 percent, and the percentage on widow-only benefits fell from 23 percent to 12 percent. In contrast, the percentage who received earned worker benefits rose from 43 percent to 80 percent (Indicator 9: Social Security Beneficiaries).• Between 1989 and 2016, the median net worth, in 2016 dollars, of households headed by people age 65 and over increased by about 60 percent, from $158,225 to $253,800 (Indicator 10: Net Worth).• In 2019, labor force participation rates for women age 55 and over remained high after rising steadily for decades. Since the last recession, participation rates for women age 55 and over leveled off. Among men age 55 and over, labor participation rates increased in the mid-1990s, following declines in the rates in the previous decades. Since the recent recession, participation rates among men have been fairly flat (Indicator 11: Participation in Labor Force).• The most prevalent housing problem for older American households remains housing cost burden (expenditures on housing and utilities that exceed 30 percent of household income). In 2017, about

xvii39 percent of older owner/renter households and 32 percent of older-member households had housing cost burden problems (Indicator 12: Housing Problems).• As a share of total expenditures, health care increased dramatically with age. In 2018, for the group age 75 and over, the share (16 percent) was more than double the share for the ages 45–54 group (7 percent) and larger than the share the oldest group allocated to transportation (12 percent) or the share allocated to food (13 percent; Indicator 13: Total Expenditures).Health Status• Life expectancies at both age 65 and age 85 have increased for both sexes and for Hispanics, non-Hispanic Whites, and non-Hispanic Blacks. Overall for men, life expectancy at age 65 increased from 17.2 years to 18.1 years from 2006 to 2018, and the increase for women overall was from 19.9 years to 20.7 years. During the same period, life expectancy at age 85 increased from 5.6 years to 6.0 years for men and from 6.7 years to 7.0 years for women (Indicator 14: Life Expectancy).• Between 2000 and 2018, age-adjusted death rates among people age 65 and over declined by 20 percent. Death rates declined for heart disease, cancer, chronic lower respiratory diseases, stroke, diabetes, and influenza and pneumonia. Death rates for Alzheimer’s disease and unintentional injuries increased during the same period (Indicator 15: Mortality).• In 2018, the prevalence of certain chronic health conditions differed by sex. Women reported higher levels of asthma and arthritis than men. Men reported higher levels of heart disease, hypertension, cancer, and diabetes (Indicator 16: Chronic Health Conditions).• In 2018, about 66 percent of people age 65 and over had a dental visit in the past year. The percentage visiting a dentist was higher among people ages 65–74 than among people age 85 and over (68 percent versus 57 percent; Indicator 17: Oral Health).• In 2018, older non-Hispanic Whites were more likely to report good to excellent health than their non-Hispanic Black and Hispanic counterparts (81 percent versus 65 percent and 64 percent, respectively; Indicator 18: Respondent-Assessed Health Status).• In 2015, 7.4 percent of men and 7.5 percent of women age 65 and over not living in nursing homes had dementia (Indicator 19: Dementia).• Older women were more likely to report clinically relevant depressive symptoms than older men. In 2018, 13 percent of women age 65 and over reported clinically relevant depressive symptoms, compared with 9 percent of men (Indicator 20: Depressive Symptoms).• In 2018, 22 percent of the population age 65 and over reported having a disability as defined by having a lot of difficulty or being unable to do at least one of the following functioning domains: vision, hearing, mobility, communication, cognition, or self-care (Indicator 21: Functional Limitations).Health Risks and Behaviors• In 2018, 69 percent of people age 65 and over reported receiving a flu shot in the past 12 months; however, there were differences by race and ethnicity. About 70 percent of non-Hispanic Whites reported receiving a flu shot, compared with 60 percent of non-Hispanic Blacks and 63 percent of Hispanics (Indicator 22: Vaccinations).• The percentage of people ages 50–75 who received colorectal cancer screening increased from 2000 to 2018 (Indicator 23: Cancer Screenings).• Among older Americans age 65 and over during 2015–2016, Healthy Eating Index-2015 (HEI-2015) component scores were highest for Whole Fruits, Total Protein Foods, and Seafood and Plant Proteins. Overall diet quality, as measured by the total HEI-2015 score, was 64 out of 100 for people age 65 and over (Indicator 24: Diet Quality).• In 2018, only 14 percent of people age 65 and over participated in leisure-time physical activity that met the Physical Activity Guidelines for Americans(Indicator 25: Physical Activity).• The percentage of people age 65 and over with obesity increased from 22 percent in 1988–1994 to 30 percent in 2003–2006 to 40 percent in 2015–2018 (Indicator 26: Obesity).• The percentage of people age 65 and over who were current cigarette smokers declined between 1965 and 2018 and has been stable for the past decade. In 2018, 10 percent of men and 7 percent of women age 65 and over were current smokers (Indicator 27: Cigarette Smoking).

xviiiHealth Care• Between 1992 and 2017, the hospitalization rate decreased from 306 hospital stays per 1,000 Medicare beneficiaries to 245 per 1,000 beneficiaries (Indicator 28: Use of Health Care Services).• After adjusting for inflation, health care costs per capita increased slightly among those age 65 and over between 1992 and 2017. In all years, average costs were substantially higher for those age 85 and over compared with those in the younger age groups (Indicator 29: Health Care Expenditures).• After adjusting for inflation, average prescription drug costs for noninstitutionalized Americans age 65 and over increased between 1992 and 2017—from $1,114 to $4,499 (Indicator 30: Prescription Drug Costs).• Enrollment in Medicare Advantage (MA)/Capitated Payment Plans has grown rapidly in recent years. In 2005, 16 percent of Medicare beneficiaries age 65 and over were enrolled in an MA plan, compared with 35 percent in 2017 (Indicator 31: Sources of Health Insurance).• From 1977 to 2017, the percentage of household income that people age 65 and over allocated to out-of-pocket spending for health care services increased among those in the poor/near-poor income category from 12 percent to 19 percent (Indicator 32: Out-of-Pocket Health Care Expenditures).• Medicare paid for approximately 65 percent of all health care costs of enrollees age 65 and over in 2017. Medicare financed all hospice costs and most hospital, physician, home health care, and short-term institution costs (Indicator 33: Sources of Payment for Health Care Services).• The number of veterans age 65 and over enrolled with Veterans Health Administration has been steadily increasing since 1999, when eligibility for this benefit was reformed. The number of veterans age 85 and over enrolled is projected to exceed 1.1 million by 2038 (Indicator 34: Veterans’ Health Care).• In 2017, about 2 percent of the Medicare population age 65 and over resided in community housing with at least one service available (Indicator 35: Residential Services).• In 2017, about two-thirds of people who had difficulty with one or more activities of daily living (ADLs) received personal assistance or used special equipment: 6 percent received personal assistance only, 39 percent used equipment only, and 29 percent used both personal assistance and equipment (Indicator 36: Personal Assistance and Equipment).• In 2016, about 1.1 million people age 65 and over were residents of nursing homes. Nearly 760,000 people of that age lived in residential care communities such as assisted living facilities. In both settings, people age 85 and over were the largest age group among residents (Indicator 37: Long-Term Care Providers).Environment• The proportion of leisure time that older Americans spent socializing and communicating—such as visiting friends or attending or hosting social events—declined with age. In 2018, the percentage of leisure time spent socializing and communicating was about 11 percent for those ages 55–64 and 7 percent for those age 75 and over (Indicator 38: Use of Time).• The percentage of people age 65 and over living in counties that experienced poor air quality decreased from 69 percent in 2000 to 40 percent in 2018 (Indicator 39: Air Quality).• In 2017, about 18 percent of the noninstitutionalized Medicare population age 65 and over limited their driving to daytime because of a health or physical problem. The percentage of people who limited their driving to daytime was greater for those age 85 and over (41 percent) than for those ages 65–74 (13 percent; Indicator 40: Transportation).

Population

2INDICATOR 1: Number of Older AmericansThe growth of the population age 65 and over, predicted by researchers to swell in part because of declining death rates at older ages, affects many aspects of our society, presenting challenges to families, businesses, health care providers, and policymakers, among others, to meet the needs of aging individuals.2Population age 65 and over and age 85 and over, selected years, 1900–2018, and projected years, 2020–2060Millions02040608010065 and overProjected85 and over19001910192019301940195019601970198019902000201020202030205020602040NOTE: Some data for 2020–2060 have been revised and differ from previous editions of Older Americans.Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, 1900–1940, 1970, and 1980, U.S. Census Bureau, 1983, Table 42; 1950, U.S. Census Bureau, 1953, Table 38; 1960, U.S. Census Bureau, 1964, Table 155; 1990, U.S. Census Bureau, 1991, 1990 Summary Table File; 2000, U.S. Census Bureau, 2001, Census 2000 Summary File 1; U.S. Census Bureau, Table 1: Intercensal Estimates of the Resident Population by Sex and Age for the U.S.: April 1, 2000, to July 1, 2010 (US-EST00INT-01); U.S. Census Bureau, 2011. 2010 Census Summary File 1; U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010, to July 1, 2018 (PEPAGESEX); U.S. Census Bureau, Table 3: Projections of the Population by Sex and Selected Age Groups for the United States: 2017 to 2060 (NP2017-T3).• In 2018, 52 million people age 65 and over lived in the United States, accounting for 16 percent of the total population. • The older population grew from 3 million in 1900 to 52 million in 2018. The oldest-old population (those age 85 and over) grew from slightly more than 100,000 in 1900 to 7 million in 2018.• In 2020, around 1 in 6 Americans are age 65 and over, and this is projected to rise to 1 in 5 as soon as 2030. This not only represents a change in age composition, but a large increase in the number of older Americans, from 56 million in 2020 to 73 million in 2030.• As the Baby Boomers (those born between 1946 and 1964) age, they create dramatic shifts in America’s age composition. The first Baby Boomers turned 65 in 2011 and in the 8-year period between 2010 and 2018, the older population grew from 13 percent to 16 percent, the same number of percentage points it had grown in the 40 years prior (1970–2010). The 65 and over age group is expected to continue to increase, though this growth will likely slow starting around 2030 as the Baby Boomers age into the 85 and over age group. • The oldest-old will break with their relatively stable rise to increase from 2 percent of the population in 2020 to 5 percent by 2060.20602000201020201990198019701960195019401930192019101900

3Percentage of population age 65 and over, by county and state, 2018Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010, to July 1, 2018 (PEPAGESEX).• The proportion of the population age 65 and over varies by state and is partly affected by the state fertility and mortality levels and partly by the number of older and younger people who migrate to and from the state. In 2018, Maine and Florida had the largest proportion, with 1 out of 5 people age 65 and over, while Utah had the smallest proportion, with 1 out of 9. • The proportion of the population age 65 and over varies even more by county. In 2018, 58 percent of Sumter County, Florida, was age 65 and over, the highest proportion in the country. In fact, 5 of the 20 counties with the highest proportion of people age 65 and over were in Florida. At the other end of the spectrum was Chattahoochee County, Georgia, with only 5 percent of its population age 65 and over.• Older women outnumbered older men in the United States, and the proportion who are female increased with age. In 2018, women accounted for 56 percent of the population age 65 and over and for 64 percent of the population age 85 and over.• The United States is fairly young for a developed country, with 16 percent of its population age 65 and over in 2019. Japan had the highest percentage of persons age 65 and over (29 percent) among countries with a population of at least 1 million. The older population made up more than 15 percent of the population in most European countries and greater than 21 percent in Germany, Finland, Italy, and Greece.Data for this indicator’s charts and bullets can be found in Tables 1a through 1f on pages 72–77.

4INDICATOR 2: Racial and Ethnic CompositionAs the older population grows larger, it will also grow more diverse, reflecting the demographic changes in the U.S. population as a whole during the last several decades. By 2060, programs and services for older people will have to address the needs of a more diverse population.Population age 65 and over, by race and Hispanic origin, 2018 and projected 2060Non-Hispanic WhitealoneNon-Hispanic BlackaloneNon-Hispanic AsianaloneNon-Hispanic all other racesalone or in combinationHispanic orLatino (any race)Percent2060 (projected)201877559135882113020406080100NOTE: The term “non-Hispanic White alone” is used to refer to people who reported being White and no other race and who are not Hispanic. The term “non-Hispanic Black alone” is used to refer to people who reported being Black or African American and no other race and who are not Hispanic, and the term “non-Hispanic Asian alone” is used to refer to people who reported only Asian as their race and who are not Hispanic. The use of single-race populations in this chart does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches. The race group “non-Hispanic all other races alone or in combination” includes people who reported American Indian or Alaska Native alone who are not Hispanic; people who reported Native Hawaiian or Other Pacific Islander alone who are not Hispanic; and all people who reported two or more races who are not Hispanic. “Hispanic” refers to an ethnic category; Hispanics may be of any race.Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, Annual Estimates of the Resident Population by Sex, Age, Race, and Hispanic Origin for the United States and States: April 1, 2010, to July 1, 2018 (PEPASR6H); U.S. Census Bureau, Table 1. Projected Population by Single Year of Age, Sex, Race, and Hispanic Origin for the United States: 2017 to 2060 (NP2017_D1).• The older population is projected to become increasingly diverse, reflecting the demographic changes in the U.S. population as a whole during the last several decades. In 2018, 77 percent of the population was non-Hispanic White alone, 9 percent non-Hispanic Black alone, 5 percent non-Hispanic Asian alone, and 8 percent Hispanic (of any race). By 2060, it is projected that this will change to 55 percent non-Hispanic White alone, 13 percent non-Hispanic Black alone, 8 percent non-Hispanic Asian alone, and 21 percent Hispanic (of any race). • Although the older population is projected to increase among all racial and ethnic groups, the older Hispanic population is projected to grow the fastest. This difference in relative growth has implications for the larger racial and ethnic composition of the older population. For example, in 2018, the older Hispanic population was slightly smaller than the older non-Hispanic Black alone population (4.4 million versus 4.8 million, respectively). However, by 2060, it is projected to be larger—19.9 million compared to 12.1 million. • Although the number of older residents who identify as non-Hispanic, all other races alone or in combination, is projected to increase to 2.6 million in 2060, this represents a small proportion (3 percent) of the older population. Data for this indicator’s charts and bullets can be found in Table 2 on page 78.

5INDICATOR 3: Marital StatusMarital status can strongly affect one’s emotional and economic well-being. Among other factors, it influences living arrangements and the availability of caregivers for older Americans with an illness or disability.Marital status of the population age 65 and over, by sex and age group, 201875–8485 and over65–74100Percent806040200Men7441410761435737255Never marriedDivorcedWidowedMarriedWomen100Percent806040200755918141841415716Never marriedDivorcedWidowedMarried70NOTE: Married includes separated. Reference population: These data refer to the resident population. Totals may not sum to 100 percent because of rounding.SOURCE: U.S. Census Bureau, American Community Survey.• At older ages, the older population is less likely to be married and more likely to be widowed. In 2018, about 6 out of 10 people ages 65–74 were married compared with only 3 out of 10 people age 85 and over. Conversely, only about 1 out of 10 people ages 65–74 are widowed, compared with almost 6 out of 10 age 85 and over. • Marital status in older age varied greatly by sex. In general, older men were more likely than women to be married (71 percent versus 46 percent) and less likely to be widowed (11 percent versus 32 percent). This sex difference is more dramatic among the oldest old (age 85 and over), where a full 70 percent of women—twice the 35 percent of men—were widowed. Among men age 85 and over, a majority are married compared with just 16 percent of women in that age group. • Relatively small proportions of older men (12 percent) and women (16 percent) reported their marital status as divorced in 2018. An even smaller proportion (6 percent) of both sexes had never married.All comparisons presented for this indicator are significant at the 0.10 confidence level. Data for this indicator’s charts and bullets can be found in Table 3 on page 78.

6INDICATOR 4: Educational AttainmentEducational attainment has effects throughout the life course and plays an important role in well-being at older ages. Higher levels of education are usually associated with higher incomes, higher standards of living, and above-average health and life expectancy.3,4,5Educational attainment of the population age 65 and over, selected years, 1965–2018Percent020406080100196519701975198019851990199520002005201820152010High school graduate or moreBachelor’s degree or moreNOTE: A single question that asks for the highest grade or degree completed is used to determine educational attainment. Prior to 1995, educational attainment was measured using data on years of school completed. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.• In 2018, 86 percent of the older population were high school graduates or more, and 29 percent had a bachelor’s degree or more.• In 1965, 24 percent of the older population had graduated from high school, and only 5 percent had at least a bachelor’s degree. • In 2018, 86 percent of older men and 85 percent of older women had at least a high school diploma. Older men had attained at least a bachelor’s degree more often than older women (33 percent versus 24 percent, respectively).20202000201019901980197019601950

7Educational attainment of the population age 65 and over, by race and Hispanic origin, 2018TotalNon-Hispanic WhitealoneBlack aloneAsian aloneHispanic(of any race)PercentHigh school graduate or moreBachelor’s degree or more85289031761774385412020406080100NOTE: The term “non-Hispanic White alone” is used to refer to people who reported being White and no other race and who are not Hispanic. The term “Black alone” is used to refer to people who reported being Black or African American and no other race, and the term “Asian alone” is used to refer to people who reported only Asian as their race. The use of single-race populations in this chart does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches. Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, American Community Survey. • In 2018, 90 percent of the older non-Hispanic White alone population completed high school, and 31 percent received a bachelor’s degree or more. • Among older Americans, Hispanics (of any race) had the lowest levels of formal education: 54 percent completed high school, and 12 percent received a bachelor’s degree or more. • Although a slightly higher proportion of older Black alone Americans than Asian alone Americans completed high school (76 percent and 74 percent, respectively), this relationship switched for higher education. Although 17 percent of the older Black alone population received at least a bachelor’s degree, more than twice that proportion, 38 percent, of Asian alone did. In fact, the older Asian alone population had the highest proportion to earn at least a bachelor’s degree, about 7 percentage points higher than non-Hispanic White alone. All comparisons presented for this indicator are significant at the 0.10 confidence level. Data for this indicator’s charts and bullets can be found in Tables 4a and 4b on page 79.

8INDICATOR 5: Living ArrangementsThe living arrangements of America’s older population are linked to income, health status, and the availability of caregivers. Living alone, for example, often leads to conditions of social isolation and loneliness, which, in turn, are linked to higher risks for a variety of physical and mental conditions: high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease, and even death.6Living arrangements of the population age 65 and over, by sex and race and Hispanic origin, 2018TotalNon-HispanicWhite aloneBlackaloneAsianaloneHispanic(of anyrace)MenWomenTotalNon-HispanicWhite aloneBlackaloneAsianaloneHispanic(of anyrace)1947673194669265514501541663281376122Percent020406080100Percent020406080100Family household, no spouseMarried couple householdNonfamily household, no spouseLiving alone Living in groupquarters3115473333114933353128431619602322284523NOTE: The term “non-Hispanic White alone” is used to refer to people who reported being White and no other race and who are not Hispanic. The term “Black alone” is used to refer to people who reported being Black or African American and no other race, and the term “Asian alone” is used to refer to people who reported only Asian as their race. The use of single-race populations in this chart does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches. Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, American Community Survey.• In 2018, older men were more likely to live with a spouse than were older women. About 67 percent of older men lived with a spouse, while less than half (47 percent) of older women did. In contrast, older women were more likely than older men to live alone (31 percent versus 19 percent).• Regarding other types of living arrangements, older women (15 percent) were twice as likely to live in other family households (families whose householder was living with children or other relatives but no spouse present) compared with older men (7 percent). • Living arrangements of older people differed by race and Hispanic origin, but at least 50 percent of older men of all race and Hispanic groups lived with a spouse. Among older women, the proportion living with a spouse was almost 50 percent or more among non-Hispanic White (49 percent) and Asian (60 percent) women. • Older non-Hispanic White women and Black women were more likely than women of other races to live alone. In 2018, 33 percent of non-Hispanic White and 35 percent of Black women lived alone, compared with about 16 percent for older Asian women and 22 percent for older Hispanic women. • The percentage of older Black men living alone was about three times as high as the percentage of older Asian men (26 percent versus 8 percent). The percentage of older Black men living alone was also higher than that of older non-Hispanic White men (19 percent).All comparisons presented for this indicator are significant at the 0.10 confidence level. Data for this indicator’s charts and bullets can be found in Tables 5a and 5b on page 80.

9INDICATOR 6: Older VeteransAs a group, Veterans are older than the U.S. population.7 Compared with America’s older population, older Veterans tend to have higher median family income, lower percentages of individuals who are uninsured or covered by Medicaid, higher percentages of functional limitations in activities of daily living or instrumental activities of daily living, greater likelihood of having any disability, and less likelihood of rating their general health status as good or better.8 The oldest segment of the veteran population will continue to have significant ramifications with regard to the demand for health care services, particularly in the area of long-term care.8 Those with chronic conditions (e.g., diabetes, high blood pressure) or disabilities are more likely to need comprehensive care and long-term support services to address their challenges.7Percentage of population age 65 and over who are veterans, by sex and age group, 2010, 2018, and projected 2020 and 2030100Percent806040200Men125138342143322714614140256871624065 and over65−7475−8485 and overWomen100Percent80604020065 and over65−7475−8485 and over11121112111131122020 (projected)201820102030 (projected)Reference population: These data refer to the resident population of the United States and Puerto Rico.SOURCE: U.S. Census Bureau, Population Projections 2020, and 2017 Census Summary File 1; Department of Veterans Affairs, VetPop2016.• In 2018, 38 percent of men and 1 percent of women age 65 and over in the United States and Puerto Rico were veterans. In addition, 32 percent of men ages 65–74, 41 percent of men ages 75–84, and 71 percent of men age 85 and over were veterans. Women who were veterans tend to be 1 percent in the other age groups.• Approximately two out of every five men age 65 and over were veterans (8.9 million) in 2018. This percentage is projected to decrease to one out of every five men age 65 and over in 2030 (6.8 million).• By 2030, the proportion of women age 65 and over who are veterans will have increased from 1 percent (303,000) in 2010 and 1 percent (344,000) in 2018 to 2 percent (635,000). The number of women veterans age 65 and over will increase from 20 percent (389,000) of the woman veteran population in 2020 to 30 percent (635,000) in 2030.• By 2030, the proportion of men age 85 and over who are veterans will have increased from 68 percent in 2010 and 71 percent in 2018 to 40 percent.Data for this indicator’s charts and bullets can be found in Tables 6a and 6b on page 81.

10

Economics

12INDICATOR 7: PovertyPoverty rates are one way to evaluate economic well-being. People identified as living in poverty are at risk of having inadequate resources for food, housing, health care, and other needs.Poverty rate by age, by official poverty measure and Supplemental Poverty Measure (SPM), 1966–2018200920132011201520180510152065 and overRedesignUpdated65 and overSPM65 and over SPMRedesignUpdatedPercent020406080100196619701975198019851990199520002005201865 and over Under 1818–6420152010NOTE: Poverty status in the Current Population Survey (CPS) is based on prior year income. The 2014 CPS Annual Social and Economic Supplement (ASEC) included redesigned questions for income that were implemented to a subsample of the 98,000 addresses using a probability split panel design. The source for “2013 (traditional)” in this table is the portion of the sample (68,000) that received a set of income questions similar to those used in 2013; the source for “2013 (redesign)” is the portion of the 2014 CPS ASEC sample (30,000) that received the redesigned income questions. The redesigned income questions were used for the entire 2015 CPS ASEC sample. A new processing system was implemented starting in 2017. The “2017 (legacy)” data reflect estimates using the previous system. “2017 (updated)” reflect estimates using the new processing system. The official poverty level is based on money income and does not include noncash benefits such as food stamps. Poverty thresholds reflect family size and composition and are adjusted each year using the annual average Consumer Price Index. The Supplemental Poverty Measure extends the official poverty measure by taking account of many of the government programs designed to assist low-income families and individuals who are not included in the current official poverty measure and by using thresholds derived from the Consumer Expenditure Survey by the Bureau of Labor Statistics. For more detail, see U.S. Census Bureau Series P-60, No. 252. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.• In 2018, the poverty rate for the population age 65 and over was 9.7 percent.• Since 2000, the poverty rate among people age 65 and over has stayed relatively stable at around 9 percent or 10 percent—much lower than the almost 30 percent it reached in the 1960s. • Among the older population, older age is associated with higher rates of poverty (9 percent for ages 65–74 compared with 14 percent for age 85 and over). However, in the general population, children have had higher poverty rates than the working-age population for at least ten years. Children’s higher poverty rates are less pronounced when the Supplemental Poverty Measure, which takes into account noncash government benefits, is used. • Among the population age 65 and over, poverty rates varied greatly by race and ethnicity as well as sex. For example, the older non-Hispanic White alone population had the lowest poverty rate (7 percent), followed by Asian alone (12 percent), and trailed by Hispanic and Black alone (19 percent and 20 percent, not statistically distinct).• In general, older women experienced higher poverty rates than older men (11 percent versus 8 percent).• Non-Hispanic White alone men had a poverty rate of 6 percent, while Hispanic women had a rate of 22 percent.All comparisons presented for this indicator are significant at the 0.10 confidence level. Data for this indicator’s charts and bullets can be found in Tables 7a and 7b on pages 82–84. 20202000201019901980197019601950

13INDICATOR 8: IncomeThe percentage of people living below the poverty line does not give a complete picture of the economic situation of older Americans. Examining the income distribution of the population age 65 and over and their median income provides additional insights into their economic well-being.Income distribution of the population age 65 and over, 1974–20181974198019851990199520002005201820102015Percent020406080100High incomeMiddle incomeRedesignUpdatedLow incomePovertyNOTE: Income distribution in the Current Population Survey (CPS) is based on prior year income. The 2014 CPS Annual Social and Economic Supplement (ASEC) included redesigned questions for income that were implemented to a subsample of the 98,000 addresses using a probability split panel design. The source for “2013 (traditional)” in this table is the portion of the sample (68,000 addresses) that received a set of income questions similar to those used in 2013; the source for “2013 (redesign)” is the portion of the 2014 CPS ASEC sample (30,000 addresses) that received the redesigned income questions. The redesigned income questions were used for the entire 2015 CPS ASEC sample. A new processing system was implemented starting in 2017. The income categories are derived from the ratio of the family’s income (or an unrelated individual’s income) to the corresponding official poverty threshold. Being in poverty is measured as income less than 100 percent of the poverty threshold. Low income is between 100 percent and 199 percent of the poverty threshold. Middle income is between 200 percent and 399 percent of the poverty threshold. High income is 400 percent or more of the poverty threshold. Some data have been revised and differ from previous versions of Older Americans. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.• In 2018, 10 percent of the older population age 65 and over lived in poverty, and 20 percent of the older population was in the low-income group. People in the high-income group made up the largest single share of older people by income category (40 percent) in 2018.• The percentage of the population age 65 and over living in poverty and in the low-income group decreased 5 percentage points and 15 percentage points, respectively, between 1974 and 2018. The percentage of the older population in the middle-income group decreased from 33 percent in 1974 to 30 percent in 2018. The percentage with a high income increased 22 percentage points between 1974 and 2018.All comparisons presented for this indicator are significant at the 0.10 confidence level. Data for this indicator’s charts and bullets can be found in Tables 8a and 8b on pages 84–87. 20202000201019901980197019601950

14INDICATOR 9: Social Security BeneficiariesSocial Security benefits provide a baseline for retirement income for the majority of older Americans and is one of the most important income sources for the aged. Social Security provides retired worker benefits to workers with full insurance from work covered by Social Security over a lifetime. Full insurance of the aged usually requires a minimum of 10 years of covered earnings. Beneficiaries become entitled to payments once their application for benefits is approved.Percentage distribution of people who began receiving Social Security benefits in 2018, by age and sexPercentWomenMen6263646566Disabled WorkerConversionsa70 and over67–696628326767111119141817544633Pre-Full Retirement AgeFull Retirement AgePost-Full Retirement Age01020304050a At Full Retirement Age (FRA), persons formerly receiving disabled worker benefits are reclassified and begin receiving retired worker benefits.NOTE: FRA is defined as age 66 for those born between 1943 and 1955. The percentages are not probabilities of a birth cohort claiming at a particular age. A person begins receiving Social Security benefits the month after he or she becomes entitled. Totals may not sum to 100 percent because of rounding.Reference population: Persons fully insured for Social Security retired worker benefits who became entitled to benefits in 2018.SOURCE: Social Security Administration, Master Beneficiary Record.• In 2018, the majority (54 percent) of new Social Security retired worker beneficiaries became entitled to benefits prior to Full Retirement Age (FRA) at age 66 and, thus, started receiving reduced monthly Social Security benefits. Few received a greater amount of benefits by waiting to claim benefits until after reaching FRA. Persons begin receiving benefits the month after entitlement.• Of new Social Security retired worker beneficiaries in 2018, 28 percent of men and 32 percent of women became entitled at age 62, and about one-quarter of men and women became entitled at ages 63–65. In contrast, 19 percent of men and 14 percent of women became entitled at FRA, and few (12 percent of both men and women) became entitled post-FRA.• Of new Social Security retired worker beneficiaries in 2018, 18 percent of men and 17 percent of women converted from receiving disabled worker benefits to receiving retired worker benefits at FRA.

15Percentage distribution of female Social Security beneficiaries age 62 and over, by type of benefit received, selected years 1960–2018020406080100Percent1960233933223197027422251975264220710419802541186198525391612919902437151310199524361414122000223813161220051941111612201017461016122015145281411201613538141120171354814112018125581411Spouse onlyWidow onlybWorker onlyDually entitled spouseDually entitled widowWorker benefitsaSpouse or widowbenefit onlya Worker benefits include retired and disabled worker benefits.b Widow-only beneficiaries include disabled workers and mothers of surviving children under age 19.NOTE: All data for 2005 and dual-entitlement data for 1995 and 2000 are based on a 10 percent sample of administrative records. All other estimates are based on 100 percent of available data. Benefits exclude special age-72 beneficiaries and disabled adult children and include disabled workers. Totals may not sum to 100 percent because of rounding.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Social Security Administration, Master Beneficiary Record.• In 2018, 80 percent of women beneficiaries age 62 and over received earned worker benefits. The remaining portion of women (20 percent) received benefits only as the spouse or surviving widow of an entitled worker. In 2018, about 8 percent of women received spouse-only benefits, and 12 percent received widow-only benefits.• The type of benefits received by women age 62 and over dramatically changed between 1960 and 2018. The percentage of female Social Security beneficiaries who received spouse-only benefits decreased from 33 percent to 8 percent, and the percentage receiving widow-only benefits decreased from 23 percent to 12 percent. In contrast, the percentage of female Social Security beneficiaries who received earned worker benefits increased from 43 percent in 1960 to 80 percent in 2018.• Women entitled to their own earned worker benefits and to higher auxiliary benefits, such as spouse or widow benefits, are considered dually entitled. Of female Social Security beneficiaries age 62 and over in 2018, about 55 percent received only earned worker benefits, 11 percent received both earned worker and spouse benefits, and 14 percent received both earned worker and widow benefits.Data for this indicator’s charts and bullets can be found in Tables 9a and 9b on page 88. 20202000201019901980197019601950

16INDICATOR 10: Net WorthNet worth (the value of real estate, stocks, bonds, retirement investment accounts, and other assets minus debts) is an important indicator of economic security and well-being. Greater net worth allows a family to maintain its standard of living when income falls because of job loss, health problems, or family changes such as divorce.Median household net worth, in 2016 dollars, by race and educational attainment of head of household age 65 and over, selected years, 1989–2016Dollars (in thousands)0$700WhiteSome college or moreHigh school diploma onlyNonwhite or HispanicNo high school diploma2016Total198919921995199820012004200720102013100200300400500600NOTE: Median net worth is measured in constant 2016 dollars. Net worth includes assets held in investment retirement accounts such as individual retirement accounts, Keoghs, and 401(k)-type plans. All observations are weighted for analysis. The term “household” in this indicator is from the codebook of the 2016 Survey of Consumer Finances (https://www.federalreserve.gov/data.htm). The data are for the “primary economic unit” (PEU), which consists of an economically dominant single individual or couple (married or living partners) in a household and all other members of the household who are financially interdependent with the individual or couple. In the majority of cases, the PEU and household are identical. Some estimates have been revised and may differ from previous editions of Older Americans. Please note that the format of this indicator has changed from the previous edition. Changes to the indicator are to improve clarity and show trends over time.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Survey of Consumer Finances.• In 2016, the median net worth, in 2016 dollars (including the value of retirement investment accounts), of households headed by people age 65 and over was $253,800.• Between 1989 and 2016, the median net worth, in 2016 dollars, of households headed by people age 65 and over increased by about 60 percent, from $158,225 to $253,800. The rate of change was quite variable during this time period. The largest increase was between 1995 and 1998. In addition, there was a decrease between 2001 and 2004 and between 2007 and 2013.• Between 1989 and 2016, the median net worth of households headed by White people age 65 and over increased by nearly 75 percent, from $185,280 to $320,920. The median net worth of households headed by nonwhite or Hispanic people age 65 and over almost doubled during the same period, increasing from $56,853 to $102,000.• In 1989, the median net worth of households headed by White people age 65 and over was more than three times that of households headed by nonwhite or Hispanic people age 65 and over. In 2016, the median net worth of households headed by older White people was about three times that of households headed by older nonwhite or Hispanic people.• Between 1989 and 2016, the median net worth of people age 65 and over either without a high school diploma or with some college had similar decreases (2 percent and 1 percent, respectively). In 2016, households headed by persons age 65 and over who attended college had a median net worth about five and a half times greater than persons without a high school diploma.20202000201019901980197019601950

17Amount of funds held in retirement assets, by sector and type of plan, 1975–2018510152025$30Dollars (in trillions)019751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320182014201520162017Individual retirementaccountPrivate definedcontribution planPublic definedcontribution planPrivate definedbenefit planaPublic definedbenefit planaa Public and private defined benefit retirement assets do not include claims of pension funds on sponsor.NOTE: Some estimates have been revised and may differ from previous editions of Older Americans.Reference population: Public and private retirement assets for total population.SOURCE: Federal Reserve Board Z.1 Statistical Release for Dec. 12, 2019.• Retirement savings held in public and private pension plans or individual retirement accounts (IRAs) play a large role in the net worth of older Americans. In 2018, IRAs held about $8.7 trillion in assets, public and private defined contribution plans held about $7.2 trillion in assets, and public and private defined benefit plans held about $8.9 trillion in assets.• Between 1975 and 2018, an increasing proportion of retirement assets shifted from traditional defined benefit plans to individual account-based retirement vehicles such as defined contribution plans and IRAs.• Although defined contribution plans are more commonly provided in the private sector, defined benefit plans have been largely dominant in the public sector.Data for this indicator’s charts and bullets can be found in Tables 10a through 10c on pages 89–91. 20202000201019901980197019601950

18INDICATOR 11: Participation in Labor ForceThe labor force participation rate is the percentage of a population that is in the labor force—that is, either working (employed) or actively looking for work (unemployed). Some older Americans work out of economic necessity. Others may be driven back into the job market or stay employed because of the social contact, intellectual challenges, or sense of value that work often provides.Labor force participation rates (annual averages) of men age 55 and over, by age group, 1963–2019Percent0204060801001963197019751980198519901995200020052015201955–6162–6465–6970 and over2010NOTE: Data for 1994 and later years are not strictly comparable with data for 1993 and earlier years because of a redesign of the survey and methodology of the Current Population Survey.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Bureau of Labor Statistics, Current Population Survey.• In 2019, the labor force participation rate for men ages 55–61 was 77 percent, far below the rate in 1963 (90 percent). The participation rate for men ages 62–64 declined from 76 percent in 1963 to a low of 45 percent in 1995. By 2019, the participation rate for men ages 62–64 had increased to 58 percent.• Men ages 65–69 also experienced a gradual rise in labor force participation following a period of decline in the late 1960s and 1970s. The labor force participation rate for men ages 65–69 declined from a high of 43 percent in 1967 to 24 percent in 1985. Their participation rate from the mid-1980s to the early 1990s remained in the range of 24 percent to 26 percent. In the mid-1990s, the labor force participation rate for men in this age group began to increase and reached 39 percent in 2019. • From 1963 to 2019, the participation rate for men age 70 and over showed a somewhat similar pattern as men ages 65–69. In 1993, the labor force participation rate for men age 70 and over reached a low of 10 percent after declining from 21 percent in 1963. Since the mid-1990s, the participation rate for men ages 70 and over has trended higher and reached 17 percent in 2019. 20202000201019901980197019601950

19The labor force participation rate for older women reflects changes in the work experience of successive generations of women. Many women now in their 60s and 70s did not work outside the home when they were younger, or they moved in and out of the labor force. As new cohorts of women Baby Boomers approach older ages, they are participating in the labor force at higher rates than in previous generations.Labor force participation rates (annual averages) of women age 55 and over, by age group, annual averages, 1963–2019Percent0204060801001963197019751980198519901995200020052019201555–6162–6465–6970 and over2010NOTE: Data for 1994 and later years are not strictly comparable with data for 1993 and earlier years because of a redesign of the survey and methodology of the Current Population Survey.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Bureau of Labor Statistics, Current Population Survey. • In 2019, 65 percent of women ages 55–61 were in the labor force compared with 44 percent in 1963. During the same period, the labor force participation rate for women ages 62–64 increased from 29 percent to 47 percent, and the rate for women ages 65–69 increased from 17 percent to 30 percent.• Among women age 55 and over, the labor force participation rate has been fairly stable since about 2010 after rising steadily in the prior four decades. During that rise, the increase has been largest among women ages 55–61, with participation rates rising from 44 percent in 1963 to 66 percent in 2010, but the rates have leveled off in recent years. For women ages 62–64, 65–69, and 70 and over, labor force participation rates continue to increase.• The difference between labor force participation rates for men and women has narrowed over time. Among those ages 55–61, for example, the gap between men’s and women’s rates in 2019 was 12 percentage points, compared with 46 percentage points in 1963.Data for this indicator’s charts and bullets can be found in Table 11 on pages 92–93.20202000201019901980197019601950

20INDICATOR 12: Housing ProblemsMost older Americans live in adequate, affordable housing. Some, however, live in costly, physically inadequate, and/or crowded housing, which can pose serious problems for an older person’s physical or psychological well-being. Housing cost burden has remained the most prevalent housing problem for all older American households over the years. The prevalence of housing cost burden is examined for two different groups of older American households compared with all other U.S. households. Percentage of older American households and all other U.S. households that report housing cost burden, selected years 1985–2017 Percent020406080100All older-member households (not householder or spouse)All older owner/renter householdsAll other households19851989199519971999200120032005201120132015201720072009NOTE: Housing cost burden refers to expenditures on housing and utilities that exceed 30 percent of household income. All older-owner/ renter households are households with a householder or spouse age 65 and over; all older-member households are households with a member age 65 and over who is not the householder or spouse; and all other households are households without one or more persons age 65 and over. Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes are excluded.SOURCE: U.S. Department of Housing and Urban Development, American Housing Survey. • The most prevalent housing problem for older American households remains housing cost burden (expenditures on housing and utilities that exceed 30 percent of household income). In 2017, approximately 39 percent of older-owner/renter households (households with a householder or spouse age 65 and over) and 32 percent of older-member households (households with a member age 65 and over who is not the householder or spouse) had housing cost burden problems. • Housing cost burden has generally increased over time. Between 2013 and 2017, the prevalence of housing cost burden increased from 36 percent to 39 percent for older- owner/renter households, and there was no significant difference in the prevalence for older-member households. In comparison, the prevalence of housing cost burden for all other U.S. households (households without one or more persons age 65 and over) decreased from 34 percent to 32 percent during the same time period.20202000201019901980197019601950

21Housing cost burden is also the most dominant housing problem for intergenerational households, or households that have both older people (age 65 and over) and children (age 19 or younger) living in the household. Older owner/renter and older-member intergenerational households are likely to represent households in which grandparents are helping raise their grandchildren or in which three generations are living within the same household. Percentage of older American households and intergenerational households that report housing cost burden, selected years 1985–2017Older owner/renter households with childrenOlder-member householdswith childrenPercent19851989199519971999200120032005201120132015201720072009020406080100All older-member householdsAll older owner/renter householdsNOTE: Housing cost burden refers to expenditures on housing and utilities that exceed 30 percent of household income. All older owner/ renter households are households with a householder or spouse age 65 and over; all older-member households are households with a member age 65 and over who is not the householder or spouse; older owner/renter households with children are households with a householder or spouse age 65 and over and children (age 19 or younger); and older-member households with children are households with a member age 65 and over and children (age 19 or younger).Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes are excluded.SOURCE: U.S. Department of Housing and Urban Development, American Housing Survey.• In 2017, approximately 38 percent of older owner/renter intergenerational households had housing cost burden compared with 39 percent for all older owner/renter households. Approximately 35 percent of older-member intergenerational households had housing cost burden compared with 32 percent for all older-member households for the same time period. • Although housing cost burden has typically increased over time, there was no significant difference in the prevalence of housing cost burden for older American intergenerational households between 2013 and 2017.• From 2013 to 2017, the prevalence of housing cost burden remained at approximately 38 percent among older-renter/owner intergenerational households and approximately 36 percent among older-member intergenerational households.Data for this indicator’s charts and bullets can be found in Tables 12a through 12f on pages 94–96.20202000201019901980197019601950

22INDICATOR 13: Total ExpendituresHousehold expenditures are another indicator of economic well-being, showing how the older population allocates resources to food, housing, health care, and other needs. Expenditures may vary with changes in work status, health status, or income.Percentage distribution of total household annual expenditures, by expenditure category and age group of reference person, 2018Percent65–7475 and over65 and over55–6445–54020406080100Personal insurance and pensionsHealth careTransportationHousingFoodOther1571531131913916321219713143313197121632132071612361317NOTE: Other expenditures include apparel, personal care, entertainment, reading, education, alcohol, tobacco, cash contributions, and miscellaneous expenditures. Data from the Consumer Expenditure Survey by age group represent average annual expenditures for consumer units by the age of the reference person, that is, the person listed as the owner or renter of the home. For example, the data on people age 65 and over reflect consumer units with a reference person age 65 and over. The Consumer Expenditure Survey collects and publishes information from consumer units, which are generally defined as a person or group of people who live in the same household and are related by blood, marriage, or other legal arrangement (i.e., a family) or people who live in the same household who are unrelated but make financial decisions together. A household usually refers to a physical dwelling and may contain more than one consumer unit (e.g., roommates who are sharing an apartment but who are financially independent from each other). However, for convenience, the term “household” is substituted for the term “consumer unit” in this text.Reference population: These data refer to the resident noninstitutionalized population.SOURCE: Bureau of Labor Statistics, Consumer Expenditure Survey.• Housing accounted for the largest share (nearly one-third or more on average) of total expenditures for all groups of households with a reference person (i.e., a selected household owner or renter) age 45 and over. In 2018, the share was 36 percent for households with a reference person age 75 and over.• As a share of total expenditures, health care expenditures increased with age. For the group age 75 and over, the share (16 percent) was more than twice as high as it was for the group ages 45–54 (7 percent); in addition, the share that those age 75 and over allocated to health care was higher than this group allocated to food (13 percent) or transportation (12 percent). In contrast, for all three younger groups depicted (ages 45–54, 55–64, and 65–74), the health care share was smaller than either the food or transportation share.• Among the age groups studied, the share of total expenditures allocated to food at home was higher than the share allocated to food away from home. However, for the oldest group (age 75 and over), the food at home share (8 percent) was nearly double the food away from home share (5 percent).Data for this indicator’s charts and bullets can be found in Table 13 on page 97.

Health Status

24INDICATOR 14: Life ExpectancyLife expectancy is a summary measure of the overall health of a population. It represents the average number of years of life remaining to a person at a given age if death rates remain constant. Improvements in health have resulted in increased life expectancy. However, there are differences in life expectancy by socioeconomic status, and these differences have been increasing over time.9 Life expectancy in the United States is lower than in many other industrialized countries.10 Life expectancy at ages 65 and 85, by race and Hispanic origin and sex, 2006–20182007200820092010201120122013201420152016201720062018Years of life0510152025Non-Hispanic White men, at age 65Non-Hispanic White women, at age 65Non-Hispanic White men, at age 85Non-Hispanic Black men, at age 65Non-Hispanic Black women, at age 65Non-Hispanic Black women, at age 85Hispanic women, at age 65Hispanic men, at age 65Non-Hispanic White women, at age 85Hispanic women, at age 85Hispanic men, at age 85Non-Hispanic Black men, at age 85NOTE: Starting with 2018 data, race-specific estimates are tabulated according to the 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity and are not completely comparable with estimates for earlier years. Persons of Hispanic origin may be of any race.Reference population: These data refer to the resident population.SOURCE: National Center for Health Statistics, National Vital Statistics System.• Under current mortality conditions, people who survive to age 65 can expect to live an average of 19.5 more years overall, 18.1 years for men and 20.7 years for women. In 2018, the life expectancy of people who survive to age 85 was 7.0 years for women and 6.0 years for men.• Older Americans are living longer. Life expectancies at both age 65 and age 85 have increased for both sexes and for Hispanics, non-Hispanic Whites, and non-Hispanic Blacks. Overall for men, life expectancy at age 65 increased from 17.2 years to 18.1 years from 2006 to 2018, while the increase for women overall was from 19.9 years to 20.7 years. During the same period, life expectancy at age 85 increased from 5.6 years to 6.0 years for men and from 6.7 years to 7.0 years for women.• In 2018, life expectancy at age 65 was higher among Hispanics than among non-Hispanic Whites and non-Hispanic Blacks for both men and women (19.7, 18.1, and 16.1 years, respectively, for men and 22.7, 20.6, and 19.5 years, respectively, for women). Life expectancy at age 85 was highest among Hispanics (6.7 years for men and 8.0 years for women), but non-Hispanic Blacks had higher life expectancy than non-Hispanic Whites (6.1 years versus 5.9 years for men and 7.3 years versus 6.9 years for women). Data for this indicator’s charts and bullets can be found in Table 14 on page 98.20202000201019901980197019601950

25INDICATOR 15: MortalityOverall, death rates for the population age 65 and over have declined in recent decades. However, for some causes of death, rates among older Americans have increased in recent years. There are differences in death rates by sex and race and Hispanic origin for many causes of death.11Death rates among people age 65 and over, by selected leading causes of death, 2000–2018Alzheimer’s diseaseChronic lower respiratory diseasesDiabetesUnintentional injuriesPer 100,0001,8002000200120022003200420052006200720082009201020112014201520162017201802004006008001,0001,2001,4001,600Heart diseaseCancerStrokeInfluenza and pneumonia20122013NOTE: Rates are age adjusted using the 2000 U.S. standard population.Reference population: These data refer to the resident population.SOURCE: National Center for Health Statistics, National Vital Statistics System.• In 2018, the leading cause of death among people age 65 and over was heart disease (1,035 deaths per 100,000 U.S. standard population), followed by cancer (849), chronic lower respiratory diseases (270), stroke (252), Alzheimer’s disease (239), diabetes (118), unintentional injuries (112), and influenza and pneumonia (96).• Between 2000 and 2018, the age-adjusted death rate for people age 65 and over declined by 20 percent. Death rates declined for heart disease, cancer, chronic lower respiratory diseases, stroke, diabetes, and influenza and pneumonia. Death rates for Alzheimer’s disease and unintentional injuries increased during the same period.• Heart disease and cancer were the top two leading causes of death in 2018 among all people age 65 and over. They were also the top two leading causes of death for both men and women with men having higher rates of both causes (1,273 per 100,000 U.S. standard population compared with 856 for heart disease and 1,052 versus 702 for cancer). • Other causes of death also varied among older Americans by sex. For example, in 2018, women had higher age-adjusted death rates from Alzheimer’s disease than men (268 per 100,000 U.S. standard population compared with 192), while men had higher age-adjusted rates of death from unintentional injuries (141 per 100,000 U.S. standard population compared with 90). Data for this indicator’s charts and bullets can be found in Tables 15a and 15b on pages 99–100.20202000201019901980197019601950

26INDICATOR 16: Chronic Health ConditionsThe risk of chronic diseases increases with age.12 Chronic conditions usually require ongoing medical care and are major contributors to health care costs.13 The majority of older adults have multiple chronic conditions, which contribute to frailty and disability.14 Many of the negative effects of chronic conditions are caused by health risk behaviors that can be changed.13 The six leading causes of death among older Americans in 2018 were chronic diseases (see Indicator 15: Mortality).Percentage of people age 65 and over who reported having selected chronic health conditions, by sex, 2018PercentWomenMen020406080100Heart diseaseHypertensionStrokeAsthmaChronic obstructivepulmonary disease(COPD)CancerDiabetesArthritis352458561089141314272525194654NOTE: Chronic obstructive pulmonary disease (COPD) is defined as responding yes to questions on ever having emphysema, COPD, or having chronic bronchitis in the past 12 months. This definition has changed from previous editions of Older Americans.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.• In 2018, the prevalence of certain chronic health conditions differed by sex. Women reported higher levels of asthma and arthritis than men (14 percent and 54 percent versus 9 percent and 46 percent, respectively). Men reported higher levels of heart disease (35 percent), hypertension (58 percent), cancer (27 percent), and diabetes (25 percent) than women (24 percent, 56 percent, 25 percent, and 19 percent, respectively).• There were differences by race and ethnicity in the prevalence of certain chronic health conditions. In 2018, among people age 65 and over, non-Hispanic Blacks reported higher levels of hypertension and diabetes than non-Hispanic Whites (68 percent versus 55 percent for hypertension, and 34 percent versus 18 percent for diabetes). Hispanics also reported higher levels of diabetes (33 percent) than non-Hispanic Whites, but lower levels of arthritis than non-Hispanic Whites (44 percent versus 52 percent).• The prevalence of some chronic health conditions among people age 65 and over has increased over time. The percentage of people who reported hypertension, asthma, chronic obstructive pulmonary disease (COPD), cancer, and diabetes was higher in 2018 compared with 1997. Also, the prevalence of arthritis was higher in 2018 compared with 2002.Data for this indicator’s charts and bullets can be found in Tables 16a and 16b on page 101.

27INDICATOR 17: Oral HealthOral health is an important component of an older person’s general health and well-being. Oral health reflects overall health status and is related to the risk and treatment of various chronic conditions.15 Regular dental care is not covered under Medicare.Percentage of people age 65 and over who had dental insurance, had a dental visit in the past year, or had no natural teeth, by age group, 2018Percent65–7465 and over85 and over75–84Dental insurance29322521Dental visit in past year66686457No natural teeth19152231020406080100NOTE: Dental insurance is estimated from questions on whether the respondent’s private health insurance plan covers dental care and whether the respondent has a single service plan covering dental care. Dental visits in the past year were estimated from responses to the question, “About how long has it been since you last saw or talked to a dentist?” The percentage with no natural teeth was estimated from responses to the question, “Have you lost all of your upper and lower natural (permanent) teeth?” All estimates were calculated from the sample adult component of the National Health Interview Survey.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.• About 29 percent of people age 65 and over reported having dental insurance in 2018. The percentage with dental insurance declines with age, from 32 percent among people ages 65–74 to 21 percent among people age 85 and over.• In 2018, about 66 percent of people age 65 and over had a dental visit in the past year. The percentage visiting a dentist was higher among people ages 65–74 than among people age 85 and over (68 percent versus 57 percent).• The prevalence of edentulism, having no natural teeth, was about twice as high among people age 85 and over (31 percent) as among people ages 65–74 (15 percent).• Similar percentages of men and women age 65 and over in 2018 had dental insurance, had a dental visit in the past year, and had no natural teeth.• Non-Hispanic White people age 65 and over had lower levels of edentulism than non-Hispanic Blacks and Hispanics (18 percent versus 28 percent and 23 percent, respectively) and higher levels of dental visits than non-Hispanic Blacks and Hispanics.Data for this indicator’s charts and bullets can be found in Tables 17a and 17b on page 102.

28INDICATOR 18: Respondent-Assessed Health StatusAsking people to rate their health as excellent, very good, good, fair, or poor provides an indicator of health status easily measured in surveys. It represents physical, emotional, and social aspects of health and well-being. Self-rated health has been shown to predict mortality and health care expenditures.16,17Percentage of people age 65 and over with respondent-assessed good to excellent health status, by age group and race and Hispanic origin, 20187881656481846970757960556872565065 and over65–7475–8485 and over020406080100Non-Hispanic BlackHispanicNon-Hispanic WhiteTotalPercentNOTE: Total includes all other races not shown separately. See data sources for the definition of race and Hispanic origin in the National Health Interview Survey.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.• In 2018, 78 percent of people age 65 and over rated their health as good, very good, or excellent. The levels of health reported by older men and older women were similar.• The proportion of people reporting good to excellent health was lower among the oldest age groups. Eighty-one percent of those ages 65–74 reported good or better health. At age 85 and over, 68 percent of people reported good or better health. This pattern was also evident within racial and ethnic groups.• Regardless of age, older non-Hispanic White men and women were more likely to report good to excellent health than their non-Hispanic Black and Hispanic counterparts. Eighty-two percent of non-Hispanic White women age 65 and over reported good to excellent health compared with 65 percent of non-Hispanic Blacks and 61 percent of Hispanics. Among men, the percentages were 80 percent for non-Hispanic White men and 66 percent and 68 percent for non-Hispanic Black and Hispanic men, respectively.Data for this indicator’s charts and bullets can be found in Table 18 on page 103.

29INDICATOR 19: DementiaDementias, including Alzheimer’s disease and other related disorders that cause memory impairment and cognitive decline, affect the health and well-being of the U.S. population (see Indicator 15: Mortality). Dementia is a condition overwhelmingly faced by older adults, although it sometimes affects people under age 65. Increasing age is one of the strongest risk factors for dementia.Percentage of the non-nursing home population age 65 and over with dementia, by age group and sex, 2011 and 201585 and overMenWomen65–7475–8465 and over85 and over65–7475–8465 and overPercent2015201101020304050Percent0102030405077441092123982211102724NOTE: The estimate of dementia includes Alzheimer’s disease and other related dementias such as frontotemporal, Lewy body, mixed, and vascular dementia. Dementia status in the National Health and Aging Trends Study (NHATS) was determined using three types of information: (1) a report (by the respondent or proxy) that a doctor told the sample person that he or she had dementia or Alzheimer’s disease; (2) a score indicating probable dementia on a screening instrument administered to proxy respondents during the interview; and (3) cognitive tests that evaluate memory, orientation, and executive function administered to the respondent during the interview. To minimize potential learning bias and to be classified as having dementia, participants must meet criteria for dementia in two subsequent NHATS rounds, or meet dementia criteria in one round followed by death or loss to follow up in the next round, as described in Freedman, Kaspar, Spillman, and Plassman (2018).18Data from 2011 have been revised with the two-round dementia criteria and differ from Indicator 20: Dementia in Older Americans 2016. Reference population: These data refer to Medicare beneficiaries not living in nursing homes.SOURCE: Office of the Assistant Secretary for Planning and Evaluation, National Health and Aging Trends Study.• In 2015, 7.4 percent of men (1.4 million) and 7.5 percent of women (1.7 million) age 65 and over not living in nursing homes had dementia. Despite similar overall percentages with dementia in 2015 among women and men, the size of the population of women in these age groups was larger than that of men. As a result, far more women than men had dementia at older ages. Among those age 85 and over, 24.4 percent of women (830,000) and 23.4 percent of men (440,000) had dementia.• The prevalence of dementia among people age 65 and over remained largely unchanged for men between 2011 and 2015 but declined for women from 9.2 percent to 7.5 percent. Declines in prevalence were observed for women in all age groups, while prevalence among men was unchanged at younger ages and rose slightly in those age 85 and over (from 20.8 percent in 2011 to 23.4 percent in 2015). • The prevalence of dementia decreases with educational level. In both 2011 and 2015, among people age 65 and over, approximately 16 percent with less than a high school education had dementia compared with 4 percent of people who had a bachelor’s degree or more. These differences by educational level were similar for both men and women and across age groups. Data for this indicator’s charts and bullets can be found in Tables 19a through 19e on pages 104–105.

30INDICATOR 20: Depressive SymptomsDepressive symptoms are an important indicator of general well-being and mental health among older adults. People who report many depressive symptoms often experience higher rates of physical illness, greater functional disability, higher health care resource utilization,19 and dementia.20Percentage of people age 55 and over with clinically relevant depressive symptoms, by sex and age group, selected years, 1998–2018Women18191819181816171818171517141714161317151715Percent0102030405065 and over55–64Men1212111112121211141013111391310121010121291998200020022004200620082010201220142016201819982000200220042006200820102012201420162018Percent01020304050NOTE: The definition of “clinically relevant depressive symptoms” is four or more symptoms out of a list of eight depressive symptoms from an abbreviated version of the Center of Epidemiological Studies Depression Scale (CES-D), adapted by the Health and Retirement Study (HRS). The CES-D scale is a measure of depressive symptoms and is not to be used as a diagnosis of clinical depression. A detailed explanation concerning the “four or more symptoms” cutoff can be found at https://hrs.isr.umich.edu/publications/biblio/5411. Percentages are based on weighted data using the respondent weights from the HRS Tracker file. Age ranges used in previous versions of Older Americans were updated.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Institute on Aging, Health and Retirement Study.• Older women were more likely to report clinically relevant depressive symptoms than older men. In 2018, 13 percent of women age 65 and over reported clinically relevant depressive symptoms compared with 9 percent of men. There was no significant change between the sexes in this difference from 1998 to 2018. A slight downward trend is apparent for women in this age group, going from 19 percent in 1998 to 13 percent in 2018.• The percentage of people ages 55–64 reporting clinically relevant symptoms remained relatively stable during the period. Between 1998 and 2018, the percentage of men in this age group who reported clinically relevant depressive symptoms ranged between 11 percent and 14 percent. For women in this age group, the percentage reporting these symptoms ranged between 16 percent and 18 percent.20202000201019901980197019601950

31Percentage of people age 55 and over with clinically relevant depressive symptoms, by age group and sex, 2018PercentWomenMenTotal55–5916121960–6412111365–691081270–7411101275–791181480–8413101685 and over14111601020304050NOTE: The definition of “clinically relevant depressive symptoms” is four or more symptoms out of a list of eight depressive symptoms from an abbreviated version of the Center of Epidemiological Studies Depression Scale (CES-D), adapted by the Health and Retirement Study (HRS). The CES-D scale is a measure of depressive symptoms and is not to be used as a diagnosis of clinical depression. A detailed explanation concerning the “four or more symptoms” cutoff can be found at https://hrs.isr.umich.edu/publications/biblio/5411. Percentages are based on weighted data using the respondent weights from the HRS Tracker file. Age ranges used in previous versions of Older Americans were updated.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Institute on Aging, Health and Retirement Study.• The prevalence of depressive symptoms varies by age. In 2018, the percentage of people with clinically relevant depressive symptoms was higher for the youngest age group (16 percent among those ages 55–59) and the oldest age group (14 percent for those age 85 and over) than for people ages 65–69 (14 percent).• In 2018, for both sexes, a U-shaped pattern is apparent in the prevalence of clinically relevant depressive symptoms. It is especially pronounced for women, with the highest prevalence for those ages 55–59 (19 percent) and those ages 80–84 and 85 and over (both 16 percent) and lowest for women in their late 60s and early 70s (both 12 percent).Data for this indicator’s charts and bullets can be found in Tables 20a and 20b on page 106.

32INDICATOR 21: Functional LimitationsAs people age, illness or injury may result in disability, including limitations in vision, hearing, mobility, communication, cognition, or self-care. These changes may have important implications for work and retirement policies, health and long-term care needs, and policies affecting the built environment, all of which affect the well-being of the older population and the ability to fully and independently participate in society.Percentage of people age 65 and over with a disability, by functional domain, 2010–2018 Percent252010201120122013201420172016201805101520Any disabilityMobilityCognitionHearingSelf-careCommunicationVision2015NOTE: Disability is defined as “a lot” or “cannot do/unable to do” when asked about difficulty with seeing, even if wearing glasses (vision); hearing, even if wearing hearing aids (hearing); walking or climbing steps (mobility); communicating, for example, understanding or being understood by others (communication); remembering or concentrating (cognition); and self-care, such as washing all over or dressing (self-care). Any disability is defined as having a lot of difficulty or being unable to do at least one of these activities.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.• In 2018, 22 percent of the population age 65 and over reported having a disability as defined by having a lot of difficulty or being unable to do at least one of the following functioning domains: vision, hearing, mobility, communication, cognition, or self-care. • Between 2010 and 2018, the percentage of people age 65 and over who had any disability was stable.• Difficulties with mobility (walking or climbing stairs) were the most commonly reported disability for those age 65 and over in 2018 (16 percent), followed by hearing (5 percent), cognition (4 percent), and vision and self-care (3 percent each). • Women were more likely to report any disability than men (24 percent versus 20 percent). Levels of disability in vision and mobility were also higher for women than men (4 percent and 18 percent versus 3 percent and 13 percent, respectively). Men reported higher levels of hearing disability than women (7 percent versus 4 percent).• Disability increases with age. In 2018, 46 percent of people age 85 and over reported any disability, compared with 16 percent of people ages 65–74. People age 85 and over also had higher levels of disability than people ages 65–74 in all the individual domains of functioning.• Non-Hispanic Whites age 65 and over were less likely to report having any disability than non-Hispanic Blacks or Hispanics (21 percent versus 29 percent and 27 percent, respectively). 20202000201019901980197019601950

33Difficulties performing activities of daily living (ADLs), such as bathing, dressing, and toileting, and instrumental activities of daily living (IADLs), such as housework, shopping, and managing money, affect the ability to live independently. Tracking these changes over time is helpful for planning the care needs of the older population.Percentage of Medicare beneficiaries age 65 and over who have limitations in performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or who are in a long-term care facility, selected years 1992–201733Percent020406080100Limitations inperforming IADLs onlyLimitations inperforming 1‒2 ADLsLimitations inperforming 3‒4 ADLsLimitations inperforming 5‒6 ADLsIn long-term care facility561947141992335517441420013345184212200920135163912201746204412NOTE: A residence is considered a long-term care facility if it is certified by Medicare or Medicaid; has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least one personal care service; or provides 24-hour, 7-day-a-week supervision by a caregiver. Limitations in performing activities of daily living (ADL) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. Limitations in performing instrumental activities of daily living (IADL) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light housework, heavy housework, meal preparation, shopping, or managing money. Some estimates have been revised and differ from previous editions of Older Americans. Estimates may not sum to the totals because of rounding.Reference population: These data refer to Medicare beneficiaries who were continuously enrolled during the year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Access to Care (1992–2013) and Survey File (2015–2017).• In 2017, 39 percent of people age 65 and over enrolled in Medicare reported limitations in ADLs, IADLs, or were living in a long-term care facility. Roughly 12 percent had difficulty performing one or more IADLs but had no ADL limitations. Approximately 24 percent had difficulty performing at least one ADL, and 3 percent were in a facility.• The proportion of people age 65 and over with limitations in ADLs, IADLs, or who were living in a long-term care facility, was lower in 2017 than in 1992 (39 percent versus 47 percent).• Women reported higher levels of limitations than men. In 2017, about 46 percent of female Medicare beneficiaries age 65 and over had difficulty performing ADLs or IADLs, or were in a long-term care facility compared with 31 percent of male Medicare beneficiaries in this age group.• Levels of limitation varied by age. Among Medicare beneficiaries age 85 and over, 70 percent had difficulty performing ADLs or IADLs or were in a long-term care facility compared with 44 percent of people ages 75–84 and 30 percent of people ages 65–74.Data for this indicator’s charts and bullets can be found in Tables 21a through 21e on pages 107–109. 20202000201019901980197019601950

34

Health Risks and Behaviors

36INDICATOR 22: VaccinationsVaccinations against influenza and pneumococcal disease are recommended for older Americans, who are at increased risk for these diseases and their complications as they age.21,22,23 Influenza (flu) vaccinations are given annually, and pneumococcal (pneumonia) vaccinations are usually given once or twice in a lifetime.Percentage of people age 65 and over who reported having been vaccinated against influenza and pneumococcal disease, by race and Hispanic origin, 1997–2018Percent020406080100Influenzanon-Hispanic WhiteInfluenzanon-Hispanic BlackInfluenzaHispanicPneumococcal diseasenon-Hispanic WhitePneumococcal diseasenon-Hispanic BlackPneumococcal diseaseHispanic199720002005201020182015NOTE: For influenza, the percentage vaccinated consists of people who reported having a flu vaccination during the past 12 months. Beginning with data from 2005, receipt of nasal spray flu vaccine is included in the estimate of flu vaccinations. For pneumococcal disease, the percentage refers to people who reported ever having a pneumonia shot; some people receive more than one pneumonia vaccination in their lifetime. Questions concerning the use of influenza and pneumonia vaccination differed slightly on the National Health Interview Survey across the years for which data are shown. For details, see Health, United States, 2017, Appendix II. See data sources for the definition of race and Hispanic origin in the National Health Interview Survey. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.• In 2018, 69 percent of people age 65 and over reported receiving a flu vaccination in the past 12 months; however, there were differences by race and ethnicity. About 70 percent of non-Hispanic Whites reported receiving a flu vaccination compared with 60 percent of non-Hispanic Blacks and 63 percent of Hispanics.• In 2018, 69 percent of people age 65 and over had ever received a pneumonia vaccination. Non-Hispanic Whites (73 percent) were more likely to have ever received a pneumonia vaccination than non-Hispanic Blacks (60 percent) or Hispanics (54 percent).• The percentage of people age 65 and over who received a flu vaccination in the past 12 months increased during the past two decades. Increases were seen among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. Similarly, increases were observed among these groups in the percentage ever having received a pneumonia vaccination.• The percentage of older people receiving vaccinations increased with age. In 2018, about 77 percent of persons age 85 and over had received a flu vaccination compared with 65 percent of persons ages 65–74. In that same year, 76 percent of persons age 85 and over had ever received a pneumonia vaccination compared with 65 percent of persons ages 65–74.• In 2018, people age 65 and over who had not graduated from high school were less likely to be vaccinated against pneumonia than were people who had more than a high school education (60 percent versus 71 percent).Data for this indicator’s charts and bullets can be found in Tables 22a and 22b on page 110.20202000201019901980197019601950

37INDICATOR 23: Cancer ScreeningsHealth care services and screenings can help prevent disease or detect it at an early, treatable stage. The U.S. Preventive Services Task Force recommends colorectal cancer screenings for people ages 50–75 and breast cancer screenings (i.e., mammography) for women ages 50–74.24,25Percentage of women ages 50–74 who had breast cancer screening and percentage of people ages 50–75 who had colorectal cancer (CRC) screening, by sex and age group, selected years, 2000–2018100806040200Percent20002003200520082010201820132015CRC screening, male (50−64)CRC screening, female (50−64)CRC screening, male (65−75)CRC screening, female (65−75)Breast cancer screening, female (50−64)Breast cancer screening, female (65−74)NOTE: Breast cancer screening is defined as reporting having had a mammogram in the last 2 years. Colorectal cancer screening (CRC) is defined as reporting a fecal occult blood test (FOBT) in the past year, a sigmoidoscopy procedure in the past 5 years with FOBT in the past 3 years, or a colonoscopy in the past 10 years. Questions concerning the use of CRC screening and mammography differed slightly on the National Health Interview Survey across the years for which data are shown. For details, see Health, United States, 2017, Appendix II. Breast cancer screening is reported for women ages 50–74, and CRC screening is reported for men and women ages 50–75.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.• In 2018, the percentage receiving colorectal cancer screening was higher among people ages 65–75 than among people ages 50–64 (78 percent versus 61 percent for men and 77 percent versus 61 percent for women).• A higher proportion of women ages 65–74 in 2018 received a mammogram in the past 2 years compared with women ages 50–64 (75 percent versus 72 percent). • The percentage of people ages 50–75 who received colorectal cancer screening increased from 2000 to 2018. The percentage increased for both men and women.• The percentage of women ages 50–64 who received a mammogram in the past 2 years was lower in 2018 compared with 2000 (72 percent versus 79 percent). There was no significant difference between 2000 and 2018 in the percentage of women ages 65–74 receiving a mammogram.• In 2018, there were no significant differences by sex among people ages 50–64 and ages 65–75 in the percentage who received colorectal cancer screening.Data for this indicator’s charts and bullets can be found in Table 23 on page 111.20202000201019901980197019601950

38INDICATOR 24: Diet QualityThe Healthy Eating Index-2015 (HEI-2015) is a measure of diet quality used to assess how well a set of foods aligns with key recommendations of the 2015–2020 Dietary Guidelines for Americans.26,27 The HEI-2015 total and component scores in this analysis are averages across older Americans and reflect usual dietary intakes. The diet quality of older Americans can improve by shifting choices across and within food groups28 and making nutrient dense food choices. Diet quality focuses on the totality of what people eat and drink on multiple eating occasions over time, both at home and away from home.Average diet quality scoresa using the Healthy Eating Index-2015 for the population age 65 and over, by age group, 2015–2016TotalFruit(5)WholeFruit(5)TotalVegetables (5)Adequacy Components(maximum score)Moderation Components(maximum score)Greens andBeans(5)WholeGrains(10)Dairy(10)Total ProteinFoods(5)Seafood and Plant Proteins(5)Fatty Acids(10)Refined Grains(10)Sodium(10)AddedSugars (10)SaturatedFats(10)Maximum Score75 and over65–7465 and over0246810a Calculated using the population ratio method.NOTE: The Healthy Eating Index-2015 (HEI-2015) is a measure of diet quality with 13 components used to assess how well a set of foods aligns with the key recommendations of the 2015–2020 Dietary Guidelines for Americans.27 Intakes equal to or better than the standards set for each component are assigned a maximum score. Maximum HEI-2015 component scores range from 5 to 10 points. Scores for intakes between the minimum and maximum standards are scored proportionately. Scores for each component are summed to create a total maximum HEI-2015 score of 100 points. Nine of the 13 components assess adequacy components. The remaining four components assess dietary components that should be consumed in moderation. For the adequacy components, higher scores reflect higher intakes. For the moderation components, higher scores reflect lower intakes because lower intakes are more desirable. A higher total score indicates a diet that aligns better with the Dietary Guidelines. HEI-2015 total and component scores reflect usual dietary intakes among older adults in the United States. This tool was developed by the U.S. Department of Agriculture, Center for Nutrition Policy and Promotion and the U.S. Department of Health and Human Services, National Cancer Institute. The bars represent the actual scores obtained for each component. The maximum scores possible for each component are included in parentheses under each category. Total HEI scores are available in Table 24. Reference population: These data refer to the resident noninstitutionalized population.SOURCE: National Center for Health Statistics, What We Eat in America, National Health and Nutrition Examination Survey (2015–2016).• During 2015–2016, total HEI-2015 scores for age groups 65 and over, 65–74, and 75 and over were 64, 65, and 63, respectively, out of 100. • Among older Americans age 65 and over, component scores were highest for Whole Fruits, Total Protein Foods, and Seafood and Plant Proteins. • Maximum scores were not achieved, and component scores were furthest from the maximum for Whole Grains, Dairy, Fatty Acids, Sodium, and Saturated Fats, among older Americans age 65 and over. Data for this indicator’s charts and bullets can be found in Table 24 on page 112.

39INDICATOR 25: Physical ActivityPhysical activity is important for people of all ages. It improves overall health and reduces the risk of many chronic conditions. Exercise may also reduce the risk of depression and dementia. For older adults, physical activity can lower the risk of falls and fall-related injuries.29Percentage of people age 65 and over who reported participating in leisure-time aerobic and muscle-strengthening activities that meet the Physical Activity Guidelines for Americans, by age group, 1998–2018Percent0102030405065–7465 and over75–8485 and over19982000200220042006201820162014201220082010NOTE: This measure of physical activity reflects the Physical Activity Guidelines for Americans (https://health.gov/our-work/physical-activity/current-guidelines). The guidelines recommend that adults age 65 and over perform at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Aerobic activity preferably should be spread throughout the week. In addition, older adults should perform muscle-strengthening activities that are moderate or greater intensity and involve all major muscle groups on two or more days a week. When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow. The measure shown here presents the percentage of people who fully met both the aerobic activity and muscle-strengthening guidelines, irrespective of their chronic condition status.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.• In 2018, about 14 percent of people age 65 and over reported participating in leisure-time aerobic and muscle-strengthening activities that met the Physical Activity Guidelines for Americans. The percentage of older people meeting the physical activity guidelines decreased with age, ranging from 16 percent among people ages 65–74 to 7 percent among people age 85 and over.• The percentage of older Americans meeting the Physical Activity Guidelines for Americans increased over time. In 1998, about 6 percent of people age 65 and over met the guidelines compared with 14 percent in 2018.• Men age 65 and over were more likely than women in the same age group to meet the Physical Activity Guidelines for Americans in 2018 (16 percent versus 12 percent). Non-Hispanic Whites age 65 and over reported higher levels of physical activity than their non-Hispanic Black counterparts (15 percent versus 9 percent).Data for this indicator’s charts and bullets can be found in Tables 25a and 25b on page 113.20202000201019901980197019601950

40INDICATOR 26: ObesityObesity is a major cause of preventable disease and premature death.30 It is associated with increased risk of coronary heart disease, Type 2 diabetes, various types of cancer, gallstones, and disability.31Percentage of the population age 65 and over with obesity, by sex and age group, selected years, 1988–2018020406080100Men1988–19942003–20062007–20102015–20182011–20141999–200265–7475 and overPercent65–7465 and over75 and overPercent020406080100Women1988–19942003–20062007–20102015–20182011–20141999–200265 and overNOTE: Data are based on measured height and weight. Height was measured without shoes. Obesity is defined by a body mass index (BMI) of 30 kilograms/meter2 or greater. The percentage of people with obesity is a subset of the percentage of those who are overweight. See glossary for the definition of BMI. Beginning in 1999, the National Health and Nutrition Examination Survey has been in the field continuously with data released every 2 years. Two survey cycles often are combined to create increased sample size, especially for subgroup estimates. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Survey.• During 2015–2018, about 40 percent of people age 65 and over had obesity, 38 percent of men and 42 percent of women. • The percentage of people age 65 and over with obesity has increased from 22 percent in 1988–1994 to 30 percent in 2003–2006 to 40 percent in 2015–2018. • During 2015–2018, approximately 46 percent of women ages 65–74 and 36 percent of women age 75 and over had obesity. This is an increase from 1988–1994, when 27 percent of women ages 65–74 and 19 percent of women age 75 and over had obesity.• Older men followed similar trends. Some 24 percent of men ages 65–74 and 13 percent of men age 75 and over had obesity in 1988–1994 compared with 42 percent of men ages 65–74 and 32 percent of men age 75 and over in 2015–2018.Data for this indicator’s charts and bullets can be found in Table 26 on page 114.20202000201019901980197019601950

41INDICATOR 27: Cigarette SmokingCigarette smoking affects nearly every organ of the body; it causes diminished health status and raises the risk of many diseases, such as cancer, cardiovascular disease, and chronic obstructive lung diseases.32Percentage of people age 65 and over who are current cigarette smokers, by sex, selected years, 1965–201819741979198319901995200020052010MenWomen196520152018Percent01020304050NOTE: Questions concerning cigarette smoking differed slightly on the National Health Interview Survey across the years for which data are shown. For details, see Health, United States, 2018, Appendix II.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.• In 2018, 10 percent of men and 7 percent of women age 65 and over were current cigarette smokers.• The percentage of people age 65 and over who were current cigarette smokers declined between 1965 and 2018, with larger declines among men than women. Levels of cigarette smoking have been generally stable in the past decade. • In 2018, the percentage of older men who were current smokers was higher among Non-Hispanic Blacks than Non-Hispanic Whites (16 percent versus 9 percent). The percentages for older women were not statistically different between Non-Hispanic Whites and Non-Hispanic Blacks. • The percentage of people age 65 and over who were current smokers was higher among those who lived below the poverty threshold than among those with incomes above the poverty threshold. In 2018, 13 percent of people age 65 and over with incomes less than 100 percent of the poverty threshold were current smokers compared with 7 percent of people in the 200 percent or more of poverty threshold income category.Data for this indicator’s charts and bullets can be found in Tables 27a and 27b on pages 115–116.20202000201019901980197019601950

42

Health Care

44INDICATOR 28: Use of Health Care ServicesMost older Americans have health insurance through Medicare. Medicare covers a variety of services, including inpatient hospital care, physician services, hospital outpatient care, home health care, skilled nursing facility care, hospice services, and (beginning in January 2006) prescription drugs. Utilization rates for many services change over time because of changes in physician practice patterns, medical technology, Medicare payment amounts, and patient demographics.Medicare-covered hospital and skilled nursing facility stays per 1,000 Medicare beneficiaries age 65 and over in fee-for-service, 1992–20171992199520002005201520102017050100150200250300350400450500Stays per 1,000 Medicare beneficiariesHospital staysSkilled nursing facility staysNOTE: Data are for Medicare beneficiaries in fee-for-service only. Beginning in 1994, managed care beneficiaries were excluded from the denominator of all utilization rates because utilization data are not available for them. Prior to 1994, managed care beneficiaries were included in the denominators; they made up 7 percent or less of the Medicare population. See glossary for definition of fee-for-service.Reference population: These data refer to the Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare claims and enrollment data.• In 2017, Medicare beneficiaries had 245 hospital stays and 68 skilled nursing facility stays per 1,000 Medicare beneficiaries. • Between 1992 and 1999, the hospitalization rate increased from 306 hospital stays per 1,000 Medicare beneficiaries to 365 per 1,000 Medicare beneficiaries. After 1999, the rate began to decrease, reaching 245 per 1,000 Medicare beneficiaries in 2017. • The number of skilled nursing facility stays increased from 28 per 1,000 Medicare beneficiaries in 1992 to 81 per 1,000 Medicare beneficiaries in 2010. Much of the increase occurred from 1992 to 1997. The number of skilled nursing facility stays has dropped slightly since 2011, decreasing to 68 per 1,000 Medicare beneficiaries in 2017.20202000201019901980197019601950

45Medicare-covered physician and home health care visits per 1,000 Medicare beneficiaries age 65 and over in fee-for-service, 1992–2017 199520002005201520102017199202,0004,0006,0008,00010,00012,00014,00016,000Visits per 1,000 Medicare beneficiariesHome health care visitsPhysician visits and consultationsNOTE: Data are for Medicare beneficiaries in fee-for-service only. Physician visits and consultations include all settings, such as physician offices, hospitals, emergency rooms, and nursing homes. The database used to generate rates of physician visits and consultations in previous Older Americans reports prior to 2016 is no longer available. This chart uses two different databases based on the availability of data to estimate rates of physician visits and consultations. The first database provides data that begins with 1999 data through 2006, and the second database provides data beginning with 2007. As a result, data for 2007–2013 have been revised and differ from editions of Older Americans prior to 2016. Beginning in 1994, managed care beneficiaries were excluded from the denominator of all utilization rates because utilization data are not available for them. Prior to 1994, managed care beneficiaries were included in the denominators; they made up 7 percent or less of the Medicare population. See glossary for definition of fee-for-service.Reference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare claims and enrollment data.• The number of physician visits and consultations was 14,870 per 1,000 Medicare beneficiaries in 2017—an increase from 11,395 per 1,000 Medicare beneficiaries in 1999.• Following expansion in the coverage criteria for the Medicare home health care benefit, the number of home health care visits increased from 3,822 per 1,000 Medicare beneficiaries in 1992 to 8,376 per 1,000 Medicare beneficiaries in 1996. Home health care visits declined after 1997 to 2,295 per 1,000 beneficiaries in 2001. The decline coincided with changes in Medicare payment policies for home health care resulting from implementation of the Balanced Budget Act of 1997. Since 2001, the visit rate increased to 3,850 per 1,000 Medicare beneficiaries in 2009 and has declined since that time to 2,847 per 1,000 Medicare beneficiaries in 2017.• Use of home health care increases with age. In 2017, home health care agencies made 1,327 visits per 1,000 Medicare beneficiaries ages 65–74 compared with 7,868 visits per 1,000 Medicare beneficiaries for those age 85 and over.Data for this indicator’s charts and bullets can be found in Tables 28a and 28b on page 117.20202000201019901980197019601950

46INDICATOR 29: Health Care ExpendituresHealth care costs pose a major concern for older Americans. Among Medicare beneficiaries age 65 and over, these costs vary by demographic characteristics such as income, health status, and access to health care. On average, individuals with no chronic health conditions incur lower health care costs. The percentage of Medicare beneficiaries reporting difficulty obtaining health care remains low.Average annual health care costs, in 2017 dollars, for Medicare beneficiaries age 65 and over by age group, 1992–2017Dollars19921994199619982000200220042006201785 and over75−8465−7405,00010,00015,00020,00025,00030,00035,000$40,000200820102012201465 and overNOTE: Data include both out-of-pocket costs and costs covered by insurance. Dollars are inflation adjusted to 2017 using the Consumer Price Index (Series CPI-U-RS). Some data have been revised from previously published figures as a result of a CPI adjustment. To accommodate changes in sampling and data collection methodologies, the 2014 Medicare Current Beneficiary Survey data are not being released.Reference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Cost and Use (1992–2013) and Cost Supplement (2015–2017).• Annual health care costs per capita among Medicare beneficiaries age 65 and over were $18,620 in 2017.• After adjusting for inflation, annual health care costs per capita increased between 1992 and 2017—from $16,906 to $18,620.• Average annual costs were substantially higher for Medicare beneficiaries age 85 and over compared with those in other age groups.• Average annual health care costs for Medicare beneficiaries varied by demographic characteristics. In 2017, low-income individuals incurred higher health care costs; those with incomes less than $10,000 and $10,000 to $19,999 in income averaged $25,577 and $23,052 in health care costs, respectively, while those with $30,000 or more in income averaged $16,403.20202000201019901980197019601950

47Health care costs can be broken down among different types of goods and services. The amount of money older Americans spend on health care and the type of health care that they receive provide an indication of the health status and needs of older Americans in different age and income groups.Percentage distribution of annual health care costs among Medicare beneficiaries age 65 and over, by major cost component, 2008, 2012, and 2017020406080100Percent20082436123159Inpatient hospitalPhysician/outpatient hospitalHome health careNursing home/long-term care facilityPrescription drugsOther (short-term institution/hospice/dental)201222351231710201722371031910NOTE: Data include both out-of-pocket costs and costs covered by insurance. Estimates may not sum to the totals because of rounding.Reference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Cost and Use (2008, 2012) and Cost Supplement (2017).• Outpatient hospital and physician services were the largest components of health care costs, accounting for 37 percent of total health care costs in 2017. • In 2017, nursing homes and long-term care facilities accounted for 10 percent of total costs, and prescription drugs accounted for 19 percent of health care costs.• Inpatient hospital care accounted for 22 percent of total costs in 2017. “Other” costs (short-term institutions, hospice, and dental care) constituted 10 percent of total costs.• The percentage distribution of health care services remained relatively constant between 2008 and 2017.Data for this indicator’s charts and bullets can be found in Tables 29a through 29c on pages 118–119.

48INDICATOR 30: Prescription DrugsPrescription drug costs have increased rapidly in recent years as more new drugs have become available. Lack of prescription drug coverage has created a financial hardship for many older Americans. Medicare coverage of prescription drugs began in January 2006, including a low-income subsidy for beneficiaries with low incomes and assets.Average prescription drug costs, in 2017 dollars, among noninstitutionalized Medicare beneficiaries age 65 and over, by sources of payment, 1992–2017Dollars05001,0001,5002,0002,5003,5003,000$4,5004,00019921994199619982000200220042010201220142017TotalOut-of-pocketPublicPrivate20062008NOTE: Dollars have been inflation adjusted to 2017 using the Consumer Price Index (Series CPI-U-RS). Some data have been revised from previously published figures as a result of a CPI adjustment. Reported costs have been adjusted to account for underreporting of prescription drug use. The adjustment factor changed in 2006 with the initiation of the Medicare Part D prescription drug program. Public programs include Medicare, Medicaid, Department of Veterans Affairs, and other State and Federal programs. To accommodate changes in sampling and data collection methodologies, the 2014 Medicare Current Beneficiary Survey data are not being released.Reference population: These data refer to noninstitutionalized Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Cost and Use (1992–2013) and Cost Supplement (2015–2017).• Average prescription drug costs for noninstitutionalized Americans age 65 and over were $4,499 in 2017.• After adjusting for inflation, average prescription drug costs for noninstitutionalized Americans age 65 and over increased from $1,114 in 1992 to $3,517 in 2005. The increase between 2005 and 2017 was smaller—average prescription drug costs were $4,499 in 2017.• Average out-of-pocket spending and costs covered by private insurance decreased after the introduction of the Medicare Part D prescription drug program in 2006. There was a corresponding increase in drug costs covered by public insurance. Older Americans paid about 60 percent of prescription drug costs out of pocket in 1992 compared with about 19 percent in 2017. Private insurance covered 7 percent of prescription drug costs for noninstitutionalized older Americans in 2017, and public programs covered about 74 percent of those costs.20202000201019901980197019601950

49Under Medicare Part D, beneficiaries may join a stand-alone prescription drug plan or a Medicare Advantage plan that provides prescription drug coverage in addition to other Medicare-covered services. In situations where beneficiaries receive drug coverage from a former employer, the former employer may be eligible to receive a retiree drug subsidy from Medicare to help cover the cost of the drug benefit.Number of Medicare beneficiaries age 65 and over who enrolled in Part D prescription drug plans or who were covered by retiree drug subsidy payments, 2006 and 2017 200620175.611.46.57.428.51.6Part D planRetiree drug subsidyPart D planRetiree drug subsidyEnrollment (in millions)0510152025303540Low-income subsidyNo low-income subsidyReference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare claims and enrollment data.• In 2017, 7.4 million Part D beneficiaries were receiving low-income subsidies. Many of these beneficiaries had drug coverage through the Medicaid program prior to enrollment in Part D.• Approximately 1.6 million beneficiaries age 65 and over were covered by the retiree drug subsidy in 2017. • The number of Medicare beneficiaries age 65 and over enrolled in Part D prescription drug plans increased from 16.9 million (46 percent of beneficiaries) in 2006 to 35.9 million (72 percent of beneficiaries) in 2017. Data for this indicator’s charts and bullets can be found in Tables 30a through 30c on pages 120–121.

50INDICATOR 31: Sources of Health InsuranceMedicare is the primary insurance provider for all eligible beneficiaries age 65 and over. Medicare covers mostly acute care services and requires beneficiaries to pay part of the cost, leaving about half of health spending to be covered by other sources. Many beneficiaries have supplemental insurance to fill these gaps and pay for services not covered by Medicare. Prior to 2006, many beneficiaries received prescription drug coverage through supplemental insurance. Since January 2006, beneficiaries have had the option of receiving prescription drug coverage under Medicare through stand-alone prescription drug plans or through some Medicare Advantage health plans.Percentage of noninstitutionalized Medicare beneficiaries age 65 and over with supplemental health insurance, by type of insurance, 1991–2017Percent0Private (employer- or union-sponsored)Private (Medigap or other supplemental coverage)aMedicare Advantage/Capitated Payment PlansMedicaidOther publicNo supplement19911995200020052017TRICARE201020151020304050a Includes people with a private supplement of unknown sponsorship.NOTE: Estimates are based on beneficiaries’ insurance status in the fall of each year. Categories are not mutually exclusive (i.e., individuals may have more than one supplemental policy). Chart excludes beneficiaries whose primary insurance is not Medicare (approximately 1 percent to 3 percent of beneficiaries). Prior to 2015, supplemental policy estimates were calculated using the first five policies reported only. Estimates for 2015 and later were calculated using all available policy information. Medicare Advantage/Capitated Payment Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and private fee-for-service (PFFS) plans. Not all types of plans were available in all years. Since 2003, these types of plans have been known collectively as Medicare Advantage and/or Medicare Part C. Prior to 2015, Medicaid coverage was determined from both survey responses and Medicare administrative records. Starting with 2015, Medicaid coverage is determined from administrative records only. TRICARE coverage was added to Medicare Current Beneficiary Survey Access to Care files beginning in 2003. Adding TRICARE coverage to the table changes the percentage of beneficiaries in the “No supplement” group. The weighting process in the 2017 Survey File was improved to reflect the distribution of enrollment in Medicare Advantage. All 2017 estimates are based on enhanced survey weights. To accommodate changes in sampling and data collection methodologies, the 2014 Medicare Current Beneficiary Survey data are not being released.Reference population: These data refer to noninstitutionalized Medicare beneficiaries who were continuously enrolled during the calendar year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Access to Care (1991–2013) and Survey File (2015–2017).• In 2017, about 53 percent of Medicare beneficiaries had a private insurance supplement, either provided by a former employer or union or purchased as a supplemental policy.• In 2017, 35 percent of Medicare beneficiaries age 65 and over were enrolled in Medicare Advantage/Capitated Payment Plans.• About 10 percent of Medicare beneficiaries reported having no health insurance supplement in 2017.• The percentage of Medicare beneficiaries age 65 and over who were enrolled in Medicare Advantage/ Capitated Payment Plans increased from 6 percent in 1991 to 35 percent in 2017.Data for this indicator’s charts and bullets can be found in Tables 31a and 31b on page 122.20202000201019901980197019601950

51INDICATOR 32: Out-of-Pocket Health Care ExpendituresLarge out-of-pocket expenditures for use of health care services have been shown to encumber access to care, affect health status and quality of life, and leave insufficient resources for other necessities.33,34 The percentage of household income that is allocated to health care expenditures is a measure of health care expense burden placed on older people.Percentage of household income per person attributable to out-of-pocket health care expenditures among people age 65 and over, by income category and age group, 1977 and 201720171977Percent01020304050Poor/near-poor income category65 and over65–7475–8485 and over1219111614201226Percent01020304050Low/middle/high income category5453655765 and over65–7475–8485 and overNOTE: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Including expenditures for out-of-pocket premiums in the estimates of out-of-pocket spending would increase the percentage of household income spent on health care. People are classified into the “poor/near-poor” income category if their household income is below 125 percent of the poverty level; otherwise, people are classified into the “low/middle/high” income category. The poverty level is calculated according to the U.S. Census Bureau guidelines for the corresponding year. The ratio of a person’s out-of-pocket expenditures to their household income was calculated based on the person’s per capita household income. For people whose ratio of out-of-pocket expenditures to income exceeded 100 percent, the ratio was capped at 100 percent. For people with out-of-pocket expenditures and with zero income (or negative income), the ratio was set at 100 percent. For people with no out-of-pocket expenditures, the ratio was set to zero.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS) and MEPS predecessor surveys.• In 2017, the average per-person percentage of household income attributable to out-of-pocket spending for health care services for poor/near-poor persons age 65 and over was 19 percent. The average percentage for persons age 65 and over in the low/middle/high income category was lower, at 4 percent in 2017.• In 1977, the average per-person percentage of household income attributable to out-of-pocket spending for health care services for poor/near-poor persons age 65 and over was 12 percent. The average percentage for persons age 65 and over in the low/middle/high income category was 5 percent in 1977.• The average per-person percentage of household income attributable to out-of-pocket spending for health care services for poor/near-poor persons ages 65–74 in 2017 was 16 percent, an increase from 11 percent in 1977. For low/middle/high income persons of the same age group, the trend was reversed: 3 percent in 2017 versus 5 percent in 1977.• For persons age 85 and over, there was an increase in the average per-person percentage of household income attributable to out-of-pocket spending for health care services over time for the poor/near-poor income group. The percentage for poor/near-poor persons in 1977 was 12 percent, increasing to 26 percent in 2017.Data for this indicator’s charts and bullets can be found in Tables 32a through 32c on pages 123–127.

52INDICATOR 33: Sources of Payment for Health Care ServicesMedicare’s payments are focused on acute care services such as hospitals and physicians. Historically, long-term care facilities, prescription drugs, and dental care have been primarily financed out of pocket or by other payers. Medicare coverage of prescription drugs, including a low-income subsidy, began in January 2006.Average cost per beneficiary and percentage distribution of sources of payment for health care services for Medicare beneficiaries age 65 and over, by type of service, 20172*0.21111AllHospiceInpatienthospitalHomehealth careShort-terminstitutionPhysician/medicalOut-patienthospitalPrescriptiondrugsDentalLong-termcare facilityPercent02040608010065517137 $18,620100$347 8810$3,757 80*12$531 7410511$827 681615$4,250 80613$2,064 641818$3,255 7720$567 4451*5$1,684 MedicaidMedicareOut-of-pocketOtherAverage costper beneficiary* Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error of 20 percent to 30 percent.NOTE: “Other” refers to private insurance, Department of Veterans Affairs, uncollected liability, and other public programs. Estimates may not sum to 100 percent because of rounding or suppression resulting from high relative standard errors.Reference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Cost Supplement.• Total health care costs for Medicare beneficiary age 65 and over averaged $18,620 in 2017. The largest components of this cost were physician/medical services ($4,250), inpatient hospital services ($3,757), prescription drugs ($3,255), outpatient hospital services ($2,064), and long-term care facilities ($1,684).• Medicare paid for approximately 65 percent of all health care costs of Medicare beneficiaries age 65 and over in 2017. Medicare financed all hospice costs and most hospital, physician, home health care, and short-term institution costs.• Medicaid covered 5 percent of all health care costs of Medicare beneficiaries age 65 and over, and other payers (primarily private insurers) covered another 13 percent. Medicare beneficiaries age 65 and over paid 17 percent of their health care costs out of pocket (not including insurance premiums).• In 2017, about 44 percent of long-term care facility costs for Medicare beneficiaries age 65 and over were covered by Medicaid; another 51 percent of these costs were paid out of pocket. About 64 percent of prescription drug costs for Medicare beneficiaries age 65 and over were covered by Medicare, 18 percent were covered by third-party payers other than Medicare and Medicaid (consisting mostly of private insurers), and 18 percent were paid out of pocket. About 77 percent of dental care received by older Americans was paid out of pocket.Data for this indicator’s charts and bullets can be found in Table 33 on page 128.

53INDICATOR 34: Veterans’ Health CareNumber of veterans age 65 and over who are enrolled in Veterans Health Administration, by age group, selected years 2003–2018 and projected 2023–2038 80–8485 and over75–7970–7465–6902,000,0003,000,0004,000,0005,000,0006,000,000Number200320082013201820232028203320381,000,000ProjectedNOTE: Department of Veterans Affairs (VA) enrollees are veterans who have signed up to receive health care from Veterans Health Administration (VHA). Counts for 2023, 2028, 2033, and 2038 are projections from the 2019 VA Enrollee Health Care Projection Model.Reference population: These data refer to the count of unique VHA enrollees per fiscal year.SOURCE: Department of Veterans Affairs, Chief Strategy Office, 2019 VA Enrollee Health Care Projection Model.The number of veterans age 65 and over who are enrolled in and receive health care from the Veterans Health Administration (VHA), within the Department of Veterans Affairs (VA), has been steadily increasing since eligibility for this benefit was reformed in 1999. Older veterans continue to turn to VHA for their health care needs, despite their eligibility for other sources of health care. VHA fills important gaps in the health care needs for older veterans that are not currently covered or fully covered by Medicare, such as long-term services and supports (nursing home care for eligible veterans and community-based care for all enrolled veterans) and specialized services for the disabled, including acute mental health services. In addition, VHA provides access to these important services in rural and highly rural communities.• In 2018, approximately 4.5 million of the 9.1 million veterans enrolled with VHA were age 65 and over (49 percent).• The percentages of older veterans among the enrollee population are expected to increase as the Vietnam-era enrollee cohort gets older. In 2018, approximately 21 percent of enrollees were age 75 and over; by 2038, approximately 30 percent of enrollees are projected to be age 75 and over.• In 2018, the largest number of enrollees in the older veteran cohort (age 65 and over) were in the age group 70–74 (1.33 million). By 2038, those in the age group 85 and over will compromise the largest number of enrollees in the older veteran cohort (1.16 million).Data for this indicator’s charts and bullets can be found in Table 34 on page 128.203820202000201019901980197019601950

54INDICATOR 35: Residential ServicesMost older Americans live independently in traditional communities. Others live in licensed long-term care facilities, and still others live in communities with access to various services through their place of residence. Such services may include meal preparation, laundry and cleaning services, and help with medications. Availability of such services through the place of residence may help older Americans maintain their independence and avoid institutionalization.Percentage distribution of Medicare beneficiaries age 65 and over residing in selected residential settings, by age group, 2017 020406080100Percent65 and over75–8465–7485 and overCommunity housingwith servicesTraditional communityLong-term care facilities95232311989581812NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior citizen housing, continuing care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations and who reported they had access to one or more of the following services through their place of residence: meal preparation, cleaning or housekeeping services, laundry services, or help with medications. Respondents were asked about access to these services, but not whether they actually used the services. A residence (or unit) is considered a long-term care facility if it is certified by Medicare or Medicaid; or has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least one personal care service; or provides 24-hour, 7-day-a-week supervision by a nonfamily, paid caregiver.Reference population: These data refer to Medicare beneficiaries who were continuously enrolled during the calendar year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Survey File.• In 2017, about 2 percent of the Medicare population age 65 and over resided in community housing with at least one service available. About 3 percent resided in long-term care facilities, and 95 percent resided in traditional community settings.• The percentage of people residing in community housing with services and in long-term care facilities was higher for the older age groups than for the 65–74 age group. Among individuals age 85 and over, 8 percent resided in community housing with services, and 12 percent resided in long-term care facilities. Among individuals ages 65–74, about 98 percent resided in traditional community settings.

55Percentage distribution of Medicare beneficiaries age 65 and over with limitations performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs), by residential setting, 2017OverallTraditionalcommunityCommunity housingwith servicesLong-term carefacilities020406080100PercentLimitations in 1–2 ADLsLimitations only in IADLsNo functional limitationsLimitations in 3 or more ADLs61131796313178411828137162454NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior citizen housing, continuing care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations, and who reported they had access to one or more of the following services through their place of residence: meal preparation, cleaning or housekeeping services, laundry services, or help with medications. Respondents were asked about access to these services, but not whether they actually used the services. A residence (or unit) is considered a long-term care facility if it is certified by Medicare or Medicaid; or has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least one personal care service; or provides 24-hour, 7-day-a-week supervision by a nonfamily, paid caregiver. Long-term care facility residents with no limitations may include individuals with limitations in performing certain IADLs, such as doing light or heavy housework or meal preparation. These questions were not asked of facility residents.Reference population: These data refer to Medicare beneficiaries who were continuously enrolled during the calendar year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Survey File.• In 2017, among the Medicare beneficiaries age 65 and over, 39 percent reported at least one limitation with an activity of daily living (ADL) or an instrumental activity of daily living (IADL), regardless of setting.• People living in community housing with services had more limitations in performing ADLs and IADLs than traditional community residents but not as many as those living in long-term care facilities. About 40 percent of individuals living in community housing with services had at least one ADL limitation compared with 24 percent of traditional community residents and 78 percent of long-term care facility residents in 2017.• Approximately 63 percent of traditional community residents had no ADL or IADL limitations compared with 41 percent of those living in community housing with services and 7 percent in long-term care facilities.Data for this indicator’s charts and bullets can be found in Tables 35a and 35b on page 129.

56INDICATOR 36: Personal Assistance and EquipmentAs the proportion of the older population residing in long-term care facilities has declined, the use of personal assistance and/or special equipment among those with limitations has increased. This assistance helps older people living in the community maintain their independence.Percentage distribution of noninstitutionalized Medicare beneficiaries age 65 and over who have limitations in performing activities of daily living (ADLs), by type of assistance, selected years 1992–201719922001200920172922409372433640252963929256020406080100PercentPersonal assistanceand equipmentEquipment onlyPersonal assistance onlyNo personal assistanceor equipmentNOTE: Some data have been revised and differ from previous editions of Older Americans. Limitations in performing activities of daily living (ADLs) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. Personal assistance is defined as assistance with performing the task. In this chart, personal assistance does not include supervision. Estimates may not sum to the totals because of rounding.Reference population: These data refer to noninstitutionalized Medicare beneficiaries who have limitations in performing one or more ADLs and are continuously enrolled during the year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Access to Care (1992–2013) and Survey File (2015–2017).• In 2017, about three quarters of people who had difficulty with one or more activities of daily living (ADLs) received personal assistance or used special equipment: 6 percent received personal assistance only, 39 percent used equipment only, and 29 percent used both personal assistance and equipment.• Between 1992 and 2017, the proportion of people age 65 and over who had difficulty with one or more ADLs and who did not receive personal assistance or use special equipment for these activities decreased from 40 percent to 25 percent. During the same period, the percentage of people using equipment only increased from 29 percent to 39 percent, while the percentage of people who used personal assistance only decreased from 9 percent to 6 percent.• In 2017, men age 65 and over were more likely than women to have received no assistance with their limitations (31 percent versus 22 percent). Women were more likely than men to have received personal assistance and used equipment (32 percent versus 24 percent). There were no differences in the percentages of women and men with limitations in performing ADLs who received personal assistance only or used equipment only.• In 2017, only 13 percent of people age 85 and over with limitations in performing ADLs did not receive assistance or use equipment compared with 35 percent of people ages 65–74. In addition, people age 85 and over were more likely to receive both personal assistance and use equipment compared with younger age groups. 20202000201019901980197019601950

57Percentage of noninstitutionalized Medicare beneficiaries age 65 and over who have limitations in performing instrumental activities of daily living (IADLs) and who receive personal assistance, by age group, selected years 1992–20171992200120092017Percent85 and over75–8465–7465 and over62667665666977696871747069707971020406080100NOTE: Some data have been revised and differ from previous editions of Older Americans. Limitations in performing instrumental activities of daily living (IADLs) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light housework, heavy housework, meal preparation, shopping, or managing money. Reference population: These data refer to noninstitutionalized Medicare beneficiaries who have limitations in performing one or more IADLs and are continuously enrolled during the year. The population excludes beneficiaries who also have limitations in performing activities of daily living (ADLs).SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Access to Care (1992–2013) and Survey File (2015–2017).• In 2017, slightly more than two-thirds of people age 65 and over who had difficulty with one or more instrumental activities of daily living (IADLs) received personal assistance.• In 2017, people age 85 and over were more likely to receive assistance with IADLs compared with people ages 65–74 and ages 75–84.• Between 1992 and 2017, there were increases in the percentages of people ages 65–74 who received assistance with IADLs. Among people ages 75–84 and age 85 and over, there was no significant increase.• Men age 85 and over were less likely than women of the same age group to receive personal assistance with their IADLs in 2017.Data for this indicator’s charts and bullets can be found in Tables 36a through 36d on pages 130–131.20202000201019901980197019601950

58INDICATOR 37: Long-Term Care ProvidersLong-term care refers to a broad range of services and supports to meet the needs of frail older adults and other people who are limited in their abilities for self-care because of chronic illness, disability, or other health-related conditions. Long-term care services include health care-related services and services that are not health care related; they include assistance with activities of daily living (ADLs), assistance with instrumental activities of daily living (IADLs), and health maintenance tasks. Care can be provided in the home or in a variety of other settings.35,36Number of users of long-term care services, by sector and age group, 2015 and 2016MillionsNursing homes(2016)Residential carecommunities(2016)Adult dayservices centers(2016)Home healthagencies (2015)Hospices (2015)012345Less than 6565–7475–8485 and overNOTE: The long-term care services described here are provided by paid, regulated providers. They comprise both health care-related and non-health care-related services, including postacute care and rehabilitation. People can receive more than one type of service. The estimated number of nursing home residents represents current residents in 2016. The estimated number of residential care community residents represents current residents in 2016. The estimated number of adult day services center participants represents current participants in 2016. The estimated number of home health patients represents patients who ended care in 2015 (i.e., discharges). The estimated number of hospice patients represents patients who received care at any time in 2015. The number in each age group is calculated by applying the percentage distribution by age to the estimated total number of users and may differ slightly from other published estimates because of rounding. See https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf for definitions.Reference population: These data refer to the resident population.SOURCE: National Center for Health Statistics, National Study of Long-Term Care Providers.• In 2016, about 1.1 million people age 65 and over were residents of nursing homes. In the same year, nearly 760,000 people age 65 and over lived in residential care communities such as assisted living facilities. In both settings, people age 85 and over were the largest share by age group among residents.• In 2016, approximately 290,000 participants received care in adult day services centers. Nearly two-thirds of the participants (180,000) were age 65 and over.• About 4.5 million people received care from a home health agency in 2015. People ages 75–84 (about 1.3 million) made up the largest share by age group of people receiving care from a home health agency. About 1.2 million people ages 65–74 and 1.1 million age 85 and over received home health care.• In 2015, 1.4 million people received hospice care. About 48 percent of the hospice patients were age 85 and over.

59Percentage of users of long-term care services needing any assistance with activities of daily living (ADLs), by sector and activity, 2015 and 2016Nursing homes(2016)Residential carecommunities(2016)Adult dayservices centers(2016)Home healthagencies(2015)PercentBathingEatingToiletingDressingWalking or locomotionTransferring in/out of bed or chair020406080100609793878992196448294057233936293446928161979591NOTE: The long-term care services described here are provided by paid, regulated providers. They comprise both health care-related and non-health care-related services, including postacute care and rehabilitation. People can receive more than one type of service. Users of formal long-term care include persons of all ages. In nursing homes, 84 percent of residents were age 65 and over. In residential care communities, 93 percent of residents were age 65 and over. In adult day services centers, 63 percent of participants were age 65 and over. Among home health care patients, 82 percent were age 65 and over. Data were not available for hospice patients. Participants, patients, or residents were considered needing any assistance with a given activity if they needed help or supervision from another person or used assistive devices to perform the activity. See https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf for definitions.Reference population: These data refer to the resident population.SOURCE: National Center for Health Statistics, National Study of Long-Term Care Providers.• In 2016, most residents of nursing homes needed help with activities of daily living (ADLs). Nearly all (97 percent) needed help with bathing, and almost as many needed help with dressing, toileting, and walking (93 percent, 89 percent, and 92 percent, respectively).• In 2016, 64 percent of residents of residential care communities needed assistance with bathing. About 57 percent needed help with walking, and 29 percent needed assistance transferring in or out of beds or chairs.• In 2016, less than half of adult day center participants needed assistance with ADLs. About 39 percent needed help with bathing, and 46 percent needed help with walking.• The majority of home health care patients in 2015 needed assistance with all six ADLs. Nearly all (97 percent) needed help with bathing.• Assistance with bathing was the most common need across all sectors except adult day services centers, while assistance with eating was the least common.Data for this indicator’s charts and bullets can be found in Tables 37a and 37b on page 132.

60

Environment

62INDICATOR 38: Use of TimeHow individuals spend their time reflects their financial, health, and personal situations; employment status; needs; and desires. Time-use data show that as Americans get older, they spend more of their time in leisure activities. As people age, they are less likely to be employed. In 2018, a majority (63 percent) of people ages 55–64 were employed compared with 26 percent of those ages 65–74 and 8 percent of those age 75 and over.37 This change in employment status is reflected in how older Americans spent their time.Percentage of day that people age 55 and over spent doing selected activities on an average day, by age group, 201855–6465–7475 and over3326649212332385541043037451692336Percent0204060801003SleepingLeisure activitiesWork and work-related activitiesHousehold activitiesCare for andhelping othersEating and drinkingPurchasing goods and servicesGroomingOther activitiesNOTE: “Other activities” includes activities such as educational activities; organizational, civic, and religious activities; and telephone calls. Chart includes people who did not work at all. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Bureau of Labor Statistics, American Time Use Survey.• On an average day, people ages 55–64 spent 16 percent of their time (3 hours and 47 minutes) working or doing work-related activities compared with 4 percent (about 1 hour) for people ages 65–74 and 2 percent (about 30 minutes) for people age 75 and over.• Older Americans spent, on average, more than one-quarter of their time in leisure activities. This proportion increased with age: Americans age 75 and over spent 32 percent of their time in leisure activities compared with 23 percent for those ages 55–64.

63Leisure activities are those done when free from duties such as working, shopping, doing household chores, or caring for others. During these times, individuals have flexibility in choosing what to do.Percentage of total leisure time that people age 55 and over spent doing selected leisure activities on an average day, by age group, 201855–6465–7475 and over127461111294619111083627Percent02040608010056ReadingRelaxing and thinkingOther leisure activitiesParticipating in sports, exercise,and recreationWatching TVSocializing and communicatingNOTE: “Other leisure activities” includes activities such as playing games, using the computer for leisure, doing arts and crafts as a hobby, experiencing arts and entertainment (other than sports), and engaging in related travel.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Bureau of Labor Statistics, American Time Use Survey.• Watching TV was the activity that occupied the most leisure activity time—more than one-half of the total— for Americans age 55 and over.• Americans age 75 and over spent a higher percentage of their leisure time reading than did Americans ages 55–64 (10 percent versus 5 percent). Americans age 75 and over spent 48 minutes per day reading compared with 16 minutes per day for Americans ages 55–64.• The proportion of leisure time that older Americans spent socializing and communicating—such as visiting friends or attending or hosting social events— declined with age. For Americans ages 55–64, about 11 percent of leisure time was spent socializing and communicating compared with 7 percent for those age 75 and over.Data for this indicator’s charts and bullets can be found in Tables 38a and 38b on page 133.

64INDICATOR 39: Air QualityAs people age, their bodies are less able to compensate for the effects of environmental hazards. Air pollution can aggravate chronic heart and lung diseases, leading to increased medication use, more visits to health care providers, admissions to additional emergency rooms and hospitals, and even death. An important indicator for environmental health is the percentage of older adults living in areas that have measured air pollutant concentrations above the level of the national standards set by the Environmental Protection Agency (EPA).Counties with instances of “poor air quality” for any standard in 2018Counties with “poor air quality”Other monitored countiesUnmonitored countiesNOTE: The term “poor air quality” is defined as air quality concentrations above the level of the National Ambient Air Quality Standards (NAAQS). The term “any standard” refers to any NAAQS for ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon monoxide, or lead. Measuring concentrations above the level of a standard is not equivalent to violating the standard. The level of a standard may be exceeded on multiple days before the exceedance is considered a violation of the standard.Reference population: These data refer to the resident population.SOURCE: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S. Census Bureau, 2010 Population.• In 2018, approximately 137 million people lived in counties where monitored air was unhealthy at times because of high levels of at least one of the six principal air pollutants: ozone, particulate matter (PM), nitrogen dioxide, sulfur dioxide, carbon monoxide, and lead. About 12 percent, or nearly 16 million people, of those living in counties where monitored air quality was unhealthy at times were age 65 and over. The vast majority of areas that experienced unhealthy air did so because of one or both of two pollutants—ozone and PM2.5.

65Ozone and PM, especially fine particle pollution called PM2.5, have the greatest potential to affect the health of older adults. Fine particle pollution has been linked to premature death, cardiac arrhythmias and heart attacks, asthma attacks, and the development of chronic bronchitis. Ozone, even at low levels, can exacerbate respiratory diseases such as chronic obstructive pulmonary disease or asthma.38–42Percentage of people age 65 and over living in counties with instances of “poor air quality,” by selected pollutant measures, 2000–2018Percent0204060801002000200220042006200820102018201620142012Particulate matter(PM2.5)OzoneAny standardNOTE: The term “poor air quality” is defined as air quality concentrations above the level of the National Ambient Air Quality Standards (NAAQS). The term “any standard” refers to any NAAQS for ozone, particulate matter (PM), nitrogen dioxide, sulfur dioxide, carbon monoxide, or lead. PM2.5 refers to fine inhalable particles with diameters that are generally 2.5 micrometers and smaller. Data for previous years have been computed using the standards in effect as of August 2019 to enable comparisons over time. This results in percentages that are not comparable to those in previous publications of Older Americans. Measuring concentrations above the level of a standard is not equivalent to violating the standard. The level of a standard may be exceeded on multiple days before the exceedance is considered a violation of the standard.Reference population: These data refer to the resident population.SOURCE: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S. Census Bureau, 2010 Population.• In 2018, 40 percent of people age 65 and over lived in counties that experienced poor air quality for any standard. • The percentage of people age 65 and over living in counties that experienced poor air quality for any standard decreased from 69 percent in 2000 to 40 percent in 2018. About 36 percent of people age 65 and over lived in counties with poor air quality for ozone in 2018 compared with 58 percent in 2000.• A comparison of 2000 and 2018 showed a reduction in PM2.5 pollution. In 2000, about 50 percent of people age 65 and over lived in a county where PM2.5concentrations were at times above the EPA standard compared with about 11 percent of people age 65 and over in 2018.Data for this indicator’s charts and bullets can be found in Tables 39a and 39b on pages 134–140.20202000201019901980197019601950

66INDICATOR 40: TransportationThe ability to travel independently to appointments, to the grocery store, and to visit friends plays an important role in the daily lives of older adults. For many older adults, the ability to travel independently may change because of health or physical problems. However, access to modes of transportation such as riding with a friend or using public transit may help older adults continue to get the services they need.Percentage of noninstitutionalized Medicare beneficiaries age 65 and over who made a change in transportation mode because of a health or physical problem, by type of change and age group, 2017Percent75–8485 and over65–7465 and over1813234113814371814193327213047Limits driving to daytimeHas given up driving altogetherHas trouble getting placesHas reduced travel020406080100Reference population: These data refer to noninstitutionalized Medicare beneficiaries who were continuously enrolled during the year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Survey File.• In 2017, 18 percent of the noninstitutionalized Medicare population age 65 and over had limited their driving to daytime because of a health or physical problem. The percentage of people who had limited their driving to daytime was greater for those age 85 and over (41 percent) than for those ages 65–74 (13 percent).• Furthermore, 13 percent of the noninstitutionalized Medicare population age 65 and over had given up driving altogether, about 18 percent had trouble getting places, and 27 percent had reduced their travel because of a health or physical problem.Data for this indicator’s charts and bullets can be found in Table 40 on page 140.

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Tables

72INDICATOR 1: Number of Older AmericansTable 1a. Number of people (in millions) age 65 and over and age 85 and over, selected years, 1900–2018, and projected years, 2020–2060Year65 and over85 and overEstimates19003.10.119103.90.219204.90.219306.60.319409.00.4195012.30.6196016.20.9197020.11.5198025.52.2199031.23.1200035.04.2200536.74.7201040.35.5201547.76.3201649.26.4201750.86.5201852.46.5Projections202056.16.7203073.19.1204080.814.4205085.718.6206094.719.0NOTE: Some data for 2020–2060 have been revised and differ from previous editions of Older Americans.Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, 1900–1940, 1970, and 1980, U.S. Census Bureau, 1983, Table 42; 1950, U.S. Census Bureau, 1953, Table 38; 1960, U.S. Census Bureau, 1964, Table 155; 1990, U.S. Census Bureau, 1991, 1990 Summary Table File; 2000, U.S. Census Bureau, 2001, Census 2000 Summary File 1; U.S. Census Bureau, Table 1: Intercensal Estimates of the Resident Population by Sex and Age for the U.S.: April 1, 2000, to July 1, 2010 (US-EST00INT-01); U.S. Census Bureau, 2011. 2010 Census Summary File 1; U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010, to July 1, 2018 (PEPAGESEX); U.S. Census Bureau, Table 3: Projections of the Population by Sex and Selected Age Groups for the United States: 2017 to 2060 (NP2017-T3).

73INDICATOR 1: Number of Older AmericansTable 1b. Percentage of people age 65 and over and age 85 and over, selected years, 1900–2018, and projected years, 2020–2060Year65 and over85 and overEstimates19004.10.219104.30.219204.70.219305.40.219406.80.319508.10.419609.00.519709.90.7198011.31.0199012.61.2200012.41.5200512.41.6201013.01.8201514.92.0201615.22.0201715.62.0201816.02.0Projections202016.92.0203020.62.6204021.63.9205022.04.8206023.44.7NOTE: Some data for 2020–2060 have been revised and differ from previous editions of Older Americans.Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, 1900–1940, 1970, and 1980, U.S. Census Bureau, 1983, Table 42; 1950, U.S. Census Bureau, 1953, Table 38; 1960, U.S. Census Bureau, 1964, Table 155; 1990, U.S. Census Bureau, 1991, 1990 Summary Table File; 2000, U.S. Census Bureau, 2001, Census 2000 Summary File 1; U.S. Census Bureau, Table 1: Intercensal Estimates of the Resident Population by Sex and Age for the U.S.: April 1, 2000, to July 1, 2010 (US-EST00INT-01); U.S. Census Bureau, 2011. 2010 Census Summary File 1; U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010, to July 1, 2018 (PEPAGESEX); U.S. Census Bureau, Table 3: Projections of the Population by Sex and Selected Age Groups for the United States: 2017 to 2060 (NP2017-T3).

74INDICATOR 1: Number of Older AmericansTable 1c. Population of countries or areas with at least 10 percent of their population age 65 and over, 2019Country or areaPopulation (number in thousands)PercentTotal65 and over65 and overJapan125,85336,24128.8Germany80,31318,20422.7Finland5,5551,21621.9Italy62,33513,63421.9Greece10,7532,29821.4Puerto Rico3,24068021.0Slovenia2,10343520.7Portugal10,3282,12620.6Estonia1,23725420.6Sweden10,1222,07220.5Croatia4,24986920.5Lithuania2,76255720.1France67,61113,61920.1Latvia1,90238320.1Hungary9,7991,96820.1Czechia10,6962,12119.8Bulgaria7,0131,38819.8Denmark5,8421,14919.7Austria8,8281,73419.6Canada36,1367,07119.6Serbia7,0451,37219.5Netherlands17,2163,35019.5Belgium11,6472,21119.0Switzerland8,3491,54718.5United Kingdom65,43711,99918.3Spain49,6839,09718.3Poland38,3566,93718.1Hong Kong7,2331,28617.8Norway5,42193117.2Romania21,3813,66417.1Ukraine43,9657,37416.8Australia23,7063,96416.7Georgia4,92781416.5Slovakia5,44389816.5United States331,88454,55716.4New Zealand4,58072715.9Bosnia and Herzegovina3,84359915.6Belarus9,5041,47715.5Cuba11,0871,71915.5Korea, South51,6367,82115.1Russia141,94521,35315.0Taiwan23,5773,54215.0Uruguay3,37849114.5Macedonia2,12329213.8Ireland5,12369513.6Moldova3,40146113.5Cyprus1,25215912.7Albania3,06638712.6See notes at end of table.

75INDICATOR 1: Number of Older AmericansTable 1c. Population of countries or areas with at least 10 percent of their population age 65 and over, 2019—continuedCountry or areaPopulation (number in thousands)PercentTotal65 and over65 and overArmenia3,03036712.1Argentina45,0895,39212.0China1,389,619163,77511.8Israel8,5501,00611.8Trinidad and Tobago1,21214011.6Chile18,0582,06911.5Thailand68,8047,83611.4Mauritius1,37214610.6Singapore6,10363910.5Sri Lanka22,7372,34110.3NOTE: Table excludes countries and areas with less than 1,000,000 total population.SOURCE: U.S. Census Bureau, International Data Base, accessed on October 1, 2019.

76INDICATOR 1: Number of Older AmericansTable 1d. Percentage of the population age 65 and over, by state, 2018State (listed alphabetically)PercentState (ranked by percentage)PercentUnited States16.0United States16.0Alabama16.9Puerto Rico20.7Alaska11.8Maine20.6Arizona17.5Florida20.5Arkansas17.0West Virginia19.9California14.3Vermont19.4Colorado14.2Montana18.7Connecticut17.2Delaware18.7Delaware18.7Hawaii18.4District of Columbia12.1Pennsylvania18.2Florida20.5New Hampshire18.1Georgia13.9South Carolina17.7Hawaii18.4Oregon17.6Idaho15.9Arizona17.5Illinois15.6New Mexico17.5Indiana15.8Rhode Island17.2Iowa17.1Connecticut17.2Kansas15.9Michigan17.2Kentucky16.4Iowa17.1Louisiana15.4Ohio17.1Maine20.6Arkansas17.0Maryland15.4Wisconsin17.0Massachusetts16.5Alabama16.9Michigan17.2Missouri16.9Minnesota15.9South Dakota16.6Mississippi15.9Wyoming16.5Missouri16.9Massachusetts16.5Montana18.7New York16.4Nebraska15.7Tennessee16.4Nevada15.7Kentucky16.4New Hampshire18.1North Carolina16.3New Jersey16.1New Jersey16.1New Mexico17.5Mississippi15.9New York16.4Kansas15.9North Carolina16.3Idaho15.9North Dakota15.3Minnesota15.9Ohio17.1Indiana15.8Oklahoma15.7Nebraska15.7Oregon17.6Oklahoma15.7See notes at end of table.

77INDICATOR 1: Number of Older AmericansTable 1d. Percentage of the population age 65 and over, by state, 2018—continuedState (listed alphabetically)PercentState (ranked by percentage)PercentPennsylvania18.2Nevada15.7Rhode Island17.2Illinois15.6South Carolina17.7Washington15.4South Dakota16.6Virginia15.4Tennessee16.4Louisiana15.4Texas12.6Maryland15.4Utah11.1North Dakota15.3Vermont19.4California14.3Virginia15.4Colorado14.2Washington15.4Georgia13.9West Virginia19.9Texas12.6Wisconsin17.0District of Columbia12.1Wyoming16.5Alaska11.8Puerto Rico20.7Utah11.1NOTE: Puerto Rico is not included in the U.S. average.Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010, to July 1, 2018 (PEPAGESEX).Table 1e. Percentage of the population age 65 and over, by county, 2018Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010, to July 1, 2018 (PEPAGESEX).Data for this table can be found at https://www.agingstats.gov.Table 1f. Number and percentage of people age 65 and over and age 85 and over, by sex, 2018Age and sexNumber (in thousands)Percent65 and over52,431100.0Men 23,30744.5Women29,12455.585 and over6,545100.0Men2,32635.5Women4,21964.5Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010, to July 1, 2018 (PEPAGESEX).

78INDICATOR 2: Racial and Ethnic CompositionTable 2. Population age 65 and over, by race and Hispanic origin, 2018 and projected 2060Race and Hispanic or Latino origin20182060 projectionsNumber (in thousands)PercentNumber (in thousands)PercentTotal52,431100.094,676100.0Non-Hispanic or Latino White alone40,12476.552,15655.1Black alone4,7719.112,14412.8Asian alone2,3694.57,8598.3All other races alone or in combination7491.42,6282.8Hispanic or Latino (any race)4,4188.419,88921.0NOTE: The presentation of racial and ethnic composition data in this table has changed from previous editions of Older Americans. Unlike in previous editions, Hispanics are not counted in any race group. The term “non-Hispanic White alone” is used to refer to people who reported being White and no other race and who are not Hispanic. The term “non-Hispanic Black alone” is used to refer to people who reported being Black or African American and no other race and who are not Hispanic, and the term “non-Hispanic Asian alone” is used to refer to people who reported only Asian as their race and who are not Hispanic. The use of single-race populations in this table does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches. The race group “non-Hispanic All other races alone or in combination” includes people who reported American Indian or Alaska Native alone who are not Hispanic; people who reported Native Hawaiian or Other Pacific Islander alone who are not Hispanic; and all people who reported two or more races who are not Hispanic. “Hispanic” refers to an ethnic category; Hispanics may be of any race.Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, Annual Estimates of the Resident Population by Sex, Age, Race, and Hispanic Origin for the United States and States: April 1, 2010, to July 1, 2018 (PEPASR6H); U.S. Census Bureau, Table 1. Projected Population by Single Year of Age, Sex, Race, and Hispanic Origin for the United States: 2017 to 2060 (NP2017_D1). INDICATOR 3: Marital StatusTable 3. Marital status of the population age 65 and over, by age group and sex, 2018Sex and marital status65 and over65–7475–8485 and overPercentTotal100.0100.0100.0100.0Married57.164.154.329.8Widowed22.912.629.057.9Divorced14.216.512.28.0Never married5.86.84.54.4Men100.0100.0100.0100.0Married70.672.571.854.7Widowed11.16.113.934.9Divorced12.314.410.16.5Never married5.97.04.33.9Women100.0100.0100.0100.0Married46.356.840.716.2Widowed32.318.340.770.4Divorced15.718.413.98.8Never married5.76.64.64.7NOTE: Married includes separated.Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, American Community Survey.

79INDICATOR 4: Educational AttainmentTable 4a. Educational attainment of the population age 65 and over, selected years 1965–2018Educational attainment1965197019751980198519901995200020012002200320042005PercentHigh school graduate or more23.528.337.340.748.255.463.869.570.069.971.573.174.0Bachelor’s degree or more5.06.38.18.69.411.613.015.616.216.717.418.718.92006200720082009201020112012201320142015201620172018High school graduate or more75.276.177.478.379.580.781.182.683.784.385.486.186.4Bachelor’s degree or more19.519.220.521.722.523.224.325.326.326.728.129.729.3NOTE: A single question that asks for the highest grade or degree completed is used to determine educational attainment. Prior to 1995, educational attainment was measured using data on years of school completed. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.Table 4b. Educational attainment of the population age 65 and over, by sex and race and Hispanic origin, 2018Sex and race and Hispanic originHigh school graduate or moreBachelor’s degree or more PercentTotal85.128.2SexMen85.833.2Women84.624.2Race and Hispanic originNon-Hispanic White alone90.330.8Black alone76.317.4Asian alone74.337.5Hispanic (any race)54.012.2NOTE: The term “non-Hispanic White alone” is used to refer to people who reported being White and no other race and who are not Hispanic. The term “Black alone” is used to refer to people who reported being Black or African American and no other race, and the term “Asian alone” is used to refer to people who reported only Asian as their race. The use of single-race populations in this table does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches. Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, American Community Survey.

80INDICATOR 5: Living ArrangementsTable 5a. Living arrangements of the population age 65 and over, by sex and race and Hispanic origin, 2018Sex and race and Hispanic originTotalWith spouseWith other relativesWith nonrelativesAloneLiving in group quartersPercentMen100.067.47.44.218.52.5Non-Hispanic White alone100.069.45.54.218.72.3Black alone100.050.014.45.025.55.2Asian alone100.075.812.62.47.91.3Hispanic (any race)100.063.315.74.214.52.3Women100.047.315.03.231.33.2Non-Hispanic White alone100.049.411.13.332.83.4Black alone100.028.230.72.535.03.6Asian alone100.060.019.12.816.41.7Hispanic (any race)100.045.028.13.021.92.0NOTE: Living with other relatives indicates no spouse present. Living with nonrelatives indicates no spouse or other relatives present. The term “non-Hispanic White alone” is used to refer to people who reported being White and no other race and who are not Hispanic. The term “Black alone” is used to refer to people who reported being Black or African American and no other race, and the term “Asian alone” is used to refer to people who reported only Asian as their race. The use of single-race populations in this table does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches. Totals may not sum to 100 percent because of rounding. Reference population: These data refer to the resident population.SOURCE: U.S. Census Bureau, American Community Survey.Table 5b. Percentage of population age 65 and over living alone, by sex and age group, selected years, 1970–2019YearMenWomen65–74 75 and over65–74 75 and over197011.319.131.737.0198011.621.635.649.4199013.020.933.254.0200013.821.430.649.5200315.622.929.649.8200415.523.229.449.9200516.123.228.947.8200616.922.728.548.0200716.722.028.048.8200816.321.529.150.12009————201016.422.627.747.4201116.322.227.746.5201216.722.227.246.3201316.323.027.045.0201417.122.626.946.0201518.523.027.746.3201618.023.827.545.5201717.924.126.944.6201818.524.226.244.3201919.423.925.844.3— Not available.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.

81INDICATOR 6: Older VeteransTable 6a. Percentage of population age 65 and over who are veterans, by age group and sex, selected years 2000–2018, and projected 2020 and 2030 Year65 and over65–7475–8485 and overMenWomenMenWomenMenWomenMenWomenEstimates200064.31.765.21.170.92.732.61.0201051.31.342.81.160.81.168.32.5201545.41.340.01.349.31.166.21.7201838.11.231.81.240.80.970.71.4Projections202034.11.327.01.439.71.061.91.3203020.71.614.41.925.21.439.81.5NOTE: Some data for 2020 have been revised and differ from previous editions of Older Americans.Reference population: These data refer to the resident population of the United States and Puerto Rico.SOURCE: U.S. Census Bureau, Population Projections 2014, and 2017 Census Summary File 1; Department of Veterans Affairs, VetPop2014.Table 6b. Number of veterans age 65 and over, by age group and sex, selected years 2000–2018, and projected, 2020 and 2030Age group and sexEstimatesProjections200020102015201820202030Number (in thousands)65 and over9,7239,1699,934 9,224 8,907 7,466Men9,3748,8669,591 8,881 8,519 6,831Women349303343344 389 63565–745,6284,3775,360 4,743 4,382 3,008Men5,5164,2535,174 4,541 4,136 2,618Women112124186202 246 39075–843,6673,4033,060 2,851 2,976 3,029Men3,4603,3212,972 2,766 2,887 2,836Women207828885 89 19385 and over4271,3891,513 1,631 1,549 1,429Men3981,2921,444 1,573 1,496 1,377Women309769575352NOTE: Some data for 2020 have been revised and differ from previous editions of Older Americans. Estimates may not sum to the totals because of rounding.Reference population: These data refer to the resident population of the United States and Puerto Rico.SOURCE: U.S. Census Bureau, Population Projections 2014, and 2017 Census Summary File 1; Department of Veterans Affairs, VetPop2014.

82INDICATOR 7: PovertyTable 7a. Poverty rate by age, by official poverty measure and Supplemental Poverty Measure, 1966–2018YearUnder 1818–6465 and overTotal65–7475–8485 and overPercent196617.610.528.5———196716.610.029.5———196815.69.025.0———196914.08.725.3———197015.19.024.6———197115.39.321.6———197215.18.818.6———197314.48.316.3———197415.48.314.6———197517.19.215.3———197616.09.015.0———197716.28.814.1———197815.98.714.0———197916.48.915.2———198018.310.115.7———198120.011.115.3———198221.912.014.612.417.421.2198322.312.413.811.916.721.3198421.511.712.410.315.218.4198520.711.312.610.615.318.7198620.510.812.410.315.317.6198720.310.612.59.916.018.9198819.510.512.010.014.617.8198919.610.211.48.814.618.4199020.610.712.29.714.920.2199121.811.412.410.614.018.9199222.311.912.910.615.219.9199322.712.412.210.014.119.7199421.811.911.710.112.818.0199520.811.410.58.612.315.7199620.511.410.88.812.516.5199719.910.910.59.211.315.7199818.910.510.59.111.614.2199917.110.19.78.89.814.2200016.29.69.98.610.614.5200116.310.110.19.210.413.9200216.710.610.49.411.113.6200317.610.810.29.011.013.8200417.811.39.89.49.712.6200517.611.110.18.910.913.42006 17.410.89.48.610.011.4200718.010.99.78.89.813.0200819.011.79.78.410.712.7200920.712.98.98.09.411.6201022.013.88.98.19.212.2201121.913.78.77.410.011.5201221.813.79.17.99.912.3See notes at end of table.

83INDICATOR 7: PovertyTable 7a. Poverty rate by age, by official poverty measure and Supplemental Poverty Measure, 1966–2018—continuedYearUnder 1818–6465 and overTotal65–7475–8485 and overPercent2013 (traditional)19.913.69.58.310.911.82013 (redesign)21.513.310.28.811.114.2201421.113.510.08.711.312.7201519.712.48.88.09.112.4201618.011.69.38.69.512.12017 (legacy)17.511.29.28.210.012.12017 (updated)17.411.19.68.410.513.3201816.210.79.78.710.314.0Supplemental Poverty Measure200917.014.414.912.617.019.1201017.915.215.813.317.721.8201118.015.515.112.717.619.2201218.015.514.812.317.120.92013 (traditional)16.415.414.612.117.220.12013 (redesign)18.115.115.613.617.022.0201417.115.314.412.516.119.6201516.214.113.712.214.319.6201615.213.314.512.616.020.72017 (legacy)15.613.214.112.415.719.02017 (updated)14.212.413.612.114.718.9201813.712.213.612.214.319.0— Data not available.NOTE: Poverty status in the Current Population Survey (CPS) is based on prior year income. The 2014 CPS Annual Social and Economic Supplement (ASEC) included redesigned questions for income that were implemented to a subsample of the 98,000 addresses using a probability split panel design. The source for “2013 (traditional)” in this table is the portion of the sample (68,000) that received a set of income questions similar to those used in 2013; the source for “2013 (redesign)” is the portion of the 2014 CPS ASEC sample (30,000) that received the redesigned income questions. The redesigned income questions were used for the entire 2015 CPS ASEC sample. A new processing system was implemented starting in 2017. The “2017 (legacy)” data reflect estimates using the previous system. “2017 (updated)” reflect estimates using the new processing system. The official poverty level is based on money income and does not include noncash benefits such as food stamps. Poverty thresholds reflect family size and composition and are adjusted each year using the annual average Consumer Price Index. The Supplemental Poverty Measure extends the official poverty measure by taking account of many of the government programs designed to assist low-income families and individuals who are not included in the current official poverty measure and by using thresholds derived from the Consumer Expenditure Survey by the Bureau of Labor Statistics. For more detail, see U.S. Census Bureau Series P-60, No. 252.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.

84INDICATOR 7: PovertyTable 7b. Percentage of the population age 65 and over living in poverty, by selected characteristics, 2018Selected characteristic65 and over65–7475 and overTotalLiving aloneMarried couplesBoth SexesTotal9.717.65.28.711.3Non-Hispanic White alone7.313.44.06.28.9Black alone18.931.18.318.120.2Asian alone11.723.59.510.114.2Hispanic (any race)19.537.311.917.223.1MenTotal8.115.65.37.78.8Non-Hispanic White alone6.012.13.95.56.8Black alone17.730.99.518.416.3Asian alone10.115.69.38.812.2Hispanic (any race)15.627.212.314.317.9WomenTotal11.118.75.29.613.2Non-Hispanic White alone8.414.14.16.810.5Black alone19.731.36.817.922.6Asian alone12.826.89.711.215.6Hispanic (any race)22.443.011.419.527.1NOTE: The poverty level is based on money income and does not include noncash benefits such as food stamps. Poverty thresholds reflect family size and composition and are adjusted each year using the annual average Consumer Price Index. For more detail, see U.S. Census Bureau, Series P-60, No. 252. The term “non-Hispanic White alone” is used to refer to people who reported being White and no other race and who are not Hispanic. The term “Black alone” is used to refer to people who reported being Black or African American and no other race, and the term “Asian alone” is used to refer to people who reported only Asian as their race. The use of single-race populations in this table does not imply that this is the preferred method of presenting or analyzing data. The U.S. Census Bureau uses a variety of approaches. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.INDICATOR 8: IncomeTable 8a. Income distribution of the population age 65 and over, 1974–2018YearPovertyLow incomeMiddle incomeHigh incomePercent197414.634.632.618.2197515.335.032.317.4197615.034.731.818.5197714.135.931.518.5197814.033.434.218.5197915.233.033.618.2198015.733.532.418.4198115.332.833.118.9198214.631.433.320.7198313.829.734.122.4198412.430.233.823.6198512.629.434.623.4198612.428.434.424.8198712.527.835.124.7198812.028.434.525.1198911.429.133.625.9See notes at end of table.

85INDICATOR 8: IncomeTable 8a. Income distribution of the population age 65 and over, 1974–2018—continuedYearPovertyLow incomeMiddle incomeHigh incomePercent199012.227.035.225.6199112.428.036.323.3199212.928.635.622.9199312.229.835.023.0199411.729.535.623.2199510.529.136.124.3199610.829.534.725.1199710.528.135.326.0199810.526.835.327.519999.726.236.427.720009.927.535.527.1200110.128.135.226.7200210.428.035.326.2200310.228.533.827.520049.828.134.627.5200510.126.635.228.120069.426.235.728.620079.826.333.330.620089.726.533.730.120098.924.835.131.220108.925.634.031.520118.724.934.232.220129.124.633.732.62013 (traditional)9.523.633.033.82013 (redesign)10.222.130.936.8201410.022.531.136.420158.822.331.437.520169.321.231.438.120179.221.029.940.020189.719.630.340.4NOTE: Income distribution in the Current Population Survey (CPS) is based on prior year income. The 2014 CPS Annual Social and Economic Supplement (ASEC) included redesigned questions for income that were implemented to a subsample of the 98,000 addresses using a probability split panel design. The source for “2013 (traditional)” in this table is the portion of the sample (68,000 addresses) that received a set of income questions similar to those used in 2013; the source for “2013 (redesign)” is the portion of the 2014 CPS ASEC sample (30,000 addresses) that received the redesigned income questions. The redesigned income questions were used for the entire 2015 CPS ASEC sample. A new processing system was implemented starting in 2017. The income categories are derived from the ratio of the family’s income (or an unrelated individual’s income) to the corresponding official poverty threshold. Being in poverty is measured as income less than 100 percent of the poverty threshold. Low income is between 100 percent and 199 percent of the poverty threshold. Middle income is between 200 percent and 399 percent of the poverty threshold. High income is 400 percent or more of the poverty threshold. Some data have been revised and differ from previous versions of Older Americans. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.

86INDICATOR 8: IncomeTable 8b. Median income of householders age 65 and over, in current and in 2018 dollars, 1974–2018YearNumber (in thousands)Current dollars2018 dollars1974 14,263 $5,292$24,371197514,8025,58523,767197614,8165,96223,991197715,2256,34724,024197815,7957,08125,082197916,5447,87925,491198016,9128,78125,548198117,3129,90326,327198217,67111,04127,681198317,90111,71828,175198418,15512,79929,545198518,59613,25429,580198618,99813,84530,367198719,41214,44330,625198819,71614,92330,540198920,15615,77130,923199020,52716,85531,496199120,92116,97530,606199220,68217,13530,145199320,80617,75130,461199421,36518,09530,416199521,48619,09631,344199621,40819,44831,093199721,49720,76132,490199821,58921,72933,551199922,47822,79734,466200022,46923,08333,753200122,47623,11832,868200222,65923,15232,406200323,04823,78732,555200423,15124,51632,670200523,45926,03633,559200623,72927,79834,705200724,11328,30534,364200824,83429,74434,775200925,27031,35436,785201025,73731,46136,312201126,84333,11837,056201227,92433,84837,0872013 (traditional)28,72935,61138,4492013 (redesign)29,06937,29740,270See notes at end of table.

87INDICATOR 8: IncomeTable 8b. Median income of householders age 65 and over, in current and in 2018 dollars, 1974–2018—continuedYearNumber (in thousands)Current dollars2018 dollars201429,94636,89539,172201530,99838,51540,822201631,79939,82341,6712017 (legacy)32,97341,12542,1272017 (updated)32,96641,29742,304201834,15643,69643,696NOTE: Income distribution from the Current Population Survey Annual and Social Economic Supplement (CPS ASEC) is based income for the year prior. The 2014 CPS ASEC included redesigned questions for income that were implemented to a subsample of the 98,000 addresses using a probability split panel design. The source for “2013 (traditional)” in this table is the portion of the sample (68,000 addresses) that received a set of income questions similar to those used in 2013; the source for “2013 (redesign)” is the portion of the 2014 CPS ASEC sample (30,000 addresses) that received the redesigned income questions. The redesigned income questions were used for the entire 2015 CPS ASEC sample and beyond. Implementation of an updated CPS ASEC processing system was used beginning with 2017 data. The “2017 (legacy)” estimates are produced using the legacy processing system. The “2017 (updated)” estimates are produced using the new processing system. Some data have been revised and differ from previous versions of Older Americans. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.

88INDICATOR 9: Social Security BeneficiariesTable 9a. Percentage distribution of people who began receiving Social Security benefits in 2018, by age and sexSexTotalyearsPre-Full Retirement AgeFull Retirement AgePost-Full Retirement AgeAge 62Age63Age64Age65Age 66Disabled Worker ConversionsaAge 66Ages67–69Age70 andoverMen100.028.46.06.110.818.917.73.44.64.1Women100.032.16.57.010.614.117.12.64.15.9a At Full Retirement Age (FRA), persons formerly receiving disabled worker benefits are reclassified and begin receiving retired worker benefits.NOTE: FRA is defined as age 66 for those born between 1943 and 1955. The percentages are not probabilities of a birth cohort claiming at a particular age. A person begins receiving Social Security benefits the month after he or she becomes entitled. Totals may not sum to 100 percent because of rounding.Reference population: Persons fully insured for Social Security retired worker benefits who became entitled to benefits in 2018.SOURCE: Social Security Administration, Master Beneficiary Record.Table 9b. Percentage distribution of female Social Security beneficiaries age 62 and over, by type of benefit received, selected years 1960–2018Type of benefit19601970197519801985199019952000200520102015201620172018Worker benefit onlya38.742.142.341.038.536.936.238.041.446.352.153.154.255.3Spouse or widow benefit only Spouse only32.822.419.617.616.415.314.312.911.49.68.48.38.07.8Widow onlyb23.426.826.125.424.924.323.621.519.317.013.713.212.712.2Dual entitlementWorker and spouse2.43.44.46.28.710.411.512.012.012.111.411.211.010.7Worker and widow2.15.07.49.611.513.014.415.616.015.514.414.214.113.9a Worker benefits include retired and disabled worker benefits.b Widow-only beneficiaries include disabled workers and mothers of surviving children under age 19. NOTE: All data for 2005 and dual-entitlement data for 1995 and 2000 are based on a 10 percent sample of administrative records. All other estimates are based on 100 percent of available data. Benefits exclude special age-72 beneficiaries and disabled adult children and include disabled workers. Totals may not sum to 100 percent because of rounding.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Social Security Administration, Master Beneficiary Record.

89INDICATOR 10: Net WorthTable 10a. Median household net worth, in 2016 dollars, by selected characteristics of head of household, selected years 1989–2016Selected characteristic1989199219951998200120042007201020132016Age of family head45–54 $204,610 $150,198 $170,929 $174,989 $209,596 $199,161 $247,815 $160,273 $142,396 $160,700 55–64 194,572 211,730 211,880 218,796 267,380 356,099 327,718 241,791 211,789 219,200 65 and over 158,225 165,644 166,623 213,056 242,518 234,517 267,386 257,873 228,802 253,800 65–74 158,225 176,260 186,511 231,499 266,865 258,681 301,084 267,456 263,550 231,800 75 and over 162,423 148,253 152,059 190,187 230,189 214,931 253,721 244,167 213,532 272,400 Marital status,a family head age 65 and overMarried 261,220 261,287 250,874 325,353 400,358 377,211 350,531 375,038 343,152 378,090 Unmarried 87,751 114,145 129,086 146,144 137,382 160,245 208,524 165,059 139,818 176,730 Race,b family head age 65 and overWhite 185,280 189,509 196,064 238,877 317,144 285,019 298,884 300,340 278,398 320,920 Nonwhite or Hispanic 56,853 63,058 52,508 78,199 85,220 69,821 115,744 128,218 83,932 102,000 Education, family head age 65 and overNo high school diploma 83,964 73,271 102,934 98,856 108,388 75,290 141,278 108,256 103,843 82,190 High school diploma only 157,199 183,974 176,802 216,155 234,430 223,579 225,118 198,738 159,966 187,700 Some college or more 463,032 331,775 317,586 358,064 540,044 482,514 602,168 476,728 439,044 460,000 a “Married” includes legally married and cohabiting couples. “Unmarried” includes separated, divorced, widowed, and never married.b Race refers to the designated respondent for the household in the Survey of Consumer Finances (SCF).NOTE: Median net worth is measured in constant 2016 dollars. Net worth includes assets held in investment retirement accounts such as individual retirement accounts, Keoghs, and 401(k)-type plans. All observations are weighted for analysis. The term “household” in this indicator is from the codebook of the 2016 SCF (https://www.federalreserve.gov/data.htm). The data are for the “primary economic unit” (PEU), which consists of an economically dominant single individual or couple (married or living partners) in a household and all other members of the household who are financially interdependent with the individual or couple. In the majority of cases, the PEU and household are identical. All data are for households with positive values. Some estimates have been revised and may differ from previous editions of Older Americans. Please note that the format of this indicator has changed from the previous edition. Changes to the indicator are to improve clarity and show trends over time.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Survey of Consumer Finances.Table 10b. Percent holding and median household financial assets held in retirement investment accounts, in 2016 dollars, by selected characteristics of head of household, selected years 1989–2016Selected characteristic19891992199519982001In dollarsPercent holdingIn dollarsPercent holdingIn dollarsPercent holdingIn dollarsPercent holdingIn dollarsPercent holdingMedian (among holders)Median (among holders)Median (among holders)Median (among holders)Median (among holders)Age of family head45–54 $31,720 52.2 $46,958 51.9 $43,848 57.4 $51,641 59.3 $65,033 63.7 55–64 44,781 47.4 50,312 53.0 50,112 51.0 69,347 58.3 74,517 59.8 65 and over 27,988 20.3 33,541 22.8 42,282 27.3 51,641 32.1 77,227 36.5 65–74 27,988 30.1 33,541 35.1 45,414 36.6 56,067 46.1 81,291 45.1 75 and over 29,854 6.3 46,958 6.3 36,801 15.9 44,264 16.7 65,033 27.7 Marital status,a family head age 65 and overMarried 37,317 32.0 43,604 36.9 59,195 39.0 54,592 46.0 108,388 47.1 Unmarried 18,659 10.5 16,771 11.9 25,056 15.6 41,313 19.8 36,581 24.8 See notes at end of table.

90INDICATOR 10: Net WorthTable 10b. Percent holding and median household financial assets held in retirement investment accounts, in 2016 dollars, by selected characteristics of head of household, selected years 1989–2016—continuedSelected characteristic19891992199519982001In dollarsPercent holdingIn dollarsPercent holdingIn dollarsPercent holdingIn dollarsPercent holdingIn dollarsPercent holdingMedian (among holders)Median (among holders)Median (among holders)Median (among holders)Median (among holders)Race,b family head age 65 and overWhite 27,988 23.6 35,218 25.2 42,282 29.8 54,592 35.4 78,852 41.1 Nonwhite or Hispanic 31,720 5.7 23,479 9.7 50,112 11.3 26,558 11.3 27,097 10.0 Education, family head age 65 and overNo high school diploma 27,988 8.8 15,094 8.0 23,490 13.8 20,952 12.8 27,097 12.9 High school diploma only 18,659 22.4 31,864 28.1 32,886 28.5 48,690 30.1 47,420 33.0 Some college or more 31,720 38.9 41,927 37.0 62,640 40.4 69,347 49.0 132,775 57.5 Selected characteristic20042007201020132016In dollarsPercent holdingIn dollarsPercent holdingIn dollarsPercent holdingIn dollarsPercent holdingIn dollarsPercent holdingMedian (among holders)Median (among holders)Median (among holders)Median (among holders)Median (among holders)Age of family head45–54 $70,584 58.2 $72,955 65.4 $66,320 60.1 $89,706 56.5 $82,000 59.8 55–64 105,558 63.5 115,802 61.2 110,533 59.8 107,235 59.3 120,000 59.3 65 and over 69,948 36.1 70,407 40.8 78,478 41.1 121,670 39.4 120,000 45.8 65–74 101,743 43.2 89,167 51.7 110,533 48.9 153,635 48.0 126,200 49.8 75 and over 38,154 29.2 40,531 30.0 59,688 32.7 71,146 29.0 120,000 40.8 Marital status,a family head age 65 and overMarried 96,655 49.1 85,693 53.4 103,901 55.3 164,977 50.5 165,000 56.7 Unmarried 38,154 23.7 40,531 28.9 54,161 26.8 70,115 28.7 80,000 34.7 Race,b family head age 65 and overWhite 73,763 41.4 75,966 45.3 87,321 45.7 127,857 45.5 131,000 51.5 Nonwhite or Hispanic 13,990 11.8 30,108 16.6 49,740 23.2 51,555 17.1 90,000 28.2 Education, family head age 65 and overNo high school diploma 13,990 11.7 35,898 19.0 26,528 16.1 22,684 9.1 50,000 18.2 High school diploma only 47,056 38.4 40,531 35.1 50,845 34.0 63,929 31.4 52,000 33.3 Some college or more 108,102 50.2 134,330 59.1 134,850 57.4 175,288 55.5 185,000 60.1 a “Married” includes legally married and cohabiting couples. “Unmarried” includes separated, divorced, widowed, and never married.b Race refers to the designated respondent for the household in the Survey of Consumer Finances (SCF).NOTE: Median values are measured in constant 2016 dollars. Retirement accounts include the total value of investment retirement accounts such as individual retirement accounts, Keoghs, thrift-type plans, and current and future account-type pensions. All observations are weighted for analysis. The term “household” in this indicator is from the codebook of the 2016 SCF (https://www.federalreserve.gov/data.htm). The data are for the “primary economic unit” (PEU), which consists of an economically dominant single individual or couple (married or living partners) in a household and all other members of the household who are financially interdependent with the individual or couple. In the majority of cases, the PEU and household are identical. All estimates of median levels are calculated only for households with positive values. Some estimates have been revised and may differ from previous editions of Older Americans. Please note that the format of this indicator has changed from the previous edition. Changes to the indicator are to improve clarity and show trends over time.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Survey of Consumer Finances.

91INDICATOR 10: Net WorthTable 10c. Amount of funds (in millions of dollars) held in retirement assets, by sector and type of plan, 1975–2018YearAll sectorsPrivate onlyPublic onlyIndividual retirement accounts (IRAs)Defined contribution Defined benefitaDefined contribution Defined benefitaDefined contribution Defined benefita1975 — $74,612$315,782$74,612$169,719 — $146,0631976 — 84,341356,82484,341190,962 — 165,8621977 — 92,766388,64792,766204,503 — 184,1441978 — 110,620452,980110,620240,687 — 212,2931979 — 139,717515,723136,320279,781$3,397235,9421980 — 163,363622,636158,812349,6224,551273,0141981$38,000174,363673,378169,597364,8534,766308,525198268,000208,297818,105202,201460,7316,096357,3741983107,000254,655974,341246,783560,3987,872413,9431984159,000287,4751,067,492278,883588,7218,592478,7711985241,000431,7141,368,996420,382795,06411,332573,9321986329,000469,6971,494,230455,466816,03314,231678,1971987404,000551,7501,567,113535,617803,29416,133763,8191988468,000597,1291,674,304577,118812,80020,011861,5041989546,000715,1951,918,853688,709921,49426,486997,3591990637,000737,1961,962,358708,546899,85728,6501,062,5011991776,000890,1782,274,407852,7731,051,65437,4051,222,7531992873,000974,0942,427,769930,2111,079,86043,8831,347,9091993993,0001,108,9982,684,9681,056,8331,195,10952,1651,489,85919941,056,0001,183,8772,853,2271,125,8441,275,96458,0331,577,26319951,288,0001,465,4783,299,5211,388,4631,466,12277,0151,833,39919961,467,0001,839,7853,660,8411,632,5191,590,232207,2662,070,60919971,728,0002,219,8354,159,7551,948,2011,763,538271,6342,396,21719982,150,0002,581,5944,581,2832,238,0021,907,730343,5922,673,55319992,651,0002,951,0095,084,4322,527,7582,074,645423,2513,009,78720002,629,0002,900,5724,977,0002,497,3181,978,987403,2542,998,01320012,619,0002,631,7734,782,6512,249,7481,810,236382,0252,972,41520022,532,0002,399,8594,463,0242,051,3801,639,303348,4792,823,72120032,993,0002,987,8865,151,8822,546,4691,994,538441,4173,157,34420043,299,0003,321,6265,671,2032,816,4222,132,170505,2043,539,03320053,425,0003,699,1985,900,4063,140,0972,281,326559,1013,619,08020064,207,0004,079,8266,320,3563,437,0772,380,547642,7493,939,80920074,748,0004,367,2006,660,8343,662,2162,523,174704,9844,137,66020083,681,0003,262,3355,296,3722,723,3491,885,268538,9863,411,10420094,488,0003,998,1925,891,5003,335,3552,150,270662,8373,741,23020105,029,0004,514,9546,406,3563,768,4352,398,216746,5194,008,14020115,153,0004,500,3676,424,6133,775,3632,449,294725,0043,975,31920125,785,0005,007,2296,960,7734,224,4262,640,925782,8034,319,84820136,819,0005,877,2827,607,5724,983,5142,822,831893,7684,784,74120147,292,0006,168,8857,941,7405,247,6622,922,939921,2235,018,80120157,477,0006,100,9847,847,6515,166,8602,790,740934,1245,056,91120168,015,0006,515,1358,162,8905,619,0812,850,541896,0545,312,34920179,105,0007,511,1189,046,8136,513,7633,152,754997,3555,894,05920188,715,0007,229,6778,882,6346,236,6042,989,081993,0735,893,553— Not available.a Public and private defined benefit retirement assets do not include claims of pension funds on sponsor.Reference population: Public and private retirement assets for total population.NOTE: Some estimates have been revised and may differ from previous editions of Older Americans.SOURCE: Federal Reserve Board Z.1 Statistical Release for Dec. 12, 2019.

92INDICATOR 11: Participation in Labor ForceTable 11. Labor force participation rates (annual averages) of persons age 55 and over, by sex and age group, 1963–2019YearMenWomen55–6162–6465–6970 and over55–6162–6465–6970 and over196389.975.840.920.843.728.816.55.9196489.574.642.619.544.528.517.56.2196588.873.243.019.145.329.517.46.1196688.673.042.717.945.531.617.05.8196788.572.743.417.646.431.517.05.8196888.472.643.117.946.232.117.05.8196988.070.242.318.047.331.617.36.1197087.769.441.617.647.032.317.35.7197186.968.439.416.947.031.717.05.6197285.666.336.816.646.430.917.05.4197384.062.434.115.645.729.215.95.3197483.460.832.915.545.328.914.44.8197581.958.631.715.045.628.914.54.8197681.156.129.314.245.928.314.94.6197780.954.629.413.945.728.514.54.6197880.354.030.114.246.228.514.94.8197979.554.329.613.846.628.815.34.6198079.152.628.513.146.128.515.14.5198178.449.427.812.546.627.614.94.6198278.548.026.912.246.928.514.94.5198377.747.726.112.246.429.114.74.5198476.947.524.611.447.128.814.24.4198576.646.124.410.547.428.713.54.3198675.845.825.010.448.128.514.34.1198776.346.025.810.548.927.814.34.1198875.845.425.810.949.928.515.44.4198976.345.326.110.951.430.316.44.6199076.746.526.010.751.730.717.04.7199176.145.525.110.552.129.317.04.7199275.746.226.010.753.630.516.24.8199374.946.125.410.353.831.716.14.7199473.845.126.811.755.533.117.95.5199574.345.027.011.655.932.517.55.3199674.845.727.511.556.431.817.25.2199775.446.228.411.657.333.617.65.1199875.547.328.011.157.633.317.85.2199975.446.928.511.757.933.718.45.5200074.347.030.312.058.334.119.55.8200174.948.230.212.158.936.720.05.9200275.450.432.211.561.137.620.76.0200374.949.532.812.362.538.622.76.4200474.450.832.612.862.138.723.36.7200574.752.533.613.562.740.023.77.1See notes at end of table.

93INDICATOR 11: Participation in Labor ForceTable 11. Labor force participation rates (annual averages) of persons age 55 and over, by sex and age group, 1963–2019—continuedYearMenWomen55–6162–6465–6970 and over55–6162–6465–6970 and over200675.252.434.413.963.841.524.27.1200775.451.734.314.063.841.825.77.7200875.853.035.614.664.642.026.48.1200975.455.136.314.865.544.026.68.3201075.654.636.514.765.645.327.08.3201175.453.237.415.465.344.727.38.4201275.554.637.116.265.244.127.68.5201375.754.037.215.964.445.227.69.1201474.956.236.115.764.044.727.59.2201574.955.836.815.863.545.227.99.2201675.356.136.916.563.545.328.09.3201775.557.737.316.563.946.227.99.8201876.358.337.616.964.046.928.99.9201976.858.239.417.164.647.329.810.3NOTE: Data for 1994 and later years are not strictly comparable with data for 1993 and earlier years because of a redesign of the survey and methodology of the Current Population Survey.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Bureau of Labor Statistics, Current Population Survey.

94INDICATOR 12: Housing ProblemsTable 12a. Prevalence of housing problems among older owner/renter households,a by type of problem, selected years, 2013–2017 201320152017House­holds%Personsb%House­holds%Personsb%House­holds%Personsb%Number (in thousands)Total28,330100.038,327100.029,734100.040,574100.032,396100.044,248100.0Number and percent withOne or more housing problems10,90538.513,54135.312,25141.215,44738.113,42041.416,98238.4Housing cost burden (>30%)10,31636.412,80933.411,41938.414,35135.412,66339.115,98436.1Physically inadequate housing1,0633.81,2903.41,3724.61,7014.21,2433.81,5533.5Crowded housing1060.41470.41720.62410.61560.52370.5a Older owner/renter households are defined as households with a householder or spouse age 65 and over. b Number of persons age 65 and over. NOTE: Additional data for selected years 1985–2017 are available at agingstats.gov.Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes are excluded.SOURCE: U.S. Department of Housing and Urban Development, American Housing Survey. Table 12b. Prevalence of housing problems among older-member households,a by type of problem, selected years, 2013–2017 201320152017House­holds%Personsb%House­holds%Personsb%House­holds%Personsb%Number (in thousands)Total2,115100.02,366100.02,174100.02,459100.02,533100.02,896100.0Number and percent withOne or more housing problems81838.794039.784238.795538.899739.41,14839.6Housing cost burden (>30%)71133.682034.771733.081333.181832.393332.2Physically inadequate housing813.8923.91054.81164.7993.91053.6Crowded housing1296.11566.61386.41696.91977.82468.5a Older­member households are defined as households with one or more members age 65 and over and exclude households with a householder or spouse age 65 and over. b Number of persons (excluding householder and spouse) age 65 and over. NOTE: Additional data for selected years 1985–2017 are available at agingstats.gov.Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes are excluded.SOURCE: U.S. Department of Housing and Urban Development, American Housing Survey.

95INDICATOR 12: Housing ProblemsTable 12c. Prevalence of housing problems among all U.S. households except those householdsa with one or more persons age 65 and over, by type of problem, selected years, 2013–2017 201320152017House­holds%Persons%House­holds%Persons%House­holds%Persons%Number (in thousands)Total85,406100.0230,689100.086,382100.0229,250100.086,631100.0234,250100.0Number and percent withOne or more housing problems32,28537.887,83538.133,13338.488,83038.731,58336.585,31736.4Housing cost burden (>30%)28,60633.574,58732.329,31533.975,41632.927,86132.271,30830.4Physically inadequate housing4,7445.611,8075.15,2026.014,0556.14,6545.412,3875.3Crowded housing2,2622.614,1016.12,2282.613,3995.82,2432.613,5365.8a Households with no persons age 65 and over.NOTE: Additional data for selected years 1985–2017 are available at agingstats.gov.Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes are excluded. SOURCE: U.S. Department of Housing and Urban Development, American Housing Survey. Table 12d. Prevalence of housing problems among older owner/renter intergenerational households,a by type of problem, selected years, 2013–2017 201320152017House­holds%Personsb%House­holds%Personsb%House­holds%Personsb%Number (in thousands)Total1,220100.01,494100.01,293100.01,674100.01,435100.01,880100.0Number and percent withOne or more housing problems53243.663042.257244.274544.564144.782343.8Housing cost burden (>30%)45737.454236.344334.256433.754738.270337.4Physically inadequate housing574.7654.4816.31006.0714.9854.5Crowded housing897.31218.112910.017910.71147.91729.2a Older owner/renter intergenerational households are defined as households with a householder or spouse age 65 and over with children age 19 or younger. b Number of persons age 65 and over.NOTE: Additional data for selected years 1985–2017 are available at agingstats.gov.Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes are excluded.SOURCE: U.S. Department of Housing and Urban Development, American Housing Survey.

96INDICATOR 12: Housing ProblemsTable 12e. Prevalence of housing problems among older-member intergenerational households,a by type of problem, selected years, 2013–2017 201320152017House­holds%Personsb%House­holds%Personsb%House­holds%Personsb%Number (in thousands)Total862100.0982100.0783100.0898100.0950100.01,127100.0Number and percent withOne or more housing problems39145.344745.536446.541045.745147.553347.3Housing cost burden (>30%)31937.036437.128836.932536.233335.139034.6Physically inadequate housing404.7484.9354.5364.0323.4373.3Crowded housing11813.713613.912115.413815.416517.419817.6a Older­member intergenerational households are defined as households with one or more members age 65 and over with children age 19 or younger, and exclude households with a householder or spouse age 65 and over. b Number of persons age 65 and over. NOTE: Additional data for selected years 1985–2017 are available at agingstats.gov.Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes are excluded.SOURCE: U.S. Department of Housing and Urban Development, American Housing Survey. Table 12f. Prevalence of housing problems among all older households: householder, spouse, or member(s) age 65 and over,a by type of problem, selected years, 2013–2017 201320152017House­holds%Personsa%House­holds%Personsa%House­holds%Personsa%Number (in thousands)Total30,446100.040,693100.031,908100.043,033100.034,929100.047,144100.0Number and percent withOne or more housing problems11,72338.514,48135.613,09241.016,40138.114,41641.318,13038.5Housing cost burden (>30%)11,02736.213,63033.512,13638.015,16435.213,48138.616,91735.9Physically inadequate housing1,1453.81,3823.41,4774.61,8164.21,3423.81,6583.5Crowded housing2350.83030.73101.04101.03531.04831.0a Number of persons age 65 and over. NOTE: Additional data for selected years 1985–2017 are available at agingstats.gov.Reference population: These data refer to the resident noninstitutionalized population. People residing in noninstitutional group homes are excluded.SOURCE: U.S. Department of Housing and Urban Development, American Housing Survey.

97INDICATOR 13: Total ExpendituresTable 13. Percentage distribution of total household annual expenditures, by age of reference person, 2018Annual expenditure45–5455–6465 and overTotal65–7475 and overPersonal insurance and pensions14.612.87.07.36.5Health care6.88.713.411.916.0Transportation15.315.814.315.711.8Housing31.331.633.332.035.7Food12.612.113.013.012.9Food at home6.87.27.97.68.4Food away from home5.84.95.15.44.5Other19.419.119.020.117.0NOTE: Other expenditures include apparel, personal care, entertainment, reading, education, alcohol, tobacco, cash contributions, and miscellaneous expenditures. Data from the Consumer Expenditure Survey by age group represent average annual expenditures for consumer units by the age of the reference person, that is, the person listed as the owner or renter of the home. For example, the data on people age 65 and over reflect consumer units with a reference person age 65 and over. The Consumer Expenditure Survey collects and publishes information from consumer units, which are generally defined as a person or group of people who live in the same household and are related by blood, marriage, or other legal arrangement (i.e., a family) or people who live in the same household who are unrelated but make financial decisions together. A household usually refers to a physical dwelling and may contain more than one consumer unit (e.g., roommates who are sharing an apartment but who are financially independent from each other). However, for convenience, the term “household” is substituted for the term “consumer unit” in this text.Reference population: These data refer to the resident noninstitutionalized population.SOURCE: Bureau of Labor Statistics, Consumer Expenditure Survey.

98INDICATOR 14: Life ExpectancyTable 14. Life expectancy at ages 65 and 85, by race and Hispanic origin and sex, 2006–2018Age and yearAll races and originsaHispanicNon-Hispanic WhiteNon-Hispanic Black or African AmericanBoth sexesMenWomenBoth sexesMenWomenBoth sexesMenWomenBoth sexesMenWomenAt age 65200618.717.219.920.218.521.518.717.219.917.115.118.5200718.817.420.020.518.721.718.817.420.017.215.318.7200818.817.420.020.418.721.618.817.420.017.415.418.8200919.117.720.320.719.021.919.117.720.317.715.819.1201019.117.720.321.219.222.619.117.720.317.715.819.1201119.217.820.321.219.522.519.117.820.317.916.019.2201219.317.920.521.419.622.619.217.920.418.016.119.4201319.317.920.521.319.522.519.317.920.418.016.119.4201419.418.020.621.519.722.819.318.020.518.116.319.5201519.318.020.521.419.722.619.318.020.418.116.219.5201619.418.120.621.519.822.719.418.020.518.116.219.5201719.418.020.621.419.722.719.318.020.518.116.219.52018b19.518.120.721.419.722.719.418.120.618.016.119.52018c——————19.418.120.618.116.219.6At age 8520066.35.66.77.26.37.56.35.66.76.55.56.920076.45.76.87.36.47.56.45.76.86.55.67.020086.45.76.77.16.27.46.35.66.76.65.77.020096.65.87.07.36.47.76.55.86.96.85.97.220106.55.86.97.66.68.26.55.86.96.75.97.120116.55.96.97.66.88.06.55.86.86.86.07.220126.65.96.97.76.88.16.55.96.96.86.07.220136.65.97.07.66.78.06.55.86.96.85.97.220146.76.07.17.86.98.26.65.97.06.96.17.320156.65.97.07.76.88.06.55.96.96.86.17.220166.76.07.17.76.98.06.65.97.06.96.17.320176.65.97.07.66.78.06.55.96.96.96.17.32018b6.66.07.07.66.78.06.55.96.96.96.17.32018c——————6.55.96.96.96.17.3— Not available.a “All races and origins” includes races not shown separately.b Estimates are calculated using single-race population estimates.c Estimates are calculated using bridged-race population estimates.NOTE: The race groups, White and Black or African American, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with 2018 data, race on death records is available based on the 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity and are presented as “single” race estimates. Before 2018, data were tabulated according to the 1977 standards, and race data were “bridged” to retain comparability across states as they transitioned from the 1977 standards to the 1997 standards. Single race estimates for 2018 and beyond are not completely comparable with bridged estimates for earlier years. Bridged race estimates for 2018 are presented for comparison. See Health, United States, 2018, Appendix II for a description of changes in life table methodology over time. Estimates for 2018 are found in Arias, E., and Xu, J.Q. (in press, 2020). United States life tables, 2018 (National Vital Statistics Reports).Reference population: These data refer to the resident population.SOURCE: National Center for Health Statistics, National Vital Statistics System.

99INDICATOR 15: MortalityTable 15a. Death rates among people age 65 and over, by selected leading causes of death, 2000–2018YearTotalaHeartdiseaseCancerStrokeChroniclower respiratory diseasesInfluenza and pneumoniaDiabetesAlzheimer’s diseaseUnintentional injuriesRate per 100,000 standard population20005,1691,7071,1244263051691501418920015,0961,6521,1054103031571521519320025,0821,6161,0984023041651541639420034,9921,5571,0803813021591521739520044,8011,4561,0613562881441481779620054,8041,4221,0533313041481491889920064,6401,3401,0363072841291391869720074,5401,2751,0242982861171351879920084,5551,2461,00828831012113020210020094,3731,1809882702951071231909720104,3891,15698726729210312219710120114,3421,11696225829410612619410220124,2791,0919462502879912318710320134,2671,08592724529010612218410320144,1981,0629152472779711920010520154,2411,07390125628510312023110920164,1661,0488852532768811823811020174,1881,0478692552799512024411320184,1391,03584925227096118239112a Includes other causes of death not shown separately.NOTE: Rates are age adjusted using the 2000 U.S. standard population. Reference population: These data refer to the resident population.SOURCE: National Center for Health Statistics, National Vital Statistics System.

100INDICATOR 15: MortalityTable 15b. Number of deaths and age-adjusted death rates among people age 65 and over, by selected leading causes of death and sex, 2018 SexTotalaHeart diseaseCancerAge-adjusted death rateNumber ofdeathsAge-adjusted death rateNumber ofdeathsAge-adjusted death rateNumber of deathsAll4,1392,099,2631,035526,509849431,102SexMen4,756997,4171,273264,9201,052227,938Women3,6661,101,846856261,589702203,164SexChronic lower respiratory diseasesStrokeAlzheimer’s diseaseAge-adjusted death rateNumber ofdeathsAge-adjusted death rateNumber ofdeathsAge-adjusted death rateNumber ofdeathsAll270135,560252127,244239120,658SexMen30063,09724951,05119237,359Women24972,46325076,19326883,299SexDiabetesUnintentional injuriesInfluenza and pneumoniaAge-adjusted death rateNumber ofdeathsAge-adjusted death rateNumber ofdeathsAge-adjusted death rateNumber ofdeathsAll11860,18211257,2139648,888SexMen14832,02714129,93411222,923Women9628,1559027,2798525,965a Includes other causes of death not shown separately.NOTE: Rates are age adjusted using the 2000 U.S. standard population. Ranking of causes of death are based on number of deaths.Reference population: These data refer to the resident population.SOURCE: National Center for Health Statistics, National Vital Statistics System.

101INDICATOR 16: Chronic Health ConditionsTable 16a. Percentage of people age 65 and over who reported having selected chronic health conditions, by sex and race and Hispanic origin, 2018Sex and race and Hispanic originHeart diseaseHyper- tensionStrokeAsthmaChronic obstructive pulmonary disease (COPD) CancerDiabetesArthritisTotal29.157.08.911.713.725.821.550.5SexMen34.958.59.58.613.127.225.046.0Women24.555.78.314.214.224.718.754.1Race and Hispanic originNon-Hispanic White30.255.08.411.214.329.118.252.0Non-Hispanic Black27.268.111.614.613.416.933.551.9Hispanic22.060.08.512.911.613.432.744.2NOTE: Chronic obstructive pulmonary disease (COPD) is defined as responding yes to questions on ever having emphysema, COPD, or chronic bronchitis in the past 12 months. This definition is changed from previous editions of Older Americans. See data sources for the definition of race and Hispanic origin in the National Health Interview Survey. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.Table 16b. Percentage of people age 65 and over who reported having selected chronic health conditions, 1997–2018YearHeart diseaseHyper -tensionStrokeAsthmaChronic obstructive pulmonary disease (COPD)CancerDiabetesArthritis199731.646.77.87.610.619.413.2—199832.146.28.37.89.917.813.2—199928.945.87.86.69.519.513.2—200030.348.58.38.410.120.114.6—200131.549.69.08.710.519.815.3—200231.050.58.68.09.121.716.047.8200331.551.39.08.19.419.716.648.9200432.152.49.49.89.821.517.350.9200531.552.09.29.99.621.817.050.3200631.053.29.310.610.021.118.149.6200731.253.98.39.78.622.118.747.7200832.557.59.411.09.322.818.551.1200930.856.29.011.310.724.519.551.1201030.155.58.211.29.923.521.451.3201130.956.58.310.49.724.820.649.9201229.855.28.210.411.724.320.047.9201329.855.08.610.311.723.721.049.3201428.956.87.211.012.423.120.548.8201529.557.77.910.312.025.621.750.6201628.257.18.410.911.925.820.649.4201727.956.18.711.112.125.519.151.3201829.157.08.911.713.725.821.550.5— Not available.NOTE: In 2012–2018, chronic obstructive pulmonary disease (COPD) is defined as responding yes to questions on ever having emphysema, COPD, or chronic bronchitis in the past 12 months. In 1997–2011, the single question on COPD was not included.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.

102INDICATOR 17: Oral HealthTable 17a. Percentage of people age 65 and over who had dental insurance, had a dental visit in the past year, or had no natural teeth, by age group, 2018 Age groupDental insuranceDental visit in past yearNo natural teeth65 and over29.065.619.265–7432.467.915.475–8424.763.922.385 and over21.557.331.4NOTE: Dental insurance is estimated from questions on whether the respondent’s private health insurance plan covers dental care and whether the respondent has a single service plan covering dental care. Dental visits in the past year were estimated from responses to the question, “About how long has it been since you last saw or talked to a dentist?” The percentage with no natural teeth was estimated from responses to the question, “Have you lost all of your upper and lower natural (permanent) teeth?” All estimates were calculated from the sample adult component of the National Health Interview Survey.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.Table 17b. Percentage of people age 65 and over who had dental insurance, had a dental visit in the past year, or had no natural teeth, by sex and race and Hispanic origin, 2018 Sex and race and Hispanic originDental insuranceDental visit in past yearNo natural teethSexMen30.464.419.4Women27.866.519.0Race and Hispanic originNon-Hispanic White30.168.817.6Non-Hispanic Black30.254.128.2Hispanic21.655.922.5NOTE: Dental insurance is estimated from questions on whether the respondent’s private health insurance plan covers dental care and whether the respondent has a single service plan covering dental care. Dental visits in the past year were estimated from responses to the question, “About how long has it been since you last saw or talked to a dentist?” The percentage with no natural teeth was estimated from responses to the question, “Have you lost all of your upper and lower natural (permanent) teeth?” All estimates were calculated from the sample adult component of the National Health Interview Survey.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.

103INDICATOR 18: Respondent-Assessed Health StatusTable 18. Percentage of people age 65 and over with respondent-assessed health status, by race and Hispanic origin, sex, and age group, 2018Selected characteristicTotalNon-HispanicWhiteNon-HispanicBlackHispanicGood to excellent healthBoth sexes65 and over77.881.165.364.365–7480.983.769.070.575–8475.379.359.954.885 and over68.572.255.950.0Men65 and over77.679.966.068.465–7480.182.668.572.475–8475.077.261.760.485 and over68.771.5**Women65 and over78.082.064.961.165–7481.584.769.568.875–8475.481.059.051.485 and over68.372.654.247.6Fair or poor healthBoth sexes65 and over22.219.034.735.765–7419.116.331.029.575–8424.820.740.145.385 and over31.527.844.150.0Men65 and over22.420.134.031.665–7419.917.431.527.675–8425.022.838.339.685 and over31.328.5**Women65 and over22.018.035.138.965–7418.515.330.531.375–8424.619.041.048.685 and over31.727.445.852.4* Statistic does not meet National Center for Health Statistics standards of reliability or precision.NOTE: Total includes all other races not shown separately. See data sources for the definition of race and Hispanic origin in the National Health Interview Survey.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.

104INDICATOR 19: DementiaTable 19a. Number and percentage of the non-nursing home population age 65 and over with dementia, by age group, 2011 and 2015Age group20112015NumberPercentNumberPercent65 and over3,020,0008.43,100,0007.565–74550,0002.9570,0002.575–79550,0008.1530,0007.180–84670,00012.9700,00013.485–89690,00021.7680,00020.390 and over520,00032.7590,00030.6NOTE: Population estimates that are representative of Medicare beneficiaries age 65 and over living in settings other than nursing homes were calculated according to the methodology in Freedman, Kaspar, Spillman, and Plassman (2018).18Reference population: These data refer to Medicare beneficiaries not living in nursing homes.SOURCE: Office of the Assistant Secretary for Planning and Evaluation, National Health and Aging Trends Study.Table 19b. Number and percentage of the non-nursing home population age 65 and over with dementia, by sex and age group, 2011 and 2015Age group20112015MenWomenMenWomenNumberPercentNumberPercentNumberPercentNumberPercent65 and over1,150,0007.31,870,0009.21,370,0007.41,740,0007.565–74330,0003.5240,0002.4400,0003.5200,0001.675–84480,0009.5730,00010.7530,0009.4700,0009.985 and over340,00020.8860,00027.4440,00023.4830,00024.4NOTE: Population estimates that are representative of Medicare beneficiaries age 65 and over living in settings other than nursing homes were calculated according to the methodology in Freedman, Kaspar, Spillman, and Plassman (2018).18Reference population: These data refer to Medicare beneficiaries not living in nursing homes.SOURCE: Office of the Assistant Secretary for Planning and Evaluation, National Health and Aging Trends Study.Table 19c. Number and percentage of the non-nursing home population age 65 and over with dementia, by sex and educational attainment, 2011 and 2015Educational attainment2011TotalMenWomenNumberPercentNumberPercentNumberPercentLess than high school1,250,00016.5500,00015.2750,00017.6High school graduate810,0008.4250,0007.0570,0009.3Some college450,0004.9160,0004.5290,0005.2Bachelor’s degree or more330,0003.9180,0003.7160,0004.2Beyond high school780,0004.4330,0004.0450,0004.8See notes at end of table.

105INDICATOR 19: DementiaTable 19c. Number and percentage of the non-nursing home population age 65 and over with dementia, by sex and educational attainment, 2011 and 2015—continuedEducational attainment2015TotalMenWomenNumberPercentNumberPercentNumberPercentLess than high school1,080,00015.9480,00015.5600,00016.2High school graduate860,0008.4360,0009.2500,0007.8Some college460,0004.1190,0004.4270,0004.0Bachelor’s degree or more440,0003.9210,0003.4230,0004.5Beyond high school900,0004.0410,0003.8490,0004.2NOTE: The beyond high school category includes trade school and any college education whether or not a degree was completed. In 2011 and 2015, 1.3 percent and 3.0 percent, respectively, of the overall population were missing data on education. These cases were excluded. Reference population: These data refer to Medicare beneficiaries not living in nursing homes.SOURCE: Office of the Assistant Secretary for Planning and Evaluation, National Health and Aging Trends Study.Table 19d. Number and percentage of the non-nursing home population age 65 and over with dementia, by age group and educational attainment, 2011 and 2015Educational attainment201165–7475–8485 and overNumberPercentNumberPercentNumberPercentLess than high school250,0007.7540,00018.3460,00033.9High school graduate140,0002.8350,0009.8330,00024.5Beyond high school150,0001.5290,0005.5340,00017.7Educational attainment201565–7475–8485 and overNumberPercentNumberPercentNumberPercentLess than high school190,0006.7460,00017.1420,00034.3High school graduate190,0003.6360,00010.5310,00020.0Beyond high school150,0001.1320,0005.1430,00019.5NOTE: The beyond high school category includes trade school and any college education whether or not a degree was completed. In 2011 and 2015, 1.3 percent and 3.0 percent, respectively, of the overall population were missing data on education. These cases were excluded. Reference population: These data refer to Medicare beneficiaries not living in nursing homes.SOURCE: Office of the Assistant Secretary for Planning and Evaluation, National Health and Aging Trends Study.Table 19e. Number and percentage of the non-nursing home population age 65 and over with dementia, by race and Hispanic origin, 2011 and 2015Race and Hispanic origin20112015NumberPercentNumberPercentWhite, non-Hispanic250,0007.7190,0006.7Black, non-Hispanic140,0002.8190,0003.6Other150,0001.5150,0001.1NOTE: Population estimates that are representative of Medicare beneficiaries age 65 and over living in settings other than nursing homes were calculated according to the methodology in Freedman, Kaspar, Spillman, and Plassman (2018).18 The “Other” race/ethnicity category includes people who reported Hispanic ethnicity or reported a race other than White, non-Hispanic or Black, non-Hispanic.Reference population: These data refer to Medicare beneficiaries not living in nursing homes.SOURCE: Office of the Assistant Secretary for Planning and Evaluation, National Health and Aging Trends Study.

106INDICATOR 20: Depressive SymptomsTable 20a. Percentage of people age 55 and over with clinically relevant depressive symptoms, by age group and sex, selected years 1998–2018Sex19982000200220042006200855–6465 and over55–6465 and over55–6465 and over55–6465 and over55–6465 and over55–6465 and overBoth sexesMen12.012.011.011.012.012.012.011.014.010.013.011.0Women18.019.018.019.018.018.016.017.018.018.017.015.0Sex2010201220142016201855–6465 and over55–6465 and over55–6465 and over55–6465 and over55–6465 and overBoth sexesMen13.09.013.010.012.010.012.010.012.09.0Women17.014.017.015.017.015.017.014.016.013.0NOTE: The definition of “clinically relevant depressive symptoms” is four or more symptoms out of a list of eight depressive symptoms from an abbreviated version of the Center of Epidemiological Studies Depression Scale (CES-D), adapted by the Health and Retirement Study (HRS). The CES-D scale is a measure of depressive symptoms and is not to be used as a diagnosis of clinical depression. A detailed explanation concerning the “four or more symptoms” cutoff can be found at https://hrs.isr.umich.edu/publications/biblio/5411. Percentages are based on weighted data using the respondent weights from the HRS Tracker file. Age ranges used in previous versions of Older Americans were updated.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Institute on Aging, Health and Retirement Study.Table 20b. Percentage of people age 55 and over with clinically relevant depressive symptoms, by age group and sex, 2018Age groupBoth sexesMenWomen55–5916.012.019.060–6412.011.013.065–6910.08.012.070–7411.010.012.075–7911.08.014.080–8413.010.016.085 and over14.011.016.0NOTE: The definition of “clinically relevant depressive symptoms” is four or more symptoms out of a list of eight depressive symptoms from an abbreviated version of the Center of Epidemiological Studies Depression Scale (CES-D), adapted by the Health and Retirement Study (HRS). The CES-D scale is a measure of depressive symptoms and is not to be used as a diagnosis of clinical depression. A detailed explanation concerning the “four or more symptoms” cutoff can be found at https://hrs.isr.umich.edu/publications/biblio/5411. Percentages are based on weighted data using the respondent weights from the HRS Tracker file. Age ranges used in previous versions of Older Americans were updated.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Institute on Aging, Health and Retirement Study.

107INDICATOR 21: Functional LimitationsTable 21a. Percentage of people age 65 and over with a disability, by sex and functional domain, 2010–2018Sex and functional domain201020112012201320142015201620172018TotalAny disability22.620.717.921.921.621.618.219.521.9Vision3.32.83.54.03.73.52.42.63.1Hearing4.25.03.95.36.05.04.93.75.2Mobility17.115.613.315.614.215.912.214.115.5Communication1.21.61.31.81.51.71.71.21.5Cognition 2.73.22.53.13.13.03.33.23.7Self-care3.03.62.13.02.32.42.53.03.0MenAny disability20.016.816.919.619.319.617.416.720.1Vision2.62.03.73.23.43.12.82.42.5Hearing6.06.15.26.08.15.96.44.37.2Mobility13.711.410.612.010.512.79.610.112.5Communication1.91.41.71.91.61.22.01.01.5Cognition 2.83.32.12.83.13.13.23.23.6Self-care2.32.02.32.81.82.31.71.82.6WomenAny disability24.823.718.823.723.523.218.821.723.5Vision4.03.53.34.63.93.82.12.73.6Hearing2.84.22.84.84.44.23.83.13.5Mobility19.818.815.518.517.118.514.217.418.1Communication0.61.81.01.61.42.21.41.41.6Cognition 2.63.22.73.53.02.93.43.23.9Self-care3.54.82.03.32.72.53.13.93.3NOTE: Disability is defined as “a lot” or “cannot do/unable to do” when asked about difficulty with seeing, even if wearing glasses (vision); hearing, even if wearing hearing aids (hearing); walking or climbing steps (mobility); communicating, for example, understanding or being understood by others (communication); remembering or concentrating (cognition); and self-care, such as washing all over or dressing (self-care). Any disability is defined as having a lot of difficulty or being unable to do at least one of these activities.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.Table 21b. Percentage of people age 65 and over with a disability, by age group and functional domain, 2018Functional domain65–7475–8485 and overAny disability16.224.745.9Vision2.43.16.6Hearing2.96.713.4Mobility11.717.332.1Communication1.01.35.2Cognition 2.53.611.1Self-care1.53.98.8NOTE: Disability is defined as “a lot” or “cannot do/unable to do” when asked about difficulty with seeing, even if wearing glasses (vision); hearing, even if wearing hearing aids (hearing); walking or climbing steps (mobility); communicating, for example, understanding or being understood by others (communication); remembering or concentrating (cognition); and self-care, such as washing all over or dressing (self-care). Any disability is defined as having a lot of difficulty or being unable to do at least one of these activities.Reference population: These data refer to the civilian noninstitutionalized population. SOURCE: National Center for Health Statistics, National Health Interview Survey.

108INDICATOR 21: Functional LimitationsTable 21c. Percentage of people age 65 and over with a disability, by race and Hispanic origin and functional domain, 2018Functional domainNon-Hispanic WhiteNon-Hispanic BlackHispanicAny disability20.528.626.9Vision2.84.83.9Hearing5.34.35.6Mobility14.422.918.5Communication1.32.52.4Cognition 3.44.55.7Self-care2.44.35.6NOTE: Disability is defined as “a lot” or “cannot do/unable to do” when asked about difficulty with seeing, even if wearing glasses (vision); hearing, even if wearing hearing aids (hearing); walking or climbing steps (mobility); communicating, for example, understanding or being understood by others (communication); remembering or concentrating (cognition); and self-care, such as washing all over or dressing (self-care). Any disability is defined as having a lot of difficulty or being unable to do at least one of these activities. See data sources for the definition of race and Hispanic origin in the National Health Interview Survey.Reference population: These data refer to the civilian noninstitutionalized population. SOURCE: National Center for Health Statistics, National Health Interview Survey.Table 21d. Percentage of Medicare beneficiaries age 65 and over who have limitations in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or who are in a long-term care facility, 1992–2017YearTotalIADLs only1–2 ADLs3–4 ADLs5–6 ADLsLong-term care facility199247.313.619.35.93.35.2199346.113.418.05.83.45.5199446.214.117.65.63.45.5199544.812.917.25.73.35.6199642.812.916.75.03.15.1199742.412.816.74.93.14.9199842.612.517.35.23.04.7199944.012.918.05.13.14.9200043.913.117.65.62.84.8200143.913.617.45.32.94.7200244.613.418.65.22.84.7200343.613.017.95.62.94.3200443.313.318.54.62.64.4200542.712.518.64.82.44.4See notes at end of table.

109INDICATOR 21: Functional LimitationsTable 21d. Percentage of Medicare beneficiaries age 65 and over who have limitations in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or who are in a long-term care facility, 1992–2017—continuedYearTotalIADLs only1–2 ADLs3–4 ADLs5–6 ADLsLong-term care facility200642.812.518.35.22.64.3200742.814.018.04.62.24.1200842.011.919.24.62.34.0200942.112.218.05.22.74.0201042.512.019.05.12.83.6201144.212.319.95.43.03.7201247.111.922.06.43.03.8201344.111.720.15.72.83.82014******201543.110.320.95.73.03.1201639.711.217.45.32.83.0201739.312.316.34.92.92.9* To accommodate changes in sampling and data collection methodologies, the 2014 Medicare Current Beneficiary Survey data are not being released.NOTE: A residence is considered a long-term care facility if it is certified by Medicare or Medicaid; has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least one personal care service; or provides 24-hour, 7-day-a-week supervision by a caregiver. Limitations in performing activities of daily living (ADL) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. Limitations in performing instrumental activities of daily living (IADL) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light housework, heavy housework, meal preparation, shopping, or managing money. Some estimates have been revised and differ from previous editions of Older Americans.Reference population: These data refer to Medicare beneficiaries who were continuously enrolled during the year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Access to Care (1992–2013) and Survey File (2015–2017).Table 21e. Percentage of Medicare beneficiaries age 65 and over who have limitations in performing activities of daily living (ADLs) or instrumental activities of daily living (IADLs), or who are in a long-term care facility, by sex and age group, 2017 TotalIADLs only1–2 ADLs3–4 ADLs5–6 ADLsLong-term care facilityTotal 39.3 12.3 16.3 4.9 2.9 2.9 SexMen 31.5 9.5 14.0 3.8 2.1 2.0 Women 45.6 14.6 18.2 5.8 3.5 3.7 Age group65–74 29.9 10.7 12.6 3.7 1.9 0.9 75–84 43.6 13.8 18.9 5.3 2.7 2.9 85 and over 69.6 15.6 26.0 8.9 7.4 11.7 NOTE: A residence is considered a long-term care facility if it is certified by Medicare or Medicaid; has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least one personal care service; or provides 24-hour, 7-day-a-week supervision by a caregiver. Limitations in performing activities of daily living (ADL) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. Limitations in performing instrumental activities of daily living (IADL) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light housework, heavy housework, meal preparation, shopping, or managing money.Reference population: These data refer to Medicare beneficiaries who were continuously enrolled during the year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Survey File.

110INDICATOR 22: VaccinationsTable 22a. Percentage of people age 65 and over who reported having been vaccinated against influenza and pneumococcal disease, by race and Hispanic origin, 1997–2018YearInfluenzaPneumococcal diseaseNon-Hispanic WhiteNon-HispanicBlackHispanic Non-Hispanic WhiteNon-HispanicBlackHispanic 199765.844.652.745.622.223.5199865.645.950.349.526.022.8199967.949.755.153.132.327.9200066.647.955.756.830.530.4200165.447.951.957.833.932.9200268.749.548.560.336.927.1200368.647.845.459.637.031.0200467.345.754.660.938.633.7200563.239.741.760.740.527.5200667.546.844.962.035.533.4200769.455.752.362.244.131.8200869.950.954.964.344.536.4200969.153.057.064.944.840.1201065.952.654.663.645.939.0201169.153.157.366.647.843.1201268.953.057.863.946.043.4201370.155.557.263.648.739.2201472.457.460.864.949.845.2201571.559.456.968.250.141.7201669.458.161.371.055.548.6201769.357.861.573.257.151.0201870.260.463.372.659.954.3NOTE: For influenza, the percentage vaccinated consists of people who reported having a flu vaccination during the past 12 months. Beginning with data from 2005, receipt of nasal spray flu vaccine is included in the estimate of flu vaccinations. For pneumococcal disease, the percentage refers to people who reported ever having a pneumonia shot; some people receive more than one pneumonia vaccination in their lifetime. Questions concerning the use of influenza and pneumonia vaccination differed slightly on the National Health Interview Survey across the years for which data are shown. For details, see Health, United States, 2017, Appendix II. See data sources for the definition of race and Hispanic origin in the National Health Interview Survey. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.Table 22b. Percentage of people age 65 and over who reported having been vaccinated against influenza and pneumococcal disease, by selected characteristics, 2018Selected characteristicInfluenzaPneumococcal diseaseTotal68.869.0SexMen67.266.9Women70.070.6Age group65–7465.164.875–8473.274.985 and over76.976.3EducationLess than high school graduate66.359.5High school graduate or higher69.470.8NOTE: For influenza, the percentage vaccinated consists of people who reported having a flu vaccination during the past 12 months and includes receipt of nasal spray flu vaccines. For pneumococcal disease, the percentage refers to people who reported ever having a pneumonia vaccination; some people receive more than one pneumonia vaccination in their lifetime.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.

111INDICATOR 23: Cancer ScreeningsTable 23. Percentage of women ages 50–74 who had breast cancer screening and percentage of people ages 50–75 who had colorectal cancer screening, by sex and age group, selected years, 2000–2018Selected characteristic20002003200520082010201320152018Breast cancer screeningWomen50–6478.776.271.874.272.671.471.371.865–7474.074.672.572.671.975.372.275.0Colorectal cancer (CRC) screeningMen50–6428.636.339.247.354.051.256.561.265–7543.449.958.262.470.169.876.078.2Women50–6431.034.841.149.055.954.360.860.765–7541.345.851.958.665.969.172.577.2NOTE: Breast cancer screening is defined as reporting having had a mammogram in the last 2 years. Colorectal cancer (CRC) screening is defined as reporting a fecal occult blood test (FOBT) in the past year, a sigmoidoscopy procedure in the past 5 years with FOBT in the past 3 years, or a colonoscopy in the past 10 years. Questions concerning use of CRC screening and mammography differed slightly on the National Health Interview Survey across the years for which data are shown. For details, see Health, United States, 2017, Appendix II. Breast cancer screening is reported for women ages 50–74, and colorectal cancer screening is reported for men and women ages 50–75.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.

112INDICATOR 24: Diet QualityTable 24. Average diet quality scoresa using the Healthy Eating Index-2015 for the population age 65 and over, by age group, 2015–2016Dietary component65 and over65–7475 and overTotal Healthy Eating Index-2015 Score (maximum score = 100)63.964.762.6Adequacy Components (maximum score)Total Fruit (5)3.73.44.1Whole Fruit (5)5.05.05.0Total Vegetables (5)4.04.23.8Greens and Beans (5)3.74.22.9Whole Grains (10)4.04.03.9Dairy (10)5.65.65.8Total Protein Foods (5)5.05.05.0Seafood and Plant Proteins (5)5.05.05.0Fatty Acids (10)4.24.63.7Moderation Components (maximum score)Refined Grains (10)7.47.57.2Sodium (10)4.03.54.9Added Sugars (10)7.57.77.2Saturated Fats (10) 4.75.14.2a Calculated using the population ratio method.NOTE: The Healthy Eating Index-2015 (HEI-2015) is a measure of diet quality with 13 components used to assess how well a set of foods aligns with the key recommendations of the 2015–2020 Dietary Guidelines for Americans.27 Intakes equal to or better than the standards set for each component are assigned a maximum score. Maximum HEI-2015 component scores range from 5 to 10 points. Scores for intakes between the minimum and maximum standards are scored proportionately. Scores for each component are summed to create a total maximum HEI-2015 score of 100 points. Nine of the 13 components assess adequacy components. The remaining four components assess dietary components that should be consumed in moderation. For the adequacy components, higher scores reflect higher intakes. For the moderation components, higher scores reflect lower intakes because lower intakes are more desirable. A higher total score indicates a diet that aligns better with the Dietary Guidelines. HEI-2015 total and component scores reflect usual dietary intakes among older adults in the United States. This tool was developed by the U.S. Department of Agriculture, Center for Nutrition Policy and Promotion and the U.S. Department of Health and Human Services, National Cancer Institute.Reference population: These data refer to the resident noninstitutionalized population.SOURCE: National Center for Health Statistics, What We Eat in America, National Health and Nutrition Examination Survey (2015–2016).

113INDICATOR 25: Physical ActivityTable 25a. Percentage of people age 65 and over who reported participating in leisure-time aerobic and muscle-strengthening activities that meet the Physical Activity Guidelines for Americans, by age group, 1998–2018YearTotal65 and over65–7475–8485 and over19985.57.03.92.019995.97.74.50.920006.98.45.71.920016.77.76.13.120027.18.85.82.120037.69.26.72.920047.89.76.43.520057.910.55.73.020067.59.16.53.020077.99.56.64.120089.511.39.32.3200910.012.87.92.8201010.513.67.34.0201111.314.38.94.5201211.914.89.14.7201311.714.79.04.2201411.714.59.05.1201512.715.510.25.1201612.715.710.23.9201712.915.710.05.4201813.916.511.56.8NOTE: This measure of physical activity reflects the Physical Activity Guidelines for Americans. The guidelines recommend that adults age 65 and over perform at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Aerobic activity preferably should be spread throughout the week. In addition, older adults should perform muscle-strengthening activities that are moderate or greater intensity and involve all major muscle groups on two or more days a week. When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow. The measure shown here presents the percentage of people who fully met both the aerobic activity and muscle-strengthening guidelines, irrespective of their chronic condition status.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.Table 25b. Percentage of people age 65 and over who reported participating in leisure-time aerobic and muscle-strengthening activities that meet the Physical Activity Guidelines for Americans, by sex and race and Hispanic origin, 2018Activity and race and Hispanic originTotalMenWomenAerobic and muscle-strengthening activitiesTotal13.916.511.9Non-Hispanic White14.616.912.6Non-Hispanic Black9.411.38.2Hispanic11.516.27.7NOTE: This measure of physical activity reflects the Physical Activity Guidelines for Americans. The guidelines recommend that adults age 65 and over perform at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Aerobic activity preferably should be spread throughout the week. In addition, older adults should perform muscle-strengthening activities that are moderate or greater intensity and involve all major muscle groups on two or more days a week. When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow. The measure shown here presents the percentage of people who fully met both the aerobic activity and muscle-strengthening guidelines, irrespective of their chronic condition status.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.

114INDICATOR 26: ObesityTable 26. Percentage of people age 65 and over overweight and with obesity, by sex and age group, selected years, 1976–2018Sex and age group1976–19801988–19941999–20022003–20062007–20102011–20142015–2018OverweightBoth sexes65 and over—60.168.869.572.070.977.565–7457.264.173.373.875.773.581.175 and over—53.962.863.967.267.371.8Men65 and over—64.472.873.075.774.280.465–7454.268.576.278.077.576.183.775 and over—56.567.465.873.271.074.6Women65 and over—56.965.966.769.168.475.165–7459.560.370.970.374.271.278.975 and over—52.359.962.663.264.669.9ObeseBoth sexes65 and over—22.229.630.135.134.740.265–7417.925.635.734.840.838.644.075 and over—17.021.324.127.829.034.4Men65 and over—20.326.229.335.332.638.265–7413.224.131.633.041.536.241.975 and over—13.217.724.026.526.831.8Women65 and over—23.632.030.834.936.441.865–7421.526.939.036.440.340.745.975 and over—19.223.624.228.730.536.1— Not available.NOTE: Data are based on measured height and weight. Height was measured without shoes. Overweight is defined as having a body mass index (BMI) greater than or equal to 25 kilograms/meter2. Obesity is defined by a BMI of 30 kilograms/meter2 or greater. The percentage of people with obesity is a subset of the percentage of those who are overweight. See glossary for the definition of BMI. Beginning in 1999, the National Health and Nutrition Examination Survey has been in the field continuously with data released every 2 years. Two survey cycles often are combined to create increased sample size, especially for subgroup estimates.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Survey.

115INDICATOR 27: Cigarette SmokingTable 27a. Percentage of people age 65 and over who are current cigarette smokers, by sex and race and Hispanic origin, selected years, 1965–2018YearMenWomenTotalWhiteBlack or African AmericanNon-Hispanic WhiteNon-Hispanic BlackHispanicTotalWhiteBlack or African AmericanNon-Hispanic WhiteNon-Hispanic BlackHispanic196528.527.736.4———9.69.87.1———197424.824.329.7———12.012.3*8.9———197920.920.526.2———13.213.8*8.5———198322.020.638.9———13.113.2*13.1———198519.618.927.7———13.513.314.5———198717.216.030.3———13.713.911.7———198818.016.929.8———12.812.614.8———199014.613.721.5———11.511.511.1———199115.114.224.3———12.012.19.6———199216.114.928.3———12.412.6*11.1———199313.512.5*27.9———10.510.5*10.2———199413.211.925.6———11.111.113.6———199514.914.128.5———11.511.713.3———199712.811.525.711.424.717.011.511.610.711.810.98.5199810.49.916.39.916.812.611.211.211.611.311.510.2199910.510.517.39.716.813.110.710.513.510.713.76.1200010.29.114.210.014.610.89.39.110.29.410.16.4200111.510.721.210.521.013.79.29.49.39.69.45.1200210.19.319.49.219.510.68.68.59.48.99.4*200310.19.618.09.317.712.48.38.48.08.58.76.220049.89.414.19.514.07.78.18.26.78.67.4*20058.97.916.88.016.97.28.38.410.08.610.15.9200612.612.616.012.716.810.18.38.49.38.69.0*20079.38.914.38.714.4*7.68.06.48.46.63.3200810.59.917.510.217.67.98.38.68.18.98.05.120099.59.314.09.513.87.99.59.611.59.911.85.120109.79.610.09.89.98.79.39.49.49.79.56.220118.98.713.78.513.910.77.17.09.17.39.34.6201210.610.317.410.017.314.47.57.59.17.89.03.5201310.610.015.510.014.612.07.57.96.58.36.53.520149.89.413.99.714.76.67.57.68.28.18.03.920159.79.316.09.215.511.07.47.59.77.79.94.8201610.19.119.19.319.77.37.77.68.77.89.8*20179.08.415.18.114.912.07.57.87.18.27.24.420189.99.516.09.316.211.57.27.28.97.68.4*— Data not available.* Estimate does not meet National Center for Health Statistics standards of reliability.NOTE: Data have been revised and may differ from earlier versions of Older Americans. Total includes all other races not shown separately. The value for all women includes other races who may have very low rates of cigarette smoking. Thus, the weighted average for some estimates of all women is lower than that for the race groups shown in the table. Questions concerning cigarette smoking differed slightly on the National Health Interview Survey across the years for which data are shown. For details, see Health, United States, 2018, Appendix II. See data sources for the definition of race and Hispanic origin in the National Health Interview Survey. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.

116INDICATOR 27: Cigarette SmokingTable 27b. Percentage of people age 65 and over who are current cigarette smokers, by sex and poverty status, 2018SexAllPoverty thresholdBelow 100 percent100 percent to 199 percent200 percent or moreBoth sexes8.413.311.76.9Men9.917.914.68.1Women7.210.99.95.7NOTE: Current cigarette smokers were defined as ever smoking 100 cigarettes in their lifetime and smoking now, every day, or some days. Poverty status is calculated according to the U.S. Census Bureau thresholds for the corresponding year. See glossary for definition of poverty.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.

117INDICATOR 28: Use of Health Care ServicesTable 28a. Use of Medicare-covered health care services per 1,000 Medicare beneficiaries age 65 and over, 1992–2017YearUtilization measureAverage lengthof hospital stayHospital staysSkilled nursingfacility staysPhysician visitsand consultationsHome healthcare visitsNumber per 1,000 Medicare beneficiariesDays199230628—3,8228.4199330033—4,6488.0199433143—6,3527.5199533650—7,6087.0199634159—8,3766.6199735167—8,2276.3199835469—5,0586.119993656711,3953,7086.020003616711,4902,9136.020013646911,5462,2955.920023617212,2322,3585.920033597412,6622,4405.820043537512,7302,5945.720053507913,3022,7705.720063438013,1933,0725.620073368114,5993,4095.620083208414,8583,5845.420093028215,0223,8505.220102988115,1073,6665.220112918114,8693,4395.120122767715,0253,2555.020132627514,9993,1525.120142527414,6483,0515.120152517414,9883,0365.020162457015,0202,9514.920172456814,8702,8474.9— Data not available.NOTE: Data are for Medicare beneficiaries in fee-for-service only. Physician visits and consultations include all settings, such as physician offices, hospitals, emergency rooms, and nursing homes. The database used to generate rates of physician visits and consultations in previous Older Americans reports is no longer available. This table uses two different databases based on the availability of data to estimate rates of physician visits and consultations. The first database provides data from 1999 through 2006, and the second database has data beginning with 2007. A comparison of overlapping years shows that the two databases yield slightly different rates. As a result, some data for 2007–2013 have been revised and differ from previous editions of Older Americans. Beginning in 1994, managed care beneficiaries were excluded from the denominator of all utilization rates because utilization data are not available for them. Prior to 1994, managed care beneficiaries were included in the denominators; they made up 7 percent or less of the Medicare population. See glossary for definition of fee-for-service.Reference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare claims and enrollment data.Table 28b. Use of Medicare-covered home health care and skilled nursing facility services per 1,000 Medicare beneficiaries age 65 and over, by age group, 2017Utilization measure65–7475–8485 and overNumber per 1,000 Medicare beneficiaresSkilled nursing facility stays3185192Home health care visits1,3273,5127,868NOTE: Data are for Medicare beneficiaries in fee-for-service only.Reference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare claims and enrollment data.

118INDICATOR 29: Health Care ExpendituresTable 29a. Average annual health care costs, in 2017 dollars, for Medicare beneficiaries age 65 and over, by age group, 1992–2017Age group1992199319941995199619971998199920002001200220032004Total$16,906$17,680$18,663$19,065$18,779$18,786$18,090$18,211$18,282$18,762$19,816$19,557$19,34865–7412,58112,82513,78913,87313,59313,27312,65613,82613,61414,26515,27414,81014,38275–8418,50120,20920,67020,86321,13820,87120,12419,31119,92820,86421,51921,85721,07085 and over32,70133,07534,97536,06534,38234,03833,79731,98031,51831,30232,12430,73232,473Age group2005200620072008200920102011201220132014201520162017Total$19,819$19,625$18,904$17,923$18,140$18,415$17,494$18,157$18,237*$18,536$17,985$18,62065–7414,96314,68714,13013,45513,87413,65813,19414,13014,210*14,47514,60515,19475–8421,90521,93321,19920,72020,29921,42020,10020,66219,778*21,09919,92920,75085 and over31,44930,79330,10927,03327,94928,42227,07427,71129,944*29,32227,99228,514* To accommodate changes in sampling and data collection methodologies, the 2014 Medicare Current Beneficiary Survey data are not being released.NOTE: Data include both out-of-pocket costs and costs covered by insurance. Dollars are inflation adjusted to 2017 using the Consumer Price Index (Series CPI-U-RS). Some data have been revised from previously published tables as a result of a CPI adjustment.Reference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Cost and Use (1992–2013) and Cost Supplement (2015–2017).Table 29b. Total amount and percentage distribution of annual health care costs among Medicare beneficiaries age 65 and over, by major cost component, 2008, 2012, and 2017Major cost component200820122017Total dollarsPercentTotal dollarsPercentTotal dollarsPercentTotal$593,814,582,768100$718,814,057,899 100$873,341,235,533 100Inpatient hospital144,225,616,20024157,288,552,38522189,865,172,91722Physician/outpatient hospital214,888,544,30936253,728,764,58735319,116,789,67337Nursing home/long-term care facility72,458,957,2831288,104,428,7351285,084,459,74510Home health care19,976,448,445323,853,729,622326,836,027,9303Prescription drugs90,800,824,92815121,139,985,08917164,481,897,69419Other (short-term institution/hospice/dental)51,464,191,603974,698,597,4821087,956,887,57410NOTE: Data include both out-of-pocket costs and costs covered by insurance. Dollars are not inflation adjusted. Estimates may not sum to the totals because of rounding.Reference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Cost and Use (2008, 2012) and Cost Supplement (2017).

119INDICATOR 29: Health Care ExpendituresTable 29c. Average annual health care costs among Medicare beneficiaries age 65 and over, by selected characteristics, 2017Selected characteristicCostTotal$18,620 Race and ethnicityNon-Hispanic White18,279Non-Hispanic Black20,718Hispanic21,128Other16,933Institutional statusCommunity only16,592Long-term care facility69,417Annual incomeUnder $10,00025,577$10,000–$19,99923,052$20,000–$29,99919,008$30,000 and over16,403Number of chronic conditions08,0771–29,5433–417,4275 and over24,794Veteran status (men only)Yes17,519No18,906NOTE: Data include both out-of-pocket costs and costs covered by insurance. See data sources for the definition of race and Hispanic origin in the Medicare Current Beneficiary Survey. Chronic conditions include cancer (other than skin cancer), stroke, diabetes, heart disease, hypertension, arthritis, respiratory conditions (emphysema/asthma/chronic obstructive pulmonary disease), urinary incontinence, Alzheimer’s disease, dementia, mental conditions (depression/mental disorder not depression), osteoporosis/broken hip, and Parkinson’s disease. Annual income includes that of respondent and spouse. Long-term care facility includes beneficiaries who resided in a long-term care facility at any point during the calendar year.Reference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Cost Supplement.

120INDICATOR 30: Prescription DrugsTable 30a. Average prescription drug costs, in 2017 dollars, among noninstitutionalized Medicare beneficiaries age 65 and over, by sources of payment, 1992–2017Sources of payment1992199319941995199619971998199920002001200220032004Total$1,114$1,442$1,499$1,536$1,614$1,725$1,969$2,159$2,389$2,604$2,844$2,988$3,123Out-of-pocket6708388158058028549119491,0021,0411,1221,1201,131Private2833624124535365626897558329061,0361,1371,200Public1612422722772763083694555556576867317922005200620072008200920102011201220132014201520162017Total$3,517$3,314$3,268$3,233$3,501$3,293$3,235$3,425$3,642*$4,236$4,293$4,499Out-of-pocket1,251974802756804762758769780*962884854Private1,4421,061810767784669613603471*379382325Public8231,2791,6551,7101,9131,8621,8642,0532,392*2,8963,0273,319* To accommodate changes in sampling and data collection methodologies, the 2014 Medicare Current Beneficiary Survey data are not being released.NOTE: Dollars have been inflation adjusted to 2017 using the Consumer Price Index (Series CPI-U-RS). Some data have been revised from previously published tables as a result of a CPI adjustment. Reported costs have been adjusted to account for underreporting of prescription drug use. The adjustment factor changed in 2006 with the initiation of the Medicare Part D prescription drug program. Public programs include Medicare, Medicaid, Department of Veterans Affairs, and other State and Federal programs. Reference population: These data refer to noninstitutionalized Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Cost and Use (1992–2013) and Cost Supplement (2015–2017).Table 30b. Percentage distribution of annual prescription drug costs among noninstitutionalized Medicare beneficiaries age 65 and over, 2017Cost in dollarsPercent of beneficiariesTotal100.0$06.81–49926.4500–99914.61,000–1,4998.41,500–1,9995.52,000–2,4993.82,500–2,9993.33,000–3,4992.63,500–3,9992.74,000–4,4991.94,500–4,9992.35,000 or more21.8NOTE: Reported costs have been adjusted to account for underreporting of prescription drug use. Reference population: These data refer to noninstitutionalized Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Cost Supplement.

121INDICATOR 30: Prescription DrugsTable 30c. Number of Medicare beneficiaries age 65 and over who enrolled in Part D prescription drug plans or who were covered by retiree drug subsidy payments, 2006 and 2017Part D benefit categories20062017All Medicare beneficiaries age 65 and over36,454,84049,678,033Enrollees in prescription drug plans16,935,23135,934,242Type of planStand-alone plan 11,345,01220,940,252Medicare Advantage plan5,590,21914,993,990Low-income subsidyYes5,560,1717,397,405No11,375,06028,536,838Retiree drug subsidy6,548,1381,610,847Other12,971,47112,132,944NOTE: Some data for 2006 have been revised and differ from previous editions of Older Americans. Reference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare claims and enrollment data.

122INDICATOR 31: Sources of Health InsuranceTable 31a. Percentage of noninstitutionalized Medicare beneficiaries age 65 and over with supplemental health insurance, by type of insurance, 1991–2017Type of insurance19911992199319941995199619971998199920002001200220032004Private (employer- or union-sponsored)40.741.040.840.339.137.837.637.035.835.936.036.136.136.6Private (Medigap or other supplemen-tal coverage)a44.845.045.345.244.338.635.833.933.233.534.537.534.333.7Medicare Advantage/Capitated Payment Plans 6.35.97.79.110.913.816.618.620.520.418.015.514.815.6Medicaid8.99.09.49.910.19.59.49.69.79.910.610.711.611.3TRICARE————————————4.54.2Other public4.05.35.85.55.04.84.74.85.14.95.45.55.75.2No supplement11.310.49.79.39.19.49.28.99.09.710.112.39.19.7 2005200620072008200920102011201220132014201520162017Private (employer- or union-sponsored)36.134.935.334.232.531.629.829.428.0*23.4 22.3 24.1Private (Medigap or other supplemen-tal coverage)a34.632.531.529.527.826.526.425.425.4*31.7 27.0 29.1Medicare Advantage/Capitated Payment Plans 15.520.721.523.228.529.231.332.333.8*36.3 37.7 35.4Medicaid11.811.911.911.711.812.512.913.112.8*10.5 10.3 9.5 TRICARE5.15.25.15.45.25.04.95.25.0*5.0 5.5 6.0 Other public5.64.34.03.93.63.33.22.72.3*5.2 3.5 3.4 No supplement8.99.410.510.59.39.910.010.610.8*9.7 10.6 10.2* To accommodate changes in sampling and data collection methodologies, the 2014 Medicare Current Beneficiary Survey data are not being released.— Not available.a Includes people with a private supplement of unknown sponsorship.NOTE: Estimates are based on beneficiaries’ insurance status in the fall of each year. Categories are not mutually exclusive (i.e., individuals may have more than one supplemental policy). Table excludes beneficiaries whose primary insurance is not Medicare (approximately 1 percent to 3 percent of beneficiaries). Prior to 2015, supplemental policy estimates were calculated using the first five policies only. Estimates for 2015 and later were calculated using all available policy information. Medicare Advantage/Capitated Payment Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and private fee-for-service (PFFS) plans. Not all types of plans were available in all years. Since 2003, these types of plans have been known collectively as Medicare Advantage and/or Medicare Part C. Prior to 2015, Medicaid coverage was determined from both survey responses and Medicare administrative records. Starting with 2015, Medicaid coverage is determined from administrative records only. TRICARE coverage was added to Medicare Current Beneficiary Survey Access to Care files beginning in 2003. Previous versions of the Older Americans did not include data on TRICARE coverage. Adding TRICARE coverage to the table changes the percentage of beneficiaries in the “No supplement” group. The weighting process in the 2017 Survey File was improved to reflect the distribution of enrollment in Medicare Advantage. All 2017 estimates are based on enhanced survey weights.Reference population: These estimates refer to noninstitutionalized Medicare beneficiaries who were continuously enrolled during the calendar year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Access to Care (1992–2013) and Survey File (2015–2017).Table 31b. Percentage of people ages 55–64 with health insurance coverage, by poverty status and type of insurance, 2018Type of insuranceTotalPoverty thresholdBelow 100 percent100 percent to 199 percent200 percent or morePrivate 72.317.240.885.2Medicaid 10.848.126.03.2Medicare 4.910.213.22.7Other coverage3.53.53.63.5Uninsured8.521.116.55.4NOTE: Classification of health insurance is based on a hierarchy of mutually exclusive categories. People with more than one type of health insurance were assigned to the first appropriate category in the hierarchy. The “uninsured” category includes people who had no coverage as well as those who only had Indian Health Service coverage or a private plan that paid for one type of service, such as accidents or dental care. See glossary for definition of poverty. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: National Center for Health Statistics, National Health Interview Survey.

123INDICATOR 32: Out-of-Pocket Heath Care ExpendituresTable 32a. Percentage of people age 55 and over with out-of-pocket expenditures for health care service use, by age group, 1977, 1987, 1996, and 2000–2017Age group1977198719962000200120022003200420052006200755–6481.984.089.690.290.490.990.490.090.588.989.555–6181.683.989.589.490.290.789.689.589.688.488.762–6482.684.389.792.491.191.392.791.693.390.691.965 and over83.388.692.493.694.794.494.795.595.095.094.365–7483.487.991.893.394.194.493.795.194.294.193.275–8483.890.092.993.595.694.695.795.896.196.295.385 and over80.888.693.995.294.693.895.896.395.195.595.6Age group200820092010201120122013201420152016201755–6490.188.589.489.190.088.287.387.686.086.955–6189.088.688.387.989.487.186.186.685.286.262–6493.088.392.292.091.691.390.590.087.988.565 and over95.094.393.794.094.392.793.592.892.592.765–7494.393.893.493.793.692.292.691.792.192.575–8495.794.894.194.995.994.795.495.293.793.285 and over95.895.193.993.193.789.993.092.491.892.2NOTE: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Data for the 1987 survey have been adjusted to permit comparability across years; for details, see Zuvekas and Cohen (2002).43Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS) and MEPS predecessor surveys.Table 32b. Percentage of household income per person attributable to out-of-pocket health care expenditures among people age 55 and over, by selected characteristics, 1977, 1987, 1996, 2000, and 2005–2017Selected characteristic19771987199620002005200620072008200920102011201220132014201520162017Total55–645.25.87.17.07.17.16.06.26.26.16.55.65.64.94.64.75.055–615.15.76.26.16.76.65.85.85.85.86.15.75.74.54.24.44.762–645.55.99.59.38.28.56.67.37.47.17.65.45.56.25.55.65.865 and over7.28.88.49.110.910.08.68.48.17.87.17.06.57.16.24.75.065–746.47.27.78.19.29.17.27.07.07.46.35.95.35.64.75.15.075–848.811.09.010.412.510.510.09.59.37.57.77.26.98.87.56.67.885 and over7.912.09.810.113.012.210.110.79.410.28.910.511.010.19.68.411.1Income categoryPoor/near-poor55–6416.118.130.029.927.728.823.324.326.124.825.321.720.217.014.117.517.555–6117.519.827.628.127.927.724.124.225.124.323.823.221.116.012.816.516.662–6413.314.034.3*27.331.521.224.428.526.128.618.217.419.617.320.119.565 and over12.315.819.222.627.628.121.919.422.421.420.520.017.520.116.116.119.165–7411.013.721.624.426.229.420.219.423.327.121.019.515.318.812.615.116.475–8414.419.018.322.928.627.924.518.321.515.320.217.515.923.618.315.919.785 and over12.414.7*17.628.624.920.021.622.519.920.125.225.117.619.919.425.8See notes at end of table.

124INDICATOR 32: Out-of-Pocket Heath Care ExpendituresTable 32b. Percentage of household income per person attributable to out-of-pocket health care expenditures among people age 55 and over, by selected characteristics, 1977, 1987, 1996, 2000, and 2005–2017—continuedSelected characteristic19771987199620002005200620072008200920102011201220132014201520162017Low/middle/high55–643.93.73.23.44.24.03.83.83.43.43.43.23.33.13.22.73.055–613.73.42.93.13.93.83.53.43.23.03.33.13.12.73.02.52.962–644.24.63.84.35.34.84.54.94.04.33.63.33.74.03.83.43.265 and over5.47.05.66.37.46.05.65.95.25.24.74.54.54.54.54.14.465–745.05.94.95.66.25.24.94.84.34.34.13.93.83.63.83.73.475–846.28.46.36.98.86.56.17.26.25.85.25.05.15.35.24.65.485 and over5.210.97.87.68.28.27.27.46.47.85.75.86.67.06.45.47.2Health status categoryPoor or fair health55–648.78.513.014.112.713.210.011.39.810.912.09.510.010.69.78.59.955–618.89.011.812.811.812.99.810.910.210.911.310.011.110.48.87.810.162–648.67.615.917.415.314.010.512.28.811.113.68.17.311.212.210.49.565 and over9.511.011.713.115.512.911.311.810.510.99.09.78.710.38.48.110.665–748.710.010.711.814.313.111.311.49.611.08.38.86.99.36.07.58.375–8411.312.411.814.617.113.011.311.211.99.89.99.78.610.211.68.112.085 and over8.912.2*13.814.512.211.214.410.013.29.211.913.513.811.010.615.2Excellent, very good, or good health55–643.94.65.04.04.94.84.44.14.84.34.34.13.93.73.53.94.155–613.94.54.13.54.64.34.33.94.14.03.94.03.73.33.23.63.762–644.14.97.35.65.66.35.04.86.85.35.24.34.74.94.24.65.065 and over6.17.16.66.78.18.27.06.46.86.16.15.65.56.25.65.45.665–745.35.46.36.26.67.15.35.05.75.85.54.74.74.64.44.54.475–847.59.77.27.59.28.89.28.37.86.06.35.96.08.36.56.26.685 and over7.611.86.47.111.912.29.27.99.07.88.79.28.88.89.27.99.9* Base is not large enough to produce reliable results.NOTE: Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Including expenditures for out-of-pocket premiums in the estimates of out-of-pocket spending would increase the percentage of household income spent on health care in all years. People are classified into the “poor/near-poor” income category if their household income is below 125 percent of the poverty level; otherwise, people are classified into the “low/middle/high” income category. The poverty level is calculated according to the U.S. Census Bureau guidelines for the corresponding year. The ratio of a person’s out-of-pocket expenditures to their household income was calculated based on the person’s per capita household income. For people whose ratio of out-of-pocket expenditures to income exceeded 100 percent, the ratio was capped at 100 percent. For people with out-of-pocket expenditures and with zero income (or negative income), the ratio was set at 100 percent. For people with no out-of-pocket expenditures, the ratio was set to zero. These methods differ from what was used in Older Americans 2004, which excluded persons with no out-of-pocket expenditures from the calculations (17 percent of the population age 65 and over in 1977 and 4.5 percent of the population age 65 and over in 2004). Data from the 1987 survey have been adjusted to permit comparability across years; for details see Zuvekas and Cohen (2002).43Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS) and MEPS predecessor surveys.

125INDICATOR 32: Out-of-Pocket Heath Care ExpendituresTable 32c. Percentage distribution of total out-of-pocket health care expenditures among people age 55 and over, by age group and type of health care service, 2000–2017Year and type of health care service65 and over55–6455–6162–6465–7475–8485 and over2000Total100.0100.0100.0100.0100.0100.0100.0Hospital care6.48.57.5*7.34.68.6Office-based medical provider services9.818.919.816.711.69.06.0Dental services15.820.021.317.017.515.99.6Prescription drugs53.644.744.046.557.151.548.0Other health care14.37.87.58.76.619.027.92001Total100.0100.0100.0100.0100.0100.0100.0Hospital care5.49.89.410.75.25.8*Office-based medical provider services9.419.819.919.710.59.66.0Dental services13.018.620.015.215.611.98.3Prescription drugs56.045.744.348.957.258.945.1Other health care16.26.16.45.511.513.8*2002Total100.0100.0100.0100.0100.0100.0100.0Hospital care5.010.29.213.14.65.55.1Office-based medical provider services10.521.321.620.312.39.37.8Dental services14.018.118.317.717.612.36.2Prescription drugs58.243.843.544.757.956.665.5Other health care12.36.67.44.37.716.315.42003Total100.0100.0100.0100.0100.0100.0100.0Hospital care5.29.28.810.15.94.55.1Office-based medical provider services8.718.818.319.99.49.15.4Dental services11.816.716.716.914.59.59.5Prescription drugs58.348.549.047.561.354.559.8Other health care16.06.87.35.68.922.420.22004Total100.0100.0100.0100.0100.0100.0100.0Hospital care5.09.210.16.95.14.5*Office-based medical provider services10.120.118.723.612.49.25.3Dental services11.816.918.512.813.212.07.5Prescription drugs61.446.045.048.761.964.851.9Other health care11.87.87.78.17.49.529.52005Total100.0100.0100.0100.0100.0100.0100.0Hospital care5.412.212.810.85.15.75.4Office-based medical provider services11.419.619.619.911.412.38.7Dental services15.315.716.314.319.412.69.8Prescription drugs57.845.944.749.057.959.153.3Other health care10.16.56.76.16.210.422.72006Total100.0100.0100.0100.0100.0100.0100.0Hospital care7.2*9.4*6.65.912.2Office-based medical provider services12.319.820.917.414.111.09.5Dental services16.213.915.410.619.715.37.6Prescription drugs51.143.248.532.051.553.245.2Other health care13.25.55.84.98.114.725.5See notes at end of table.

126INDICATOR 32: Out-of-Pocket Heath Care ExpendituresTable 32c. Percentage distribution of total out-of-pocket health care expenditures among people age 55 and over, by age group and type of health care service, 2000–2017—continuedYear and type of health care service65 and over55–6455–6162–6465–7475–8485 and over2007Total100.0100.0100.0100.0100.0100.0100.0Hospital care*12.412.611.94.4**Office-based medical provider services13.722.121.723.115.512.710.4Dental services18.521.121.320.721.416.414.9Prescription drugs47.338.838.838.749.545.445.3Other health care11.65.65.75.59.210.221.62008Total100.0100.0100.0100.0100.0100.0100.0Hospital care6.314.214.713.37.35.94.5Office-based medical provider services15.023.124.021.417.314.99.3Dental services19.619.919.820.221.419.814.2Prescription drugs42.035.935.836.344.841.235.9Other health care17.16.85.88.89.218.236.12009Total100.0100.0100.0100.0100.0100.0100.0Hospital care10.616.013.3*6.414.512.7Office-based medical provider services15.823.224.620.318.814.011.8Dental services18.721.623.018.623.015.415.0Prescription drugs41.332.232.232.144.240.236.1Other health care13.67.06.97.17.715.924.42010Total100.0100.0100.0100.0100.0100.0100.0Hospital care7.912.212.611.47.86.810.8Office-based medical provider services15.824.724.425.417.514.613.0Dental services20.420.619.223.421.422.213.4Prescription drugs44.436.337.633.946.344.039.3Other health care11.46.26.45.87.012.423.52011Total100.0100.0100.0100.0100.0100.0100.0Hospital care7.816.615.519.18.67.46.0Office-based medical provider services15.924.123.724.918.014.812.0Dental services20.018.318.518.120.224.311.4Prescription drugs40.234.635.033.742.441.530.7Other health care16.16.47.34.210.911.939.92012Total100.0100.0100.0100.0100.0100.0100.0Hospital care9.218.015.5*10.08.2*Office-based medical provider services15.623.724.322.419.713.58.6Dental services22.117.318.115.623.026.7*Prescription drugs34.234.936.232.137.739.418.4Other health care18.86.26.06.59.512.250.82013Total100.0100.0100.0100.0100.0100.0100.0Hospital care7.716.018.410.97.49.65.6Office-based medical provider services19.227.225.530.822.116.914.5Dental services21.018.517.720.023.223.610.5Prescription drugs33.330.529.931.735.735.522.6Other health care18.87.98.56.711.714.346.9See notes at end of table.

127INDICATOR 32: Out-of-Pocket Heath Care ExpendituresTable 32c. Percentage distribution of total out-of-pocket health care expenditures among people age 55 and over, by age group and type of health care service, 2000–2017—continuedYear and type of health care service65 and over55–6455–6162–6465–7475–8485 and over2014Total100.0100.0100.0100.0100.0100.0100.0Hospital care8.815.014.915.18.59.68.1Office-based medical provider services20.728.428.029.324.717.914.7Dental services21.116.917.914.922.322.515.2Prescription drugs32.131.030.731.734.033.924.2Other health care17.38.78.59.110.416.237.72015Total100.0100.0100.0100.0100.0100.0100.0Hospital care7.612.712.313.48.37.65.4Office-based medical provider services20.029.330.127.626.215.89.5Dental services22.018.517.520.523.422.816.0Prescription drugs30.031.532.230.333.030.020.3Other health care20.48.08.08.29.123.848.82016Total100.0100.0100.0100.0100.0100.0100.0Hospital care8.713.713.114.99.68.36.0Office-based medical provider services20.732.532.931.824.018.113.7Dental services22.520.019.321.423.223.916.5Prescription drugs29.326.026.924.332.827.021.1Other health care18.87.87.87.610.422.742.62017Total100.0100.0100.0100.0100.0100.0100.0Hospital care5.812.914.110.46.96.13.0Office-based medical provider services20.530.529.832.122.823.211.2Dental services19.821.819.825.824.320.68.6Prescription drugs26.625.227.820.133.324.215.2Other health care27.29.68.611.612.625.962.0* Estimate not shown because of a relative standard error greater than 30 percent.NOTE: Percentages in this table might not sum to 100 percent because of rounding. Out-of-pocket health care expenditures exclude personal spending for health insurance premiums. Hospital care includes hospital inpatient care and care provided in hospital outpatient departments and emergency rooms. Office-based medical provider services include services provided by medical providers in non-hospital-based medical offices or clinic settings. Dental services include care provided by any type of dental provider. Prescription drugs include prescribed medications purchased, including refills. Other health care includes care provided by home health agencies and independent home health providers and expenses for eyewear, ambulance services, orthopedic items, hearing devices, prostheses, bathroom aids, medical equipment, disposable supplies, and other miscellaneous services. The majority of expenditures in the “other” category are for home health services and eyeglasses. Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey.

128INDICATOR 33:Sources of Payment for Health Care ServicesTable 33. Average cost per beneficiary and percentage distribution of sources of payment for health care services for Medicare beneficiaries age 65 and over, by type of service, 2017Type of serviceAverage cost per beneficiarySources of paymentTotalMedicareMedicaidOut-of-pocketOtherAll$18,620100.065.45.516.612.5Hospice347100.0100.0 Inpatient hospital3,757100.087.80.91.210.2Home health care531100.079.8***11.9**Short-term institution827100.073.711.410.44.5Physician/medical4,250100.067.71.115.715.5Outpatient hospital2,064100.080.31.25.912.6Prescription drugs3,255100.063.6**18.318.0Dental567100.02.3*0.277.220.3Long-term care facility1,684100.0**43.850.6*4.9* Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error of 20 percent to 30 percent.** Estimates are not shown because of a relative standard error greater than 30 percent.NOTE: “Other” refers to private insurance, Department of Veterans Affairs, uncollected liability, and other public programs. Estimates may not sum to the totals because of rounding or suppression because of high relative standard errors.Reference population: These data refer to Medicare beneficiaries.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Cost Supplement.INDICATOR 34: Veterans’ Health CareTable 34. Total number of veterans age 65 and over who are enrolled in Veterans Health Administration, by age group, 2003–2018 and projected 2023–2038YearAll ages65 and overTotal65–6970–7475–7980–8485 and overActual20036,986,9583,218,901709,240845,958857,769599,645206,28920087,760,5023,365,055656,428697,441785,151711,054514,98120138,748,7184,015,0451,298,196680,450648,932656,241731,22620189,157,8814,503,7861,206,1861,331,767654,024541,464770,345Projected20239,223,0004,575,000853,0001,194,0001,259,000564,000705,00020289,070,0004,540,000843,000828,0001,099,0001,067,000703,00020338,806,0004,343,000768,000815,000766,000909,0001,085,00020388,453,0004,067,000762,000738,000753,000647,0001,167,000NOTE: Department of Veterans Affairs (VA) enrollees are veterans who have signed up to receive health care from Veterans Health Administration (VHA). Counts for 2023–2038 are projections from the 2019 VA Enrollee Health Care Projection Model.Reference population: These data refer to the count of unique VHA enrollees per fiscal year.SOURCE: Department of Veterans Affairs, Chief Strategy Office, 2019 VA Enrollee Health Care Projection Model.

129INDICATOR 35: Residential ServicesTable 35a. Percentage distribution of Medicare beneficiaries age 65 and over residing in selected residential settings, by age group, 2017Residential settingTotal65 and over65–7475–8485 and overTotal100.0100.0100.0100.0Traditional community94.797.994.980.8Community housing with services2.41.22.37.5Long-term care facilities2.90.92.911.7Number (in thousands)46,15025,77714,3256,048NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior citizen housing, continuing care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations and who reported they had access to one or more of the following services through their place of residence: meal preparation, cleaning or housekeeping services, laundry services, or help with medications. Respondents were asked about access to these services but not whether they actually used the services. A residence (or unit) is considered a long-term care facility if it is certified by Medicare or Medicaid; or has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least one personal care service; or provides 24-hour, 7-day-a-week supervision by a nonfamily, paid caregiver.Reference population: These estimates refer to Medicare beneficiaries who were continuously enrolled during the calendar year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Survey File.Table 35b. Percentage distribution of Medicare beneficiaries age 65 and over with limitations in performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs), by residential setting, 2017Functional statusOverallTraditionalcommunityCommunity housingwith servicesLong-termcare facilitiesTotal100.0100.0100.0100.0No functional limitations60.963.041.26.5IADL limitation(s) only12.912.618.015.71–2 ADL limitations17.116.627.724.33 or more ADL limitations9.27.713.153.5NOTE: Community housing with services applies to respondents who reported they lived in retirement communities or apartments, senior citizen housing, continuing care retirement facilities, assisted living facilities, staged living communities, board and care facilities/homes, and similar situations and who reported they had access to one or more of the following services through their place of residence: meal preparation, cleaning or housekeeping services, laundry services, or help with medications. Respondents were asked about access to these services but not whether they actually used the services. A residence (or unit) is considered a long-term care facility if it is certified by Medicare or Medicaid; or has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least one personal care service; or provides 24-hour, 7-day-a-week supervision by a nonfamily, paid caregiver. Long-term care facility residents with no limitations may include individuals with limitations in performing certain IADLs, such as doing light or heavy housework or meal preparation. These questions were not asked of facility residents.Reference population: These estimates refer to Medicare beneficiaries who were continuously enrolled during the calendar year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Survey File.

130INDICATOR 36: Personal Assistance and EquipmentTable 36a. Percentage distribution of noninstitutionalized Medicare beneficiaries age 65 and over who have limitations in performing activities of daily living (ADLs), by type of assistance, 1992–2017YearTotalPersonalassistance onlyEquipmentonlyPersonal assistance and equipmentNo personal assistance or equipment1992100.08.729.122.539.71993100.08.629.722.938.81994100.07.732.524.035.81995100.07.832.824.235.21996100.07.233.424.335.11997100.05.735.223.835.41998100.06.132.225.236.51999100.06.236.221.536.12000100.06.336.822.834.12001100.06.136.824.232.92002100.06.336.923.733.12003100.05.736.524.033.72004100.06.735.923.933.52005100.06.537.723.632.22006100.06.537.624.931.02007100.06.039.224.330.52008100.05.039.823.232.02009100.06.239.525.528.92010100.06.538.524.830.22011100.05.839.325.229.82012100.07.434.426.332.02013100.06.836.327.329.62014*****2015100.07.335.028.129.62016100.05.637.828.827.82017100.05.939.529.225.4* To accommodate changes in sampling and data collection methodologies, the 2014 Medicare Current Beneficiary Survey data are not being released. NOTE: Limitations in performing activities of daily living (ADL) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. Personal assistance is defined as assistance with performing the task. In this table, personal assistance does not include supervision. Estimates may not sum to the totals because of rounding.Reference population: These data refer to noninstitutionalized Medicare beneficiaries who have limitations in performing one or more ADLs and are continuously enrolled during the year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Access to Care (1992–2013) and Survey File (2015–2017).Table 36b. Percentage distribution of noninstitutionalized Medicare beneficiaries age 65 and over who have limitations in performing activities of daily living (ADLs), by type of assistance, age group, and sex, 2017Age group and sexTotalPersonalassistance onlyEquipmentonlyPersonal assistance and equipmentNo personal assistance or equipment65 and over100.05.939.529.225.4Men100.05.639.224.330.9Women100.06.139.732.022.265–74100.06.436.322.634.775–84100.05.643.129.122.285 and over100.05.440.041.313.3NOTE: Limitations in performing activities of daily living (ADL) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. Personal assistance is defined as assistance with performing the task. In this table, personal assistance does not include supervision. Estimates may not sum to the totals because of rounding.Reference population: These data refer to noninstitutionalized Medicare beneficiaries who have limitations in performing one or more ADLs and are continuously enrolled during the year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Survey File.

131INDICATOR 36: Personal Assistance and EquipmentTable 36c. Percentage of noninstitutionalized Medicare beneficiaries age 65 and over who have limitations in performing instrumental activities of daily living (IADLs) and who receive personal assistance, by age group, 1992–2017YearTotal65 and over65–7475–8485 and over199265.362.366.476.0199364.360.065.478.9199465.264.064.173.8199566.363.067.675.4199666.264.166.274.5199767.164.367.774.9199869.166.968.976.8199967.965.667.876.1200065.459.167.378.5200169.066.368.877.3200270.869.770.575.4200370.969.669.578.1200469.065.170.375.4200569.565.270.677.3200667.666.166.574.0200771.068.771.475.7200870.971.070.571.5200970.368.370.774.0201070.067.868.977.8201172.569.771.979.7201273.071.271.880.3201371.165.774.279.52014****201570.766.474.075.0201671.769.971.477.9201771.169.369.779.2* To accommodate changes in sampling and data collection methodologies, the 2014 Medicare Current Beneficiary Survey data are not being released. NOTE: Limitations in performing instrumental activities of daily living (IADL) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light housework, heavy housework, meal preparation, shopping, or managing money.Reference population: These data refer to noninstitutionalized Medicare beneficiaries who have limitations in performing one or more IADLs and are continuously enrolled during the year. The population excludes beneficiaries who also have limitations in performing activities of daily living.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Access to Care (1992–2013) and Survey File (2015–2017).Table 36d. Percentage of noninstitutionalized Medicare beneficiaries age 65 and over who have limitations in performing instrumental activities of daily living (IADLs) and who receive personal assistance, by sex and age group, 2017Age groupMenWomen65–7468.270.775–8470.871.885 and over71.981.5NOTE: Limitations in performing instrumental activities of daily living (IADL) refer to difficulty performing (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light housework, heavy housework, meal preparation, shopping, or managing money.Reference population: These data refer to noninstitutionalized Medicare beneficiaries who have limitations in performing one or more IADLs and are continuously enrolled during the year. The population excludes beneficiaries who also have limitations in performing activities of daily living.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Survey File.

132INDICATOR 37: Long-Term Care ProvidersTable 37a. Number of users of long-term care services, by sector and age group, 2015 and 2016Age groupNursing homes(2016)Residential care communities(2016)Adult day services centers(2016)Home health agencies(2015)Hospices(2015)Less than 65222,40053,600107,100806,50078,40065–74245,30089,30058,1001,194,100249,60075–84359,800245,90074,2001,332,300417,80085 and over520,200422,80046,7001,122,800681,600NOTE: The long-term care services described here are provided by paid, regulated providers. They comprise both health care-related and non-health care-related services, including postacute care and rehabilitation. People can receive more than one type of service. The estimated number of nursing home residents represents current residents in 2016. The estimated number of residential care community residents represents current residents in 2016. The estimated number of adult day services center participants represents current participants in 2016. The estimated number of home health patients represents patients who ended care in 2015 (i.e., discharges). The estimated number of hospice patients represents patients who received care at any time in 2015. The number in each age group is calculated by applying the percentage distribution by age to the estimated total number of users and may differ slightly from other published estimates because of rounding. See https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf for definitions.Reference population: These data refer to the resident population. SOURCE: National Center for Health Statistics, National Study of Long-Term Care Providers.Table 37b. Percentage of users of long-term care services needing any assistance with activities of daily living (ADLs), by sector and activity, 2015 and 2016ActivityNursing homes(2016)Residential care communities(2016)Adult day services centers(2016)Home healthagencies(2015)Bathing96.763.638.697.2Dressing92.748.236.092.0Toileting89.340.033.581.1Walking or locomotion92.056.545.895.4Transferring in/out of bed or chair86.829.228.591.3Eating59.919.223.261.2NOTE: The long-term care services described here are provided by paid, regulated providers. They comprise both health care-related and non-health care-related services, including postacute care and rehabilitation. People can receive more than one type of service. Users of formal long-term care include persons of all ages. In nursing homes, 84 percent of residents were age 65 and over. In residential care communities, 93 percent of residents were age 65 and over. In adult day services centers, 63 percent of participants were age 65 and over. Among home health care patients, 82 percent were age 65 and over. Data were not available for hospice patients. Participants, patients, or residents were considered needing any assistance with a given activity if they needed help or supervision from another person or used assistive devices to perform the activity. See https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf for definitions. Reference population: These data refer to the resident population. SOURCE: National Center for Health Statistics, National Study of Long-Term Care Providers.

133INDICATOR 38: Use of TimeTable 38a. Average number of hours per day and percentage of day that people age 55 and over spent doing selected activities on an average day, by age group, 2018 55 and over55–6465–7475 and overAverage hours per dayPercentof dayAverage hours per dayPercentof dayAverage hours per dayPercentof dayAverage hours per dayPercentof daySleeping8.8336.88.6636.18.8837.09.1238.0Leisure activities6.5427.35.4922.97.1729.97.7532.3Work and work-related activities2.169.03.7915.81.054.40.492.0Household activities2.229.32.108.82.4510.22.148.9Caring for and helping others0.472.00.471.90.582.40.311.3Eating and drinking1.265.31.184.91.285.31.415.9Purchasing goods and services0.823.40.793.30.853.50.833.5Grooming0.642.70.652.70.632.60.632.6Other activities1.054.40.863.61.124.61.315.5NOTE: “Other activities” includes activities such as educational activities; organizational, civic, and religious activities; and telephone calls. Table includes people who did not work at all.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Bureau of Labor Statistics, American Time Use Survey.Table 38b. Average number of hours and percentage of total leisure time that people age 55 and over spent doing selected leisure activities on an average day, by age group, 2018 55 and over55–6465–7475 and overAverage hours per dayPercent of leisure timeAverage hours per dayPercent of leisure timeAverage hours per dayPercent of leisure timeAverage hours per dayPercent of leisure timeSocializing and communicating0.609.20.5910.70.679.30.536.8Watching TV4.0061.13.3661.34.3460.64.7861.7Participation in sports, exercise, and recreation0.243.70.234.20.283.90.212.7Relaxing and thinking0.446.70.376.80.425.90.597.7Reading0.507.70.275.00.618.60.8010.3Other leisure activities0.7611.60.6712.10.8411.70.8410.8NOTE: “Other leisure activities” includes activities such as playing games, using the computer for leisure, doing arts and crafts as a hobby, experiencing arts and entertainment (other than sports), and engaging in related travel.Reference population: These data refer to the civilian noninstitutionalized population.SOURCE: Bureau of Labor Statistics, American Time Use Survey.

134INDICATOR 39: Air QualityTable 39a. Percentage of people age 65 and over living in counties with “poor air quality,” by selected pollutant measures, 2000–2018Pollutant measures2000200120022003200420052006200720082009201020112012201320142015201620172018Particulate matter (PM2.5)50.147.747.142.937.845.635.538.425.717.715.014.37.29.79.68.85.910.510.6Ozone58.259.257.459.650.558.258.457.350.333.047.848.752.926.924.330.833.928.935.5Any standard68.767.665.367.461.467.265.664.355.938.451.051.454.332.826.734.836.232.139.9NOTE: The term “poor air quality” is defined as air quality concentrations above the level of the National Ambient Air Quality Standards (NAAQS). The term “any standard” refers to any NAAQS for ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon monoxide, or lead. PM2.5 refers to fine inhalable particles with diameters that are generally 2.5 micrometers and smaller. Data for previous years have been computed using the the standards in effect as of August 2019 to enable comparisons over time. This results in percentages that are not comparable to those in previous publications of Older Americans. Measuring concentrations above the level of a standard is not equivalent to violating the standard. The level of a standard may be exceeded on multiple days before the exceedance is considered a violation of the standard.Reference population: These data refer to the resident population.SOURCE: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S. Census Bureau, 2010 Population.Table 39b. Counties with “poor air quality” for any standard in 2018StateCountyTotal population (in Census 2010)Population 65 and over (in Census 2010)AlaskaFairbanks North Star Borough 97,581 6,375 AlaskaMatanuska-Susitna Borough 88,995 7,069 ArizonaGila County 53,597 12,450 ArizonaMaricopa County 3,817,117 462,641 ArizonaPima County 980,263 151,293 ArizonaPinal County 375,770 52,071 ArizonaYuma County 195,751 30,646 CaliforniaAlameda County 1,510,271 167,746 CaliforniaAmador County 38,091 7,865 CaliforniaButte County 220,000 33,817 CaliforniaCalaveras County 45,578 9,565 CaliforniaColusa County 21,419 2,495 CaliforniaContra Costa County 1,049,025 130,438 CaliforniaEl Dorado County 181,058 26,524 CaliforniaFresno County 930,450 93,421 CaliforniaImperial County 174,528 18,152 CaliforniaInyo County 18,546 3,535 CaliforniaKern County 839,631 75,437 CaliforniaKings County 152,982 12,030 CaliforniaLake County 64,665 11,440 CaliforniaLos Angeles County 9,818,605 1,065,699 CaliforniaMadera County 150,865 17,262 CaliforniaMarin County 252,409 42,192 CaliforniaMariposa County 18,251 3,821 CaliforniaMendocino County 87,841 13,493 CaliforniaMerced County 255,793 23,960 CaliforniaMono County 14,202 1,377 CaliforniaNapa County 136,484 20,594 CaliforniaNevada County 98,764 19,174 CaliforniaOrange County 3,010,232 349,677 CaliforniaPlacer County 348,432 53,562 CaliforniaPlumas County 20,007 4,154 CaliforniaRiverside County 2,189,641 258,586 CaliforniaSacramento County 1,418,788 158,551 CaliforniaSan Benito County 55,269 5,360 See notes at end of table.

135INDICATOR 39: Air QualityTable 39b. Counties with “poor air quality” for any standard in 2018—continuedStateCountyTotal population (in Census 2010)Population 65 and over (in Census 2010)CaliforniaSan Bernardino County 2,035,210 181,348 CaliforniaSan Diego County 3,095,313 351,425 CaliforniaSan Francisco County 805,235 109,842 CaliforniaSan Joaquin County 685,306 71,181 CaliforniaSan Luis Obispo County 269,637 41,022 CaliforniaSan Mateo County 718,451 96,262 CaliforniaSanta Clara County 1,781,642 196,944 CaliforniaSanta Cruz County 262,382 29,158 CaliforniaShasta County 177,223 29,967 CaliforniaSiskiyou County 44,900 8,782 CaliforniaSolano County 413,344 46,847 CaliforniaSonoma County 483,878 67,364 CaliforniaStanislaus County 514,453 54,831 CaliforniaSutter County 94,737 11,990 CaliforniaTehama County 63,463 10,071 CaliforniaTulare County 442,179 41,779 CaliforniaTuolumne County 55,365 11,294 CaliforniaVentura County 823,318 96,309 CaliforniaYolo County 200,849 19,771 ColoradoArapahoe County 572,003 57,580 ColoradoBoulder County 294,567 29,521 ColoradoClear Creek County 9,088 1,132 ColoradoDenver County 600,158 62,132 ColoradoDouglas County 285,465 20,343 ColoradoEl Paso County 622,263 62,051 ColoradoJefferson County 534,543 67,411 ColoradoLa Plata County 51,334 5,979 ColoradoLarimer County 299,630 35,541 ColoradoMontezuma County 25,535 4,269 ColoradoWeld County 252,825 24,235 ConnecticutFairfield County 916,829 124,075 ConnecticutLitchfield County 189,927 30,342 ConnecticutMiddlesex County 165,676 25,621 ConnecticutNew Haven County 862,477 123,972 ConnecticutNew London County 274,055 38,995 ConnecticutTolland County 152,691 18,220 ConnecticutWindham County 118,428 15,215 DelawareNew Castle County 538,479 66,222 District of ColumbiaDistrict of Columbia 601,723 68,809 FloridaDuval County 864,263 96,169 GeorgiaFulton County 920,581 83,424 HawaiiHawaii County 185,079 26,834 IdahoShoshone County 12,765 2,537 IllinoisChampaign County 201,081 20,066 IllinoisCook County 5,194,675 620,329 IllinoisDuPage County 916,924 106,398 IllinoisKane County 515,269 49,690 See notes at end of table.

136INDICATOR 39: Air QualityTable 39b. Counties with “poor air quality” for any standard in 2018—continuedStateCountyTotal population (in Census 2010)Population 65 and over (in Census 2010)IllinoisLake County 703,462 73,093 IllinoisMcHenry County 308,760 31,320 IllinoisMacon County 110,768 18,142 IllinoisMadison County 269,282 38,428 IllinoisSt. Clair County 270,056 33,810 IllinoisWill County 677,560 62,814 IndianaAllen County 355,329 42,137 IndianaBoone County 56,640 6,644 IndianaClark County 110,232 14,055 IndianaFloyd County 74,578 9,660 IndianaHamilton County 274,569 23,689 IndianaHoward County 82,752 13,441 IndianaKnox County 38,440 6,062 IndianaLake County 496,005 65,870 IndianaLaPorte County 111,467 15,867 IndianaMadison County 131,636 20,234 IndianaMarion County 903,393 96,102 IndianaPorter County 164,343 20,363 IndianaSt. Joseph County 266,931 35,565 IndianaShelby County 44,436 6,188 IndianaWabash County 32,888 5,952 IowaScott County 165,224 21,605 KentuckyHenderson County 46,250 6,551 KentuckyJefferson County 741,096 99,095 KentuckyMadison County 82,916 9,312 LouisianaEast Baton Rouge Parish 440,171 48,030 MarylandAllegany County 75,087 13,402 MarylandAnne Arundel County 537,656 63,664 MarylandBaltimore County 805,029 117,476 MarylandCecil County 101,108 11,875 MarylandHarford County 244,826 30,564 MarylandPrince George’s County 863,420 81,513 MarylandBaltimore City 620,961 72,812 MassachusettsBarnstable County 215,888 53,879 MassachusettsBristol County 548,285 77,879 MichiganAllegan County 111,408 14,438 MichiganBerrien County 156,813 25,549 MichiganCass County 52,293 8,355 MichiganClinton County 75,382 9,705 MichiganKalamazoo County 250,331 30,780 MichiganKent County 602,622 67,104 MichiganLenawee County 99,892 14,580 MichiganMacomb County 840,978 120,180 MichiganMuskegon County 172,188 23,352 MichiganOakland County 1,202,362 159,124 MichiganOttawa County 263,801 31,023 MichiganSt. Clair County 163,040 23,671 See notes at end of table.

137INDICATOR 39: Air QualityTable 39b. Counties with “poor air quality” for any standard in 2018—continuedStateCountyTotal population (in Census 2010)Population 65 and over (in Census 2010)MichiganWashtenaw County 344,791 34,951 MichiganWayne County 1,820,584 230,703 MissouriClay County 221,939 24,964 MissouriJefferson County 218,733 24,394 MissouriNew Madrid County 18,956 3,045 MissouriSt. Charles County 360,485 40,378 MissouriSt. Louis County 998,954 149,493 MissouriSt. Louis city 319,294 35,175 MontanaFlathead County 90,928 13,103 MontanaLewis and Clark County 63,395 8,757 MontanaLincoln County 19,687 4,040 NevadaChurchill County 24,877 3,781 NevadaClark County 1,951,269 220,445 NevadaDouglas County 46,997 9,479 NevadaLyon County 51,980 8,215 NevadaWashoe County 421,407 50,879 NevadaWhite Pine County 10,030 1,494 NevadaCarson City 55,274 9,133 New JerseyBergen County 905,116 137,103 New JerseyCamden County 513,657 65,725 New JerseyEssex County 783,969 90,287 New JerseyGloucester County 288,288 35,699 New JerseyHudson County 634,266 66,066 New JerseyHunterdon County 128,349 16,344 New JerseyMercer County 366,513 46,347 New JerseyMiddlesex County 809,858 99,462 New JerseyMorris County 492,276 68,155 New JerseyOcean County 576,567 121,104 New MexicoBernalillo County 662,564 81,014 New MexicoDoña Ana County 209,233 25,881 New MexicoEddy County 53,829 7,541 New MexicoLea County 64,727 6,991 New MexicoLuna County 25,095 4,907 New MexicoSandoval County 131,561 15,880 New MexicoSan Juan County 130,044 14,083 New MexicoValencia County 76,569 9,742 New YorkBronx County 1,385,108 145,882 New YorkChautauqua County 134,905 22,381 New YorkMonroe County 744,344 103,594 New YorkNew York County 1,585,873 214,153 New YorkQueens County 2,230,722 286,146 New YorkRichmond County 468,730 59,344 New YorkRockland County 311,687 41,841 New YorkSt. Lawrence County 111,944 15,553 New YorkSuffolk County 1,493,350 201,793 New YorkWayne County 93,772 13,363 New YorkWestchester County 949,113 139,122 See notes at end of table.

138INDICATOR 39: Air QualityTable 39b. Counties with “poor air quality” for any standard in 2018—continuedStateCountyTotal population (in Census 2010)Population 65 and over (in Census 2010)North CarolinaHaywood County 59,036 12,416 OhioAllen County 106,331 15,697 OhioButler County 368,130 42,484 OhioClark County 138,333 22,422 OhioCuyahoga County 1,280,122 198,541 OhioGeauga County 93,389 14,474 OhioHamilton County 802,374 106,863 OhioLake County 230,041 36,965 OhioLucas County 441,815 57,809 OhioMontgomery County 535,153 81,041 OhioStark County 375,586 60,978 OhioTrumbull County 210,312 36,617 OhioWarren County 212,693 22,936 OklahomaCanadian County 115,541 12,576 OklahomaCleveland County 255,755 26,177 OklahomaComanche County 124,098 12,702 OklahomaDewey County 4,810 958 OklahomaJefferson County 6,472 1,239 OklahomaLove County 9,423 1,618 OklahomaMuskogee County 70,990 10,408 OklahomaOklahoma County 718,633 86,357 OklahomaOsage County 47,472 7,278 OklahomaTulsa County 603,403 72,856 OregonHarney County 7,422 1,402 OregonJackson County 203,206 35,834 OregonJosephine County 82,713 18,438 OregonKlamath County 66,380 11,351 OregonLake County 7,895 1,612 OregonLane County 351,715 52,781 PennsylvaniaAllegheny County 1,223,348 205,059 PennsylvaniaBeaver County 170,539 31,660 PennsylvaniaBerks County 411,442 59,558 PennsylvaniaBucks County 625,249 91,219 PennsylvaniaDelaware County 558,979 79,726 PennsylvaniaMontgomery County 799,874 120,727 PennsylvaniaNorthampton County 297,735 46,606 PennsylvaniaPhiladelphia County 1,526,006 185,309 Rhode IslandKent County 166,158 26,069 Rhode IslandProvidence County 626,667 84,389 Rhode IslandWashington County 126,979 19,017 TennesseeDavidson County 626,681 65,403 TennesseeShelby County 927,644 95,224 TennesseeSullivan County 156,823 29,215 TexasBell County 310,235 27,003 TexasBexar County 1,714,773 175,883 TexasBrazoria County 313,166 29,923 TexasCollin County 782,341 60,048 TexasDallas County 2,368,139 207,972 See notes at end of table.

139INDICATOR 39: Air QualityTable 39b. Counties with “poor air quality” for any standard in 2018—continuedStateCountyTotal population (in Census 2010)Population 65 and over (in Census 2010)TexasDenton County 662,614 46,043 TexasEl Paso County 800,647 82,223 TexasGalveston County 291,309 32,804 TexasHarris County 4,092,459 333,487 TexasHood County 51,182 10,892 TexasHoward County 35,012 4,615 TexasHunt County 86,129 12,001 TexasHutchinson County 22,150 3,266 TexasJefferson County 252,273 32,002 TexasJohnson County 150,934 17,331 TexasMontgomery County 455,746 47,404 TexasNavarro County 47,735 6,863 TexasOrange County 81,837 11,473 TexasParker County 116,927 14,283 TexasPotter County 121,073 13,142 TexasRandall County 120,725 15,079 TexasRockwall County 78,337 7,540 TexasRusk County 53,330 7,487 TexasTarrant County 1,809,034 161,385 TexasTravis County 1,024,266 74,759 UtahBox Elder County 49,975 5,563 UtahCarbon County 21,403 2,903 UtahDavis County 306,479 24,992 UtahDuchesne County 18,607 1,984 UtahSalt Lake County 1,029,655 89,367 UtahTooele County 58,218 4,379 UtahUtah County 516,564 33,457 UtahWeber County 231,236 23,388 WashingtonBenton County 175,177 20,586 WashingtonKing County 1,931,249 210,679 WashingtonKittitas County 40,915 5,212 WashingtonOkanogan County 41,120 7,070 WashingtonPierce County 795,225 87,785 WashingtonSnohomish County 713,335 73,544 WashingtonSpokane County 471,221 60,969 WashingtonWalla Walla County 58,781 8,778 WashingtonWhatcom County 201,140 26,640 WashingtonYakima County 243,231 28,122 West VirginiaMineral County 28,212 4,893 WisconsinDoor County 27,785 6,245 WisconsinKenosha County 166,426 18,679 WisconsinKewaunee County 20,574 3,393 WisconsinManitowoc County 81,442 13,714 WisconsinMilwaukee County 947,735 109,133 WisconsinOutagamie County 176,695 20,834 WisconsinOzaukee County 86,395 13,208 WisconsinRacine County 195,408 25,739 WisconsinSheboygan County 115,507 16,821 See notes at end of table.

140INDICATOR 39: Air QualityTable 39b. Counties with “poor air quality” for any standard in 2018—continuedStateCountyTotal population (in Census 2010)Population 65 and over (in Census 2010)WyomingSweetwater County 43,806 3,643 Puerto RicoArecibo Municipio, Puerto Rico 96,440 15,727 Puerto RicoBayamón Municipio, Puerto Rico 208,116 34,335 Puerto RicoGuaynabo Municipio, Puerto Rico 97,924 15,811 Puerto RicoPonce Municipio, Puerto Rico 166,327 25,178 NOTE: The term “poor air quality” is defined as air quality concentrations above the level of the National Ambient Air Quality Standards (NAAQS). The term “any standard” refers to any NAAQS for ozone, particulate matter, nitrogen dioxide, sulfur dioxide, carbon monoxide, or lead. Measuring concentrations above the level of a standard is not equivalent to violating the standard. The level of a standard may be exceeded on multiple days before the exceedance is considered a violation of the standard.Reference population: These data refer to the resident population.SOURCE: U.S. Environmental Protection Agency, Office of Air Quality Planning and Standards, Air Quality System; U.S. Census Bureau, 2010 Population.INDICATOR 40: TransportationTable 40. Percentage of noninstitutionalized Medicare beneficiaries age 65 and over who made a change in transportation mode because of a health or physical problem, by age group and type of change, 2017Type of changeTotal65 and over65–7475–8485 and overLimits driving to daytime18.112.922.741.2Has given up driving altogether12.87.713.937.1Has trouble getting places18.314.519.433.4Has reduced travel26.821.129.546.9Reference population: These data refer to noninstitutionalized Medicare beneficiaries who were continuously enrolled during the year.SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Survey File.

Data Sources

142American Community SurveyThe American Community Survey (ACS) is a nationwide survey designed to provide communities with reliable and timely demographic, social, economic, and housing data for the nation, states, congressional districts, counties, places, and other localities every year. It has an annual sample size of about 3.5 million addresses across the United States and Puerto Rico and includes both housing units and group quarters (e.g., nursing facilities, prisons). The ACS is conducted in every county throughout the nation, and every municipio in Puerto Rico, where it is called the Puerto Rico Community Survey. ACS 1-year estimates have been released annually for geographic areas with populations of 65,000 and more since 2006. ACS 5-year estimates have been released annually for all geographic areas down to the block group level, regardless of population size, since 2010. Data included in this report come from 1-year estimates. For information on the ACS sample design and other topics, visit https://www.census.gov/programs-surveys/acs/.For more information, contact:U.S. Census Bureau Customer Service Center Phone: 800-923-8282Website: https://ask.census.govAir Quality System The Air Quality System (AQS) contains ambient air pollution data collected by the U.S. Environmental Protection Agency (EPA) and state, local, and tribal air pollution control agencies. Data on criteria pollutants consist of air quality measurements collected by sensitive equipment at thousands of monitoring stations located across all 50 states plus the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Each monitor measures the concentration of a particular pollutant in the air. Monitoring data indicate the average pollutant concentration during a specified time interval (usually 1 hour or 24 hours). AQS also contains meteorological data, descriptive information about each monitoring station (including its geographic location and its operator), and data quality assurance or quality control information. The system is administered by the EPA’s Office of Air Quality Planning and Standards, Outreach and Information Division, located in Research Triangle Park, NC. For more information, contact: Nick Mangus U.S. Environmental Protection Agency Phone: 919-541-5549 Website: https://www.epa.gov/aqsAmerican Housing Survey The American Housing Survey (AHS) was mandated by Congress in 1968 to provide data for evaluating progress toward “a decent home and a suitable living environment for every American family.” It is the primary source of detailed information on housing in the United States and is used to generate a biennial report to Congress on the conditions of housing in the United States, among other reports. The survey is conducted for the Department of Housing and Urban Development (HUD) by the U.S. Census Bureau. The AHS encompasses a national survey and 35 metropolitan surveys and is designed to collect data from the same housing units for each survey. The integrated national sample, a representative sample of approximately 66,000 housing units as of 2017, is conducted biennially in odd-numbered years. This includes a representative national sample, representative samples of the 15 largest metropolitan areas, and an oversample of HUD-assisted housing units. Two sets of 10 metropolitan samples of 3,000 housing units per metropolitan area alternate in odd-numbered years on a 4-year cycle. The AHS collects data about the inventory and condition of housing in the United States and the demographics of its inhabitants. The survey provides detailed data on the types of housing in the United States and their characteristics and conditions; financial data on housing costs, utilities, mortgages, equity loans, and market value; and demographic data on family composition, income, education, and race and ethnicity. Rotating supplements to the survey collect information on neighborhood quality, walkability, public transportation, and recent movers; the health and safety aspects of a home; accommodations for older and disabled household members; doubling up of households; working from home; access to arts and culture; use of housing counseling; food security; and energy efficiency. Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this report.For more information, contact: George Carter U.S. Department of Housing and Urban Development Office of Policy Development and ResearchPhone: 202-402-5873 Website: https://www.huduser.gov/portal/datasets/ahs.htmlAmerican Time Use Survey The American Time Use Survey (ATUS) is a nationally representative sample survey conducted for the Bureau

143of Labor Statistics by the U.S. Census Bureau. The ATUS measures how people living in the United States spend their time. Estimates show the kinds of activities people do and the time they spend doing them by sex, age, educational attainment, labor force status, and other characteristics, as well as by weekday and weekend day.ATUS respondents are interviewed one time about how they spent their time on the previous day, where they were, and whom they were with. The survey is a continuous survey, with interviews conducted nearly every day of the year and a sample that builds over time. About 12,000 members of the civilian noninstitutionalized population age 15 and over are interviewed each year.Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this report. For more information, contact: American Time Use Survey Staff Bureau of Labor StatisticsU.S. Department of LaborEmail: [email protected]: 202-691-6339 Website: https://www.bls.gov/tus/Consumer Expenditure Survey The Consumer Expenditure (CE) Survey is conducted for the Bureau of Labor Statistics by the U.S. Census Bureau. The survey consists of two separate components: the Quarterly Interview Survey and the Diary Survey. Data are integrated before publication. The data presented in this report are derived from the integrated data available on the CE website. The published data are weighted to reflect the U.S. population.The Quarterly Interview Survey is designed to obtain data on the types of expenditures that respondents can recall for a period of three months or longer. These include relatively large expenditures, such as those for property, automobiles, and major durable goods and those that occur on a regular basis, such as rent and utilities. Each consumer unit is interviewed once per quarter for four consecutive quarters. The Diary Survey is designed to obtain data on frequently purchased smaller items, including food and beverages both at home and in food establishments, housekeeping supplies, tobacco, nonprescription drugs, and personal care products and services. Each consumer unit records its expenditures in a diary for two consecutive one-week periods. Respondents are less likely to recall such purchases over longer periods.Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this report. For more information, contact: Bureau of Labor Statistics U.S. Department of LaborEmail: [email protected]: 202-691-6900 Website: https://www.bls.gov/cex/Current Population Survey The Current Population Survey (CPS) is a nationally representative sample survey of about 60,000 households conducted monthly for the Bureau of Labor Statistics by the U.S. Census Bureau. The CPS is the primary source of information on the labor force characteristics of the civilian noninstitutionalized population age 16 and over, including a comprehensive body of monthly data on the labor force, employment, unemployment, persons not in the labor force, hours of work, earnings, and other demographic and labor force characteristics. In most months, CPS supplements provide additional demographic and social data. The Annual Social and Economic Supplement (ASEC) is the primary source of detailed information on income and poverty in the United States. The ASEC is used to generate the annual Population Profile of the United States, reports on geographical mobility and educational attainment, and is the primary source of detailed information on income and poverty in the United States. The ASEC, historically referred to as the March supplement, now is conducted in February, March, and April with a sample of about 100,000 addresses. The questionnaire asks about income from more than 50 sources and records up to 27 different income amounts, including receipt of many noncash benefits, such as food stamps and housing assistance.Race and Hispanic origin: CPS respondents are asked to identify themselves as belonging to one or more of five racial groups (White, Black, American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander). People who responded to the question on race by indicating only one race are referred to as the race alone or single-race population, and individuals who chose more than one race category are referred to as the Two or More Races population.The CPS includes separate questions on Hispanic origin. People who identify themselves as Hispanic, Latino, or Spanish are further classified by detailed Hispanic

144ethnicity (such as Mexican, Puerto Rican, or Cuban). People of Hispanic origin may be of any race. For more information, contact: Bureau of Labor Statistics U.S. Department of Labor Email: [email protected]: 202-691-6378 Website: http://www.bls.gov/cpsAdditional website: https://www.census.gov/cps/Decennial Census Every 10 years, beginning with the first census in 1790, the United States government conducts a census, or count, of the entire population as mandated by the U.S. Constitution. For most data collections, Census Day was April 1 of the respective year.For the 2010 Census, the U.S. Census Bureau devised a short-form questionnaire that asked for the age, sex, race, and ethnicity (Hispanic or Not Hispanic) of each household resident; his or her relationship to the person filling out the form; and whether the housing unit was rented or owned by a member of the household. The census long form, which for decades collected detailed socioeconomic and housing data from a sample of the population on education, housing, jobs, and more was replaced by the American Community Survey, an ongoing survey of about 295,000 addresses per month that gathers largely the same data as its predecessor.Race and Hispanic origin: Starting with the 2000 Census, and continuing in the 2010 Census, respondents were given the option of selecting one or more race categories to indicate their racial identities. People who responded to the question on race by indicating only one of the six race categories (White, Black, American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, and Some Other Race) are referred to as the race alone or single-race population. Individuals who chose more than one of the race categories are referred to as the Two or More Races population. The six single-race categories— which made up nearly 98 percent of all respondents— and the Two or More Races category sum to the total population. Because respondents were given the option of selecting one or more race categories in the 2000 Census and the 2010 Census, these data are not directly comparable with data from the 1990 or earlier censuses.As in earlier censuses, the 2010 Census included a separate question on Hispanic origin. In the 2010 Census, people of Spanish/Hispanic/Latino origin could identify themselves as Mexican, Mexican American or Chicano, Puerto Rican, Cuban, or Another Hispanic, Latino, or Spanish origin. People of Hispanic origin may be of any race.For more information, contact: Sex and Age Statistics BranchPhone: 301-763-2378Website: https://www.census.gov/2010census/Federal Reserve Board The Board of Governors of the Federal Reserve, also called the Federal Reserve Board, publishes the “Financial Accounts of the United States” (Z.1) data quarterly (about 10 weeks after the end of the quarter) on their website. This data release presents the financial flows and levels of sectors in the U.S. economy as well as selected balance sheets, supplemental tables, and the Integrated Macroeconomic Accounts (IMA). The IMA relate production, income, saving, and capital formation from the national income and product accounts (NIPA) to changes in net worth from the “Financial Accounts” on a sector-by-sector basis. The IMA are published jointly by the Federal Reserve Board and the Bureau of Economic Analysis and are based on international guidelines and terminology as defined in the System of National Accounts (SNA 2008). Data shown for the most recent quarters are based on preliminary and potentially incomplete information. Nonetheless, when source data are revised or estimation methods are improved, all data are subject to revision. There is no specific revision schedule; rather, data are revised on an ongoing basis. In each release of the “Financial Accounts,” major revisions are highlighted at the beginning of the publication. The data in the “Financial Accounts” come from a large variety of sources and are subject to limitations and uncertainty resulting from measurement errors, missing information, and incompatibilities among data sources. The size of this uncertainty cannot be quantified, but its existence is acknowledged by the inclusion of “statistical discrepancies” for various sectors and financial instruments. For more information, contact: Federal Reserve Board of Governors Comment form: https://www.federalreserve.gov/apps/contactus/feedback.aspxWebsite: https://www.federalreserve.gov/apps/fof/

145Health and Retirement Study The Health and Retirement Study (HRS) is a national panel study conducted by the University of Michigan’s Institute for Social Research under a cooperative agreement with the National Institute on Aging (NIA). The HRS is based on core interviews every two years of over 20,000 individuals representing the U.S. population over age 50. Respondents are followed longitudinally until death (including following people who move into a nursing home or other institutionalized setting). In 1992, the study began with an initial sample of more than 12,600 people from the 1931–1941 birth cohort and their spouses. The HRS was joined in 1993 by a companion study, Asset and Health Dynamics Among the Oldest Old (AHEAD), with a sample of 8,222 respondents (who were born before 1924 and were age 70 and over) and their spouses. In 1998, these two data collection efforts were combined into a single survey instrument and field period and were expanded through the addition of baseline interviews with two new birth cohorts: Children of the Depression Age (1924–1930) and War Babies (1942–1947). The HRS steady-state design calls for the addition every 6 years of a new cohort of Americans entering their 50s. Thus, the Early Boomer birth cohort (1948–1953) was added in 2004, the Mid-Baby Boomer birth cohort (1954–1959) was added in 2010, and the Late Baby Boomers (1960–1965) were added in 2016. The Early GenX cohort (1966–1971) will be added in 2022. The 2010 wave also included an expansion of the minority sample of Early and Mid-Baby Boomers. The minority sample will be expanded again in 2022. Telephone follow-ups are conducted every second year, with proxy interviews after death. Beginning with the 2006 wave, one-half of the sample goes through an enhanced face-to-face interview that includes the collection of physical performance measures and biomarker data. The Aging, Demographics, and Memory Study (ADAMS) and Harmonized Cognitive Assessment Protocol (HCAP) supplement the HRS with data to support population-based research on Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias. Data from a genome-wide scan on saliva samples collected from approximately 19,000 respondents from 2006–2016 supports genetic and genomic studies. Venous blood samples collected in 2016 and 2018 provided new biomarker data and a repository of serum, plasma, and cryo-preserved cells.The HRS is designed to support research on aging, and the health and well-being of the older population. Survey content includes physical/psychological health and well-being, disabilities, blood-based biomarkers, health services, labor force, economic status, family structure, and early life experiences. Linkages are available to a variety of administrative and contextual data. Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this report. For more information, contact: Health and Retirement Study Email: [email protected]: 734-936-0314 Website: https://hrs.isr.umich.edu/aboutIntercensal Population Estimates: 2000 to 2010 Intercensal population estimates are produced for the years between two decennial censuses when both the beginning and ending populations are known. They are produced by adjusting the existing time series of postcensal estimates for the entire decade to smooth the transition from one decennial census count to the next. They differ from the annually released postcensal estimates in that they rely on mathematical formulae that redistribute the difference between the April 1 postcensal estimate and the April 1 census count for the end of the decade across the postcensal estimates for that decade. For dates when both postcensal and intercensal estimates are available, intercensal estimates are preferred.The 2000–2010 intercensal estimates reconcile the postcensal estimates with the 2010 Census counts and provide a consistent time series of population estimates that reflect the 2010 Census results. The 2000–2010 intercensal estimates were produced for the nation, states, and counties by demographic characteristics (age, sex, and race and Hispanic origin).For a more detailed discussion of the methods used to create the intercensal estimates, see https://www2.census.gov/programs-surveys/popest/technical-documentation/methodology/intercensal/2000-2010-intercensal-estimates-methodology.pdf.For more information, contact:Population Estimates BranchPhone: 301-763-2385Website: https://www.census.gov/programs-surveys/popest.htmlInternational Data BaseThe U.S. Census Bureau produces the International Data Base (IDB), which includes regularly updated population estimates and projections for more than 200 countries

146and areas. The series of estimates and projections provide a consistent set of demographic indicators, including population size and growth, mortality, fertility, and net migration. The IDB is accessible online at https://www.census.gov/programs-surveys/international-programs/about/idb.html.For more information, contact:Demographic and Economic Studies BranchInternational Programs Population DivisionPhone: 301-763-1360Website: https://www.census.gov/programs-surveys/international-programs.htmlMaster Beneficiary RecordThe Social Security Administration maintains a record of Social Security Title II benefits for each beneficiary and applicant for benefits. The administrative database is for each disabled insurance, retired worker insurance, survivor insurance, and spouse insurance beneficiary. The system of records is the Master Beneficiary Record (MBR). The MBR extract file contains a record for every person who has a record on the MBR. This general-purpose extract file is comprised of 134 variables. The MBR extract is produced semiannually, and is used to support a variety of research and statistical projects.The data in Indicator 9 on Social Security beneficiaries come from tabulations of the MBR data that are published annually in the Statistical Supplement to the Social Security Bulletin. The Supplement tables used in Indicator 9 include 5A.1.2, 5A1.6, 5A5, 5A.6, 5A, and 6B5.t1.For more information, contact:Social Security AdministrationEmail: [email protected]: https://www.socialsecurity.gov/policy/docs/statcomps/supplementMedicare Claims and Enrollment Data The Medicare claims and enrollment data are captured in the Chronic Condition Warehouse (CCW). The Centers for Medicare & Medicaid Services (CMS) launched the CCW, a research database, in response to the Medicare Modernization Act of 2003 (MMA). Section 723 of the MMA outlines a plan to improve the quality of care and reduce the cost of care for chronically ill Medicare beneficiaries. In addition to chronic conditions, the CCW supports health policy analysis and other CMS initiatives.The CCW data files were designed to facilitate research across the continuum of care, using data files that could be easily merged and analyzed by beneficiary. Each beneficiary in the CCW is assigned a unique, unidentifiable link key, which allows researchers to easily merge data files and perform relevant analyses across different claim types, enrollment files, Part D event data, assessment data, and other CCW file types. CCW data files are available on request from CMS.The CCW claims data files have been streamlined to include only those variables determined by CMS to be of value and useful for research or analytic purposes. The data files delivered from the CCW contain a subset of the original source files. Variables used infrequently or not applicable to a particular setting have been removed.For more information, contact: The Research Data Assistance Center Email: [email protected]: 1-888-973-7322 Website: https://www.resdac.orgChronic Conditions Data Warehouse Email: [email protected]: 1-866-766-1915 Website: https://www.ccwdata.org/web/guest/homeMedicare Current Beneficiary Survey The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a representative sample of the Medicare population designed to help the Centers for Medicare & Medicaid Services (CMS) administer, monitor, and evaluate the Medicare program. The MCBS collects information on health care use, cost, and sources of payment; health insurance coverage; household composition; sociodemographic characteristics; health status and physical functioning; income and assets; access to care; satisfaction with care; usual source of care; and how beneficiaries get information about Medicare.MCBS data enable CMS to determine sources of payment for all medical services used by Medicare beneficiaries, including copayments, deductibles, and noncovered services; develop reliable and current information on the use and cost of services not covered by Medicare (such as long-term care and dental, vision, and hearing services); ascertain all types of health insurance coverage and relate coverage to sources of payment; and monitor the financial effects of changes in the Medicare program on the beneficiaries Additionally, the MCBS is the only source

147of multidimensional person-based information about the characteristics of the Medicare population and their access to and satisfaction with Medicare services and information about the Medicare program. The MCBS sample consists of Medicare enrollees residing in the community and in institutions.The survey is conducted in 3 rounds each year, with each round being about 4 months in length. The MCBS has a multistage, stratified, random sample design and a rotating panel survey design. Each panel is followed for 11 interviews. In-person interviews are conducted using computer-assisted personal interviewing. A sample of approximately 16,000 people is interviewed in each round. However, because of the rotating panel design, only 12,000 people receive all 3 interviews in a given calendar year. Information collected in the survey is combined with information from CMS administrative data files.The MCBS has two components: the Survey file and the Cost Supplement file. The Survey file contains information on beneficiaries’ access to health care, satisfaction with care, usual source of care, health insurance coverage, and social determinants of health. The sample for this file is the “ever enrolled” population, including those who entered the Medicare program, and those who died during the benefit year. Medicare claims are linked to survey-reported events to produce the Cost Supplement file, which provides complete expenditure and source of payment data on all health care services, including those not covered by Medicare. The sample for the Cost Supplement is a subset of those in the Survey file who met criteria for having enough covered days of reporting their expenditures. Both files have weights that also allow for analysis of the continually (always) enrolled Medicare population as well—those who participated in the Medicare program for the entire year.Race and Hispanic origin: The MCBS defines race as White, Black, Asian, Native Hawaiian or Pacific Islander, American Indian or Alaska Native, or Other. People are allowed to choose more than one category. There is a separate question on whether the person is of Hispanic or Latino origin. The “Other” category in Table 29c consists of people who answered “No” to the Hispanic/ Latino question and who answered something other than “White” or “Black” to the race question. People who answer with more than one racial category are assigned to the “Other” category.For more information, contact: MCBS Staff Centers for Medicare & Medicare ServicesEmail: [email protected]: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/indexMedical Expenditure Panel Survey The Medical Expenditure Panel Survey (MEPS) is an ongoing annual survey of the civilian noninstitutionalized population that collects detailed information on health care use and expenditures (including sources of payment), health insurance, income, health status, access, and quality of care. The MEPS, which began in 1996, is the third in a series of national probability surveys conducted by the Agency for Healthcare Research and Quality (AHRQ) on the financing and use of medical care in the United States. MEPS predecessor surveys are the National Medical Care Expenditure Survey (NMCES) conducted in 1977 and the National Medical Expenditure Survey (NMES) conducted in 1987. Each of the three surveys (NMCES, NMES, and MEPS) used multiple rounds of in-person data collection to elicit expenditures and sources of payments for each health care event experienced by household members during the calendar year. The current MEPS Household Component sample is drawn from respondents to the National Health Interview Survey (NHIS) conducted by the National Center for Health Statistics (NCHS). To yield more complete information on health care spending and payment sources, followback surveys of health providers were conducted for a subsample of events in the MEPS (and events in the MEPS predecessor surveys). Since 1977, the structure of the billing mechanism for medical services has grown more complex as a result of increasing penetration of managed care and Health Maintenance Organizations (HMOs) and various cost containment reimbursement mechanisms instituted by Medicare, Medicaid, and private insurers. As a result, there has been substantial discussion about what constitutes an appropriate measure of health care expenditures.44 Health care expenditures presented in this report refer to what is actually paid for health care services. More specifically, expenditures are defined as the sum of direct payments for care received, including out-of-pocket payments for care received. This definition of expenditures differs somewhat from what was used in the 1987 NMES, which used charges (rather than payments) as the fundamental

148expenditure construct. To improve comparability of estimates between the 1987 NMES and the 1996 and 2001 MEPS, the 1987 data presented in this report were adjusted using the method described by Zuvekas and Cohen (2002).43 Adjustments to the 1977 data were considered unnecessary because virtually all of the discounting for health care services occurred after 1977 (essentially equating charges with payments in 1977). A number of quality-related enhancements were made to the MEPS beginning in 2000, including the fielding of an annual adult self-administered questionnaire (SAQ). This questionnaire contains items regarding patient satisfaction and accountability measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®; previously known as the Consumer Assessment of Health Plans), the VR-12 physical and mental health assessment tool starting in 2018, EQ-5D EuroQol 5 dimensions with visual scale (2000–2003), and several attitude items. Starting in 2004, the K–6 Kessler mental health distress scale and the PH2 two-item depression scale were added to the SAQ. Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this report. For more information: Agency for Healthcare Research and QualityWebsite: https://meps.ahrq.gov/mepswebNational Health and Aging Trends Study The National Health and Aging Trends Study (NHATS) is a scientific study of how Americans function in later life. The study is led by investigators from the Johns Hopkins University Bloomberg School of Public Health and the Institute for Social Research at the University of Michigan, with data collection by Westat and support from the National Institute on Aging. NHATS is intended to foster research that will guide efforts to reduce disability, maximize health and independent functioning, and enhance quality of life at older ages. Since 2011, NHATS has been gathering information on a nationally representative sample of Medicare beneficiaries ages 65 and over through annual in-person interviews. The interviews collect detailed information on activities of daily life, living arrangements, economic status and well-being, aspects of early life, and quality of life. Among the specific content areas included are the general and technological environment of the home, health conditions, work status and participation in valued activities, mobility and use of assistive devices, cognitive functioning, and help provided with daily activities (self-care, household, and medical). Study participants are re-interviewed every year in order to compile a record of change over time. The content and questions included in NHATS were developed by a multidisciplinary team of researchers from the fields of demography, geriatric medicine, epidemiology, health services research, economics, and gerontology. As the population ages, NHATS will provide the basis for understanding trends in late-life functioning, how these differ for various population subgroups, and the economic and social consequences of aging and disability for individuals, families, and society. For more information, contact: National Health and Aging Trends Study Email: [email protected]: https://www.nhats.org/National Health Interview Survey The National Health Interview Survey (NHIS) is the principal source of information on the health of the civilian noninstitutionalized population of the United States and is one of the major data collection programs of the National Center for Health Statistics (NCHS). The main objective of the NHIS is to monitor the health of the United States population through the collection and analysis of data on a broad range of health topics. A major strength of this survey is its ability to display these health characteristics by many demographic and socioeconomic characteristics.The NHIS is a cross-sectional household interview survey. The target population for the NHIS is the civilian noninstitutionalized population residing in the United States at the time of the interview. Excluded from the survey are persons in long-term care institutions (e.g., nursing homes for the elderly, hospitals for the chronically ill or physically or intellectually disabled, wards for abused or neglected children), correctional facilities (e.g., prisons or jails, juvenile detention centers, halfway houses), and U.S. nationals living in foreign countries. Active-duty Armed Forces personnel are also excluded from the survey, unless at least one other family member is a civilian eligible for the survey (e.g., a child whose parents are both active-duty military). In that case, data for these Armed Forces members (259 persons in 2018) are collected and included in all relevant files in order to aid any analyses pertaining to the family (e.g., family structure, relationships, income), but these persons are given a final

149weight of zero so that their individual characteristics will not be counted when making national (i.e., weighted) estimates. Weighted estimates cover only the civilian noninstitutionalized household population. Race and Hispanic origin: Starting with data year 1999, race-specific estimates in the NHIS were collected according to 1997 standards for Federal data on race and ethnicity, which specify five single-race categories and multiple race categories and are not strictly comparable with estimates for earlier years. In Older Americans 2020, estimates presented by race and Hispanic origin calculated from the NHIS include persons of multiple race. See Health, United States, 2018, Appendix II for details on race and ethnicity in the NHIS.For more information, contact:Division of Health Interview StatisticsEmail: [email protected]: 301-458-4901Website: https://www.cdc.gov/nchs/nhis.htmNational Health and Nutrition Examination SurveyThe National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations. NHANES is a major program of the National Center for Health Statistics (NCHS). The NHANES program began in the early 1960s and has been conducted as a series of surveys focusing on different population groups and health topics. In 1999, the survey became a continuous program with a changing focus on a variety of health and nutrition measurements to meet emerging needs. The survey examines a nationally representative sample of about 5,000 persons each year. These persons are located in counties across the country, 15 of which are visited each year.The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel.Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this report.For more information, contact:Division of Health and Nutrition Examination SurveyEmail: [email protected]: 1-800-232-4636Website: https://www.cdc.gov/nchs/nhanes/index.htmNational Study of Long-Term Care Providers The biennial National Study of Long-Term Care Providers (NSLTCP) monitors trends in the supply, provision, and use of the major sectors of paid, regulated long-term care services. NSLTCP uses survey data on the residential care community and adult day services sectors and administrative data on the home health, nursing home, and hospice sectors. The main goals of NSLTCP are to1. estimate the supply and use of paid, regulated long-term care services providers.2. estimate key policy-relevant characteristics and practices.3. produce national and state-level estimates, where feasible.4. compare estimates among sectors.5. monitor trends over time.NSLTCP replaces NCHS’ previous National Nursing Home Survey, National Home and Hospice Care Survey, and National Survey of Residential Care Facilities. Race and Hispanic origin: Data from this survey are not shown by race and Hispanic origin in this report.For more information, contact: Long-Term Care Statistics BranchEmail: [email protected]: 301-458-4747Website: https://www.cdc.gov/nchs/nsltcp/index.htmNational Vital Statistics SystemThe National Vital Statistics System (NVSS) collects and disseminates official vital statistics. These data are provided through contracts between the National Center for Health Statistics (NCHS) and vital registration systems operated in the various jurisdictions legally responsible for the registration of vital events—births, deaths, marriages, divorces, and fetal deaths.

150In the United States, legal authority for the registration of these events resides individually with the 50 States, 2 cities (Washington, DC, and New York City), and 5 territories (Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands). These jurisdictions are responsible for maintaining registries of vital events and for issuing copies of birth, marriage, divorce, and death certificates.Mortality data from the NVSS are a fundamental source of demographic, geographic, and cause-of-death information. The NVSS is one of the few sources of health-related data that are comparable for small geographic areas and available for a long time period in the United States. The data are also used to present the characteristics of those dying in the United States, determine life expectancy, and compare mortality trends with other countries.Race and Hispanic origin: Race and Hispanic origin are reported separately on the death certificate. Beginning in 2018, all states reported deaths using the 2003 revision of the U.S. Standard Certificate of Death, which allows the reporting of more than one race. The race categories on the 2003 version of the certificate are consistent with the 1997 Office of Management and Budget standard. See Health, United States 2018, Appendix II for more information on race and Hispanic origin in the mortality files of the NVSS.For more information, contact:Division of Vital StatisticsEmail: [email protected]: 1-800-232-4636Website: https://www.cdc.gov/nchs/nvss/index.htmPopulation ProjectionsThe 2017 National Population Projections provide projections of the resident population and demographic components of change (births, deaths, and international migration) through 2060. Population projections are available by age, sex, and race and Hispanic origin. Where both estimates and projections are available for the same time period, the U.S. Census Bureau recommends the use of the population estimates. The following is a general description of the methods used to produce the 2017 National Population Projections.The 2017 National Population Projections start with the Vintage July 1, 2016, population estimates and are developed using a cohort-component method. Many of the characteristics of the U.S. resident population, as measured by the 2010 Census, are preserved as demographic patterns that work their way through the projection period. The components of population change (births, deaths, and international migration) are projected for each birth cohort (persons born in a given year). For each passing year, the Census Bureau advances the population 1 year of age. The Census Bureau updates the new age categories using survival rates and levels of international migration projected for the passing year. A new birth cohort is added to form the population under 1 year of age by applying projected age-specific fertility rates to the female population ages 14–54 and by updating the new cohort for the effects of mortality and international migration.The assumptions for the components of change are based on time series analysis. Because of limited information about racial characteristics in the fertility and mortality historical series, the assumptions were developed for mutually exclusive and exhaustive groups. Five groups were used for the fertility assumptions: native-born Asian/ Pacific Islander, all other native-born, foreign-born non-Hispanic Asian/Pacific Islander, all other non-Hispanic foreign-born, and foreign-born Hispanic. Three groups were used for the mortality assumptions: non-Hispanic White/Asian/Native Hawaiian/Pacific Islander, non-Hispanic Black/American Indian/Alaska Native, and Hispanic of any race. The resulting births and deaths were then applied to the matching racial and ethnic categories to project the population.For more information, contact: Population Evaluation Analysis and Projections BranchPhone: 301-763-2438Website: https://www.census.gov/programs-surveys/popproj.htmlPostcensal Population EstimatesEach year, the U.S. Census Bureau produces and publishes population estimates of the nation, states, counties, state/county equivalents, and Puerto Rico.45 The Census Bureau estimates the resident population for each year since the most recent decennial census by using measures of population change. The resident population includes all people currently residing in the United States.The population estimates are used for Federal funding allocations, as controls for major surveys including the Current Population Survey and the American Community Survey, for community development, to aid business planning, and as denominators for statistical rates.

151Overall, the estimate time series from 2000 to 2010 was very accurate, even accounting for 10 years of population change. The average absolute difference between the final total resident population estimates and 2010 Census counts was only about 3.1 percent across all counties.46The population estimate at any given time point starts with a population base (the last decennial census or the previous point in the time series), adds births, subtracts deaths, and adds net migration (both international and domestic).47 The individual methods used by the Census Bureau account for additional factors, such as input data availability and the requirement that all estimates be consistent by geography, age, sex, and race and Hispanic origin.The Census Bureau produces these estimates using a “top-down” approach. It first estimates the national population and the populations of states and counties. All of these follow a cohort component method. One key principle used by the Census Bureau is that all estimates produced must be consistent across geography and demographic characteristics. To accomplish this, the Census Bureau controls the estimates of the smaller geographic areas so that they sum to the totals produced at higher levels.For more information, contact:Population Estimates BranchPhone: 301-763-2385Website: https://www.census.gov/programs-surveys/popest/technical-documentation/methodology.htmlSupplemental Poverty Measure Concerns about the adequacy of the official measure of poverty culminated in a congressional appropriation in 1990 for an independent scientific study of the concepts, measurement methods, and information needed for a poverty measure. In response, the National Academy of Sciences (NAS) established the Panel on Poverty and Family Assistance, which released its report in spring 1995.48In 2010, an interagency technical working group, which included representatives from the Bureau of Labor Statistics (BLS), the U.S. Census Bureau, the Economics and Statistics Administration, the Council of Economic Advisers, the U.S. Department of Health and Human Services, and the Office of Management and Budget, issued a series of suggestions to the Census Bureau and the BLS on how to develop the Supplemental Poverty Measure (SPM). Their suggestions drew on the recommendations of the 1995 NAS report and the extensive research on poverty measurement conducted after the report’s publication.48Since 2011, the Census Bureau has published poverty estimates using the new measure based on these suggestions.49 The SPM serves as an additional indicator of economic well-being and provides a deeper understanding of economic conditions and policy effects. The SPM creates a more complex statistical picture incorporating additional items such as tax payments, work expenses, and medical out-of-pocket expenditures in its family resource estimates. The resource estimates also take into account the value of noncash benefits, including nutritional, energy, and housing assistance. Thresholds used in the new measure are derived by staff at the BLS from Consumer Expenditure Survey expenditure data on basic necessities (food, shelter, clothing, and utilities) and are adjusted for geographic differences in the cost of housing.In addition to the annual report, the Census Bureau makes available a research data file that enables analysts to create their own SPM estimates and cross tabulations.50For more information, contact:Dr. Trudi J. Renwick U.S. Census BureauEmail: [email protected]: 301-763-5133Website: https://www.census.gov/topics/income-poverty/supplemental-poverty-measure.htmlSurvey of Consumer Finances The Survey of Consumer Finances (SCF) is a triennial, cross-sectional, national survey of noninstitutionalized Americans conducted by the Federal Reserve Board with the cooperation of the Statistics of Income Division of the Internal Revenue Service. It includes data on household assets and debts, use of financial services, income, demographics, and labor force participation.The survey is considered one of the best sources for wealth measurement because of its detailed treatment of assets and debts and because it oversamples wealthy households.51,52 The data for the panels of the SCF used in this study were collected by the National Opinion Research Center at the University of Chicago. The SCF uses a dual-frame sample consisting of both a standard random sample and a special over-sample of wealthier households in order to correct for the underrepresentation of high-income families in the survey. It uses multiple imputation techniques to deal with missing data, which results in the creation of five data sets called “implicates.” There are five implicates for every record. In the SCF, a household unit is divided into a “primary economic unit” (PEU)—the family—and everyone else in the

152household. The PEU is intended to be the economically dominant single person or couple (whether married or living together as partners) and all other persons in the household who are financially interdependent with the economically dominant person or couple.53 The Indicator 10 data represent the PEU, which are referred to as households in the chart and discussion.Race and Hispanic origin: Data in this report for the head of the PEU are shown for White and Black. Data are not shown by Hispanic origin.For more information, contact: Chris TamboriniSocial Security AdministrationEmail: [email protected]: 202-358-6109VA Enrollee Health Care Projection Model The Department of Veterans Affairs (VA) uses the VA Enrollee Health Care Projection Model (Model) to project enrollment and utilization of the enrolled veteran population for 20 years into the future for approximately 140 categories of health care services. First, VA uses the Model to determine how many veterans will be enrolled each year and their age, priority, and geographic location. Next, VA uses the Model to project the total health care services needed by those enrollees and then estimates the portion of that care that those enrollees will demand from VA.The Model accounts for the unique demographic characteristics of the enrolled veteran population, including Post-9/11 Era Combat Veteran and other enrollee cohorts, as well as other factors that impact a veteran’s decision to enroll in VA and use VA health care services:• Enrollee age, gender, income, travel distance to VA facilities, and geographic migration patterns• Significant morbidity of the enrolled veteran population, particularly for mental health services• Economic conditions, including changes in local unemployment rates and home values (as a proxy for asset values) and the long-term downward trend in labor force participation, particularly for high school-educated males• Enrollee transition between enrollment priorities as a result of movement into service-connected priorities or changes in income• Enrollee reliance on VA health care versus the other health care options available to them (i.e., Medicare, Medicaid, TRICARE, and commercial insurance)• Unique health care utilization patterns of Post-9/11 Era Combat Veteran, female, and new enrollees, and other enrollee cohorts with unique utilization patterns for particular services• New policies, regulations, and legislation, including the Choice Act and MISSION Act• VA health care initiatives, such as the mental health capacity improvement initiative• A continually evolving VA health care system (e.g., quality and efficiency initiatives)• Changes in health care practice and technology, such as new diagnostics, drugs, and treatmentsFor more information, contact: Maggie HeimannVeterans Health AdministrationChief Strategy OfficeEmail: [email protected]: 202-461-4194Website: https://www.va.gov/HEALTHPOLICYPLANNING/planning.aspVeteran Population Estimates and Projections The VA Analytics Service provided veteran population projection by key demographic characteristics such as age and gender as well as geographic areas. VetPop2016 was last updated using 2000 Census data, VA administrative data, and Department of Defense data. VetPop2018 was released in spring 2020.Race and Hispanic origin: Data from this model are not shown by race and Hispanic origin in this report.For more information, contact: The National Center for Veterans Analysis and Statistics Email: [email protected]: https://va.gov/vetdata/veteran_population.asp

Glossary

154Activities of daily living (ADLs): Basic activities that support survival, including eating, bathing, and toileting. See also Instrumental activities of daily living (IADLs). In the Medicare Current Beneficiary Survey, ADL disabilities are measured as difficulty performing (or inability to perform because of a health reason) one or more of the following activities: eating, getting in/out of chairs, walking, dressing, bathing, or toileting. Auxiliary benefits: These benefits provide wives of dependents with half of their husband’s basic benefit and surviving widows with their husband’s full basic benefit. Divorced women can receive auxiliary spouse/widow benefits based on a marriage of at least 10 years’ duration.Body mass index (BMI): This is a measure of body weight, adjusted for height, that correlates with body fat. A tool for indicating weight status in adults, BMI is generally computed using metric units and is defined as weight divided by height2 or kilograms/meters2. The categories used in this report are consistent with those set by the World Health Organization. For adults age 20 and over, underweight is defined as having a BMI less than 18.5; healthy weight is defined as having a BMI of at least 18.5 and less than 25; overweight is defined as having a BMI equal to 25 or greater; and obese is defined as having a BMI equal to 30 or greater. To calculate your own body mass index, go to https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm. For more information about BMI, see Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.54Cause of death: For the purpose of national mortality statistics, every death is attributed to one underlying condition, based on information reported on the death certificate and using the international rules for selecting the underlying cause of death from the conditions stated on the death certificate. In addition to the underlying cause, all other conditions reported on the death certificate are captured, coded, and referred to as multiple causes of death. Cause of death is coded according to the appropriate revision of the International Classification of Diseases (ICD). Effective with deaths occurring in 1999, the United States began using the 10th Revision of the ICD (ICD-10).55Civilian noninstitutionalized population:See Population.Civilian population:See Population.Crowded housing: Households that have more than one person per room.Death rate: The death rate is calculated by dividing the number of deaths in a population in a year by the midyear resident population. For census years, rates are based on unrounded census counts of the resident population as of April 1. Death rates are expressed as the number of deaths per 100,000 people. The rate may be restricted to deaths in specific age, race, sex, or geographic groups or from specific causes of death (specific rate), or it may be related to the entire population (crude rate). Defined benefit plan: A plan that promises a specified monthly benefit at retirement. The plan may state this promised benefit as an exact dollar amount, such as $100 per month at retirement. Or, more often, it may calculate a benefit through a plan formula that considers such factors as salary and service (e.g., 1 percent of average salary for the last 5 years of employment for every year of service with an employer).Defined contribution plan: A plan that does not promise a specific benefit amount at retirement. Instead, employers and/or employees contribute money to each employee’s individual account in the plan. In many cases, employees are responsible for choosing how these contributions are invested and deciding how much to contribute from their paychecks through pretax deductions. Employers may add to employees’ accounts, in some cases, by matching a certain percentage of the employee’s contributions. The value of an employee’s account depends on how much is contributed and how well the investments perform. Dental services: In the Medicare Current Beneficiary Survey (Indicators 29 and 33), the Medical Expenditure Panel Survey (MEPS), and the data used from the MEPS predecessor surveys used in this report (Indicator 32), this category covers expenses for any type of dental care provider, including general dentists, dental hygienists, dental technicians, dental surgeons, orthodontists, endodontists, and periodontists. In Indicator 29, dental services are included as part of the “Other” category; in Indicator 33, dental services are included as a separate category.Disability rating: Ratings reflect the severity of the disability and how much the impairment impacts the ability to work.Emergency room services: In the Medical Expenditure Panel Survey (MEPS) and the data used from the MEPS predecessor surveys used in this report (Indicator 32), this category includes expenses for visits to medical providers seen in emergency rooms (except visits resulting in a hospital admission). These expenses include payments for services covered under the basic facility charge and

155those for separately billed physician services. In the Medicare Current Beneficiary Survey (Indicators 29 and 33), emergency room services are included as a hospital outpatient service unless they are incurred immediately prior to a hospital stay, in which case they are included as a hospital inpatient service. Fee-for-service: The method of reimbursing health care providers on the basis of a fee for each health service provided to the insured person. Full Retirement Age (FRA): The age when benefits are not reduced for early retirement. Benefits are increased by about 8 percent per year until age 70 for delayed retirement. Early Retirement Age (ERA) for retired workers begins at age 62 with a 25 percent reduced level from benefits at FRA, age 66 in 2014. Initial benefits at age 62 increase approximately 75 percent for a delay from ERA to age 70. The FRA was age 65 until 1937 and increased at 2 months per year for each birth year after 1937 until 1943. Please note that the percentages are not the probabilities of claiming at an age because different birth year cohorts are in each age group in a given year and somewhat vary in the size of the eligible population.Group quarters: A place where people live or stay in a group living arrangement that is owned or managed by an entity or organization providing housing and/or services for the residents. Group quarters are not a typical household-type living arrangement. These services may include custodial or medical care as well as other types of assistance, and residency is commonly restricted to those receiving these services. People living in group quarters are usually not related to each other. The group quarters definitions used in the 2010 Census are available in Appendix B at: https://www.census.gov/prod/cen2010/doc/sf1.pdf.Head of household: The Survey of Consumer Finances estimates wealth for the “primary economic unit” (PEU), which is similar to the U.S. Census Bureau’s Household. The PEU is the economically dominant single person or couple (whether married or living together as partners) and all other persons in the household who are financially interdependent with the economically dominant person or couple. If a couple is economically dominant in the PEU, the head is the male in a mixed sex couple or the older person in a same-sex couple. If a single person is economically dominant, that person is designated as the family head in this report. Health care expenditures: In the Consumer Expenditure Survey (Indicator 13), health care expenditures include out-of-pocket expenditures for health insurance, medical services, prescription drugs, and medical supplies. In the Medicare Current Beneficiary Survey (Indicators 29 and 33), health care expenditures include all expenditures for inpatient hospital, medical, nursing home, outpatient (including emergency room visits), dental, prescription drugs, home health care, and hospice services, including both out-of-pocket expenditures and expenditures covered by insurance. Personal spending for health insurance premiums is excluded. In the Medical Expenditure Panel Survey (MEPS) and the data used from the MEPS predecessor surveys used in this report (Indicator 32), health care expenditures refer to payments for health care services provided during the year. (Data from the 1987 survey have been adjusted to permit comparability across years; see Zuvekas and Cohen [2002].45) Out-of-pocket health care expenditures are the sum of payments paid to health care providers by the person, or the person’s family, for health care services provided during the year. Health care services include inpatient hospital, hospital emergency room, and outpatient department care; dental services; office-based medical provider services; prescription drugs; home health care; and other medical equipment and services. Personal spending for health insurance premium(s) is excluded. Health Maintenance Organization (HMO): A prepaid health plan delivering comprehensive care to members through designated providers, having a fixed monthly payment for health care services, and requiring members to be in a plan for a specified period of time (usually one year). Health Eating Index-2015 (HEI-2015): A dietary assessment tool with 13 components designed to measure quality in terms of how well a set of foods aligns with the key recommendations of the 2015–2020 Dietary Guidelines for Americans. Intakes equal to or better than the standards set for each component are assigned a maximum score. Maximum HEI-2015 component scores range from 5 to 10 points. Scores for intakes between the minimum and maximum standards are scored proportionately. Scores for each component are summed to create a total maximum HEI-2015 score of 100 points. Nine of the 13 components assess adequacy components. The remaining four components assess dietary components that should be consumed in moderation. For the adequacy components, higher scores reflect higher intakes that meet or exceed the standards. For the moderation components, higher scores reflect lower intakes because lower intakes are more desirable. A higher total score indicates a diet that aligns better with the Dietary Guidelines. HEI-2015 total and component scores in this report reflect usual dietary intakes among older adults in the United States.

156Hispanic origin:See specific data source descriptions. Home health care/services/visits: Home health care is care provided to individuals and families in their places of residence for promoting, maintaining, or restoring health or for minimizing the effects of disability and illness, including terminal illness. In the Medicare Current Beneficiary Survey and Medicare claims data (Indicators 28, 29, and 33), home health care refers to skilled nursing care, physical therapy, speech language pathology services, occupational therapy, and home health aide services provided to homebound patients. In the Medical Expenditure Panel Survey (Indicator 32), home health care services are classified into the “Other Health Care” category and are considered any paid formal care provided by home health agencies and independent home health providers. Services can include visits by professionals, including nurses, doctors, social workers, and therapists, as well as home health aides, homemaker services, companion services, and home-based hospice care. Home care provided free of charge (informal care by family members) is not included. Hospice care/services: Hospice care is a program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying persons, their families, and other loved ones by a hospice program or agency. Hospice services are available in home and inpatient settings. In the Medicare Current Beneficiary Survey (Indicators 29 and 33), hospice care includes only those services provided as part of a Medicare benefit. In Indicator 29, hospice services are part of the “Other” category. In Indicator 33, hospice services are a separate category. In the Medical Expenditure Panel Survey (MEPS; Indicator 32), hospice care provided in the home (regardless of the source of payment) is included in the “Other Health Care” category, while hospice care provided in an institutional setting (e.g., nursing home) is excluded from the MEPS universe. Hospital care: In the Medical Expenditure Panel Survey (Indicator 32), hospital care includes hospital inpatient care and care provided in hospital outpatient departments and emergency rooms. Care can be provided by physicians or other health practitioners. Payments for hospital care include payments billed directly by the hospital and those billed separately by providers for services provided in the hospital. Hospital inpatient services: In the Medicare Current Beneficiary Survey (Indicators 29 and 33), hospital inpatient services include room and board and all hospital diagnostic and laboratory expenses associated with the basic facility charge, as well as emergency room expenses incurred immediately prior to inpatient stays. Expenses for hospital stays with the same admission and discharge dates are included if the Medicare bill classified the stay as an “inpatient” stay. Payments for separate billed physician inpatient services are excluded. In the Medical Expenditure Panel Survey (Indicator 32), these services include room and board and all hospital diagnostic and laboratory expenses associated with the basic facility charge, payments for separately billed physician inpatient services, and emergency room expenses incurred immediately prior to inpatient stays. Expenses for reported hospital stays with the same admission and discharge dates are also included. Hospital outpatient services: These services in the Medicare Current Beneficiary Survey (Indicators 29 and 33) include visits to both physicians and other medical providers seen in hospital outpatient departments or emergency rooms (provided the emergency room visit does not result in an inpatient hospital admission), as well as diagnostic laboratory and radiology services. Payments for these services include those covered under the basic facility charge. Expenses for in-patient hospital stays with the same admission and discharge dates and classified on the Medicare bill as “outpatient” are also included. Separately billed physician services are excluded. Hospital stays: In the Medicare claims data (Indicator 28), hospital stays refer to admission to and discharge from a short-stay acute care hospital. Housing cost burden: In the American Housing Survey, housing cost burden is defined as expenditures on housing and utilities in excess of 30 percent of household reported income. Housing expenditures: In the Consumer Expenditure Survey’s Interview Survey, housing expenditures include payments for mortgage interest; property taxes; maintenance, repairs, insurance, and other expenses; rent; rent as pay (reduced or free rent for a unit as a form of pay); maintenance, insurance, and other expenses for renters; and utilities. Income: In the Medicare Current Beneficiary Survey, income is for the sample person or the sample person and spouse if the sample person was married at the time of the survey. All sources of income from jobs, pensions, Social Security benefits, Railroad Retirement and other retirement income, Supplemental Security Income, interest, dividends, and other income sources are included.

157Income, household: Household income from the Medical Expenditure Panel Survey (MEPS) and the MEPS predecessor surveys used in this report was created by summing personal income from each household member to create family income. Family income was then divided by the number of people that lived in the household during the year to create per capita household income. Potential income sources asked about in the survey interviews include annual earnings from wages, salaries, or withdrawals; Social Security and Veterans Administration payments; Supplemental Security Income and cash welfare payments from public assistance; Temporary Assistance for Needy Families, formerly known as Aid to Families with Dependent Children; gains or losses from estates, trusts, partnerships, C corporations, rent, and royalties; and a small amount of other income. See also Poverty, Indicator 32: Out-of-Pocket Health Care Expenditures.Inpatient hospital:See Hospital inpatient services.Institutionalized population:See Population. Institutions: For the 2010 Census, the U.S. Census Bureau defined institutions as adult correctional facilities, juvenile facilities, skilled-nursing facilities, and other institutional facilities such as mental (psychiatric) hospitals and in-patient hospice facilities. See also Population. Instrumental activities of daily living (IADLs):Indicators of functional well-being that measure the ability to perform more complex tasks than the related activities of daily living. See also Activities of daily living (ADLs). In the Medicare Current Beneficiary Survey, IADLs are measured as difficulty performing (or inability to perform because of a health reason) one or more of the following activities: heavy housework, light housework, preparing meals, using a telephone, managing money, or shopping. Only the questions on telephone use, shopping, and managing money are asked of long-term care facility residents. Long-term care facility: In the Medicare Current Beneficiary Survey (MCBS; Indicators 21 and 35), a residence (or unit) is considered a long-term care facility if it is certified by Medicare or Medicaid; has 3 or more beds, is licensed as a nursing home or other long-term care facility, and provides at least one personal care service; or provides 24-hour, 7-day-a-week supervision by a nonfamily, paid caregiver. In the MCBS (Indicators 29 and 33), a long-term care facility excludes “short-term institutions” (e.g., subacute care) stays. See also Short-term institution (Indicators 29 and 33), and Skilled nursing facility (Indicator 28). Mammography: An X-ray image of the breast used to detect irregularities in breast tissue. Mean: An average of n numbers computed by adding the numbers and dividing by n. Median: A measure of central tendency, the point on the scale that divides a group into two parts. Medicaid: This nationwide health insurance program is operated and administered by the states with Federal financial participation. Within certain broad, federally determined guidelines, states decide who is eligible; the amount, duration, and scope of services covered; rates of payment for providers; and methods of administering the program. Medicaid pays for health care services, community-based supports, and nursing home care for certain low-income people. Medicaid does not cover all low-income people in every state. The program was authorized in 1965 by Title XIX of the Social Security Act. Medicare: This nationwide program provides health insurance to people age 65 and over, people entitled to Social Security disability payments for 2 years or more, and people with end-stage renal disease, regardless of income. The program was enacted July 30, 1965, as Title XVIII, Health Insurance for the Aged of the Social Security Act, and became effective on July 1, 1966. Medicare covers acute care services and postacute care settings, such as rehabilitation and long-term care hospitals, and generally does not cover nursing home care. Prescription drug coverage began in 2006. Medicare Advantage:See Medicare Part C. Medicare Part A: Also known as Hospital Insurance, Medicare Part A covers inpatient care in hospitals, critical access hospitals, skilled nursing facilities, and other postacute care settings, such as rehabilitation and long-term care hospitals. It also covers hospice and some home health care. Medicare Part B: Also known as Medical Insurance, Medicare Part B covers doctor’s services, outpatient hospital care, and durable medical equipment. It also covers some other medical services that Medicare Part A does not cover, such as physical and occupational therapy and some home health care. Medicare Part B also pays for some supplies when they are medically necessary. Medicare Part C: With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans instead of through the original Medicare plan (Parts A and B). These plans were

158known as Medicare+Choice or Part C plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the types of plans allowed to contract with Medicare were expanded, and the Medicare Choice program became known as Medicare Advantage. In addition to offering comparable coverage to Part A and Part B, Medicare Advantage plans may also offer Part D coverage. Medicare Part D: This program subsidizes the costs of prescription drugs for Medicare beneficiaries. It was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and went into effect on January 1, 2006. Beneficiaries can obtain the Medicare drug benefit through two types of private plans: beneficiaries can join a Prescription Drug Plan for drug coverage only or they can join a Medicare Advantage plan that covers both medical services and prescription drugs. Alternatively, beneficiaries may receive drug coverage through a former employer, in which case the former employer may qualify for a retiree drug subsidy payment from Medicare. Medigap:See Supplemental health insurance. Noninstitutional group quarters: For the 2010 Census, the U.S. Census Bureau defined noninstitutional group quarters as facilities that house those who are primarily eligible, able, or likely to participate in the labor force while residents. The noninstitutionalized population lives in noninstitutional group quarters such as college/university student housing, military quarters, and other noninstitutional group quarters such as emergency and transitional shelters for people experiencing homelessness and group homes. For more information on noninstitutional group quarters, please see Appendix B at https://www.census.gov/prod/cen2010/doc/sf1.pdf. Obesity:See Body mass index (BMI). Office-based medical provider services: In the Medical Expenditure Panel Survey (Indicator 32), this category includes expenses for visits to physicians and other health practitioners seen in office-based settings or clinics. “Other health practitioner” includes audiologists, optometrists, chiropractors, podiatrists, mental health professionals, therapists, nurses, and physician’s assistants, as well as providers of diagnostic laboratory and radiology services. Services provided in a hospital-based setting, including outpatient department services, are excluded. Other health care: In the Medicare Current Beneficiary Survey (Indicator 33), this category includes short-term institution, hospice, and dental services. In the Medical Expenditure Panel Survey (Indicator 32), other health care includes home health services (formal care provided by home health agencies and independent home health providers) and other medical equipment and services. The latter includes expenses for eyeglasses, contact lenses, ambulance services, orthopedic items, hearing devices, prostheses, bathroom aids, medical equipment, disposable supplies, alterations/modifications, and other miscellaneous items or services that were obtained, purchased, or rented during the year. Out-of-pocket health care spending: These are health care expenditures that are not covered by insurance. Outpatient hospital: See Hospital outpatient services. Overweight:See Body mass index (BMI). Physician/medical services: In the Medicare Current Beneficiary Survey (Indicator 33), this category includes visits to a medical doctor, osteopathic doctor, and health practitioner as well as diagnostic laboratory and radiology services. Health practitioners include audiologists, optometrists, chiropractors, podiatrists, mental health professionals, therapists, nurses, paramedics, and physician’s assistants. Services provided in a hospital-based setting, including outpatient department services, are included. Physician/outpatient hospital: In the Medicare Current Beneficiary Survey (Indicator 29), this term refers to “physician/medical services” combined with “hospital outpatient services.” Physician visits and consultations: In Medicare claims data (Indicator 28), physician visits and consultations include visits and consultations with primary care physicians, specialists, and chiropractors in their offices, hospitals (inpatient and outpatient), emergency rooms, patient homes, and nursing homes. Population: Data on populations in the United States are often collected and published according to several different definitions. Various statistical systems then use the appropriate population for calculating rates. Resident population:The resident population of the United States includes people residing in the 50 states and the District of Columbia. It excludes residents of the Commonwealth of Puerto Rico and residents of the outlying areas under United States sovereignty or jurisdiction (principally American Samoa, Guam, U.S. Virgin Islands, and the Commonwealth of the Northern Mariana Islands). An area’s resident population consists of those persons “usually resident” in that

159particular area (where they live and sleep most of the time). The resident population includes people living in housing units, nursing homes, and other types of institutional settings. People whose usual residence is outside the United States, such as the U.S. military and civilian personnel as well as private U.S. citizens living overseas, are excluded from the resident population.Resident noninstitutionalized population: The resident population residing in noninstitutional group quarters. See also Resident population and Noninstitutional group quarters.Civilian population: The U.S. resident population not in the active-duty Armed Forces. Civilian noninstitutionalized population:This population includes all U.S. civilians residing in noninstitutional group quarters. See also Noninstitutional group quarters.Institutionalized population:For the 2010 Census, the U.S. Census Bureau defined institutional group quarters as facilities that house those who are primarily ineligible, unable, or unlikely to participate in the labor force while residents. The institutionalized population is the population residing in institutional group quarters such as adult correctional facilities, juvenile facilities, skilled-nursing facilities, and other institutional facilities such as mental (psychiatric) hospitals and in-patient hospice facilities. People living in noninstitutional group quarters are the noninstitutionalized population. For more information on institutional and noninstitutional group quarters, please see Appendix B at https://www.census.gov/prod/cen2010/doc/sf1.pdf.Poverty: The official measure of poverty is computed each year by the U.S. Census Bureau and is defined as having income less than 100 percent of the poverty threshold (i.e., $12,043 for one person age 65 and over in 2018).56 Poverty thresholds are the dollar amounts used to determine poverty status. Each family (including single-person households) is assigned a poverty threshold based on the family’s size and the ages of the family members. All family members have the same poverty status. Several indicators included in this report include a poverty status measure. Poverty status (less than 100 percent of the poverty threshold) was computed for Indicators 7, 8, 27, 31, and 32 using the official Census Bureau definition for the corresponding year. In addition, the following income-to-poverty categories are used in this report:Indicator 8:Income:The income categories are derived from the ratio of the family’s money income (or an unrelated individual’s money income) to the poverty threshold. Being in poverty is having income less than 100 percent of the threshold. Low income is income between 100 percent and 199 percent of the poverty threshold (i.e., between $12,043 and $24,085 for one person age 65 and over in 2018). Middle income is income between 200 percent and 399 percent of the poverty threshold (i.e., between $24,086 and $36,128 for one person age 65 and over in 2018). High income is income 400 percent or more of the poverty threshold.Indicator 27:Cigarette Smoking: Below poverty is defined as having income less than 100 percent of the poverty threshold. Above poverty is grouped into two categories: (1) income between 100 percent and 199 percent of the poverty threshold and (2) income equal to or greater than 200 percent of the poverty threshold. Indicator 31:Sources of Health Insurance: Below poverty is defined as having income less than 100 percent of the poverty threshold. Above poverty is grouped into two categories: (1) income between 100 percent and 199 percent of the poverty threshold and (2) income equal to or greater than 200 percent of the poverty threshold. Indicator 32: Out-of-Pocket Health Care Expenditures: Two income categories were used to examine out-of-pocket health care expenditures using the Medical Expenditure Panel Survey (MEPS) and MEPS predecessor survey data. The categories were expressed in terms of poverty status (i.e., the ratio of the family’s income to the Federal poverty thresholds for the corresponding year), which controls for the size of the family and the age of the head of the family. The income categories were (1) poor and near poor and (2) other income. The poor and near-poor income category includes people in families with income less than 100 percent of the poverty line, including those whose losses exceeded their earnings, resulting in negative income (i.e., the poor), as well as people in families with income from 100 percent to less than 125 percent of the poverty line (i.e., the near poor). The other income category includes people in families with income greater than or equal to 125 percent of the poverty line. See also Income, household.Prescription drugs/medicines: In the Medicare Current Beneficiary Survey (Indicators 29, 30, 33) and in the Medical Expenditure Panel Survey (Indicator 32), prescription drugs are all prescription medications (including refills), except those provided by the doctor or practitioner as samples and those provided in an inpatient setting.

160Prevalence: The number of cases of a disease, infected people, or people with some other attribute present during a particular interval of time. It is often expressed as a rate (e.g., the prevalence of diabetes per 1,000 people during a year). Private supplemental health insurance: See Supplemental health insurance. Public assistance: Public assistance is money income reported in the Current Population Survey from Supplemental Security Income (payments made to low-income people who are age 65 and over, blind, or disabled) and public assistance or welfare payments, such as Temporary Assistance for Needy Families and General Assistance. Race: See specific data source descriptions. Rate: A measure of some event, disease, or condition in relation to a unit of population, along with some specification of time. Reference population: The reference population is the base population from which a sample is drawn at the time of initial sampling. See also Population. Respondent-assessed health status: In the National Health Interview Survey, respondent-assessed health status is measured by asking the respondent, “Would you say [your/subject name’s] health is excellent, very good, good, fair, or poor?” The respondent answers for all household members, including himself or herself.Retiree Drug Subsidy: This subsidy is designed to encourage employers to continue providing retirees with prescription drug benefits. Under the program, employers may receive a subsidy of up to 28 percent of the costs of providing the prescription drug benefit.Short-term institution: This category in the Medicare Current Beneficiary Survey (Indicators 29 and 33) includes skilled nursing facility stays and other short-term (e.g., subacute care) facility stays (e.g., a rehabilitation facility stay). Payments for these services include Medicare and other payment sources. See also Skilled nursing facility (Indicator 28), Nursing facility (Indicator 35), and Long-term care facility (Indicators 21, 29, 33, and 36). Skilled nursing facility: As defined by Medicare (Indicator 28), a skilled nursing facility provides short-term skilled nursing care on an inpatient basis, following hospitalization. These facilities provide the most intensive care available outside of inpatient acute hospital care. In the Medicare Current Beneficiary Survey (Indicators 29 and 33), “skilled nursing facilities” are classified as a type of “short-term institution.” See also Short-term institution (Indicators 29 and 33), and Long-term care facility (Indicators 21, 29, 33, and 35). Skilled nursing facility stays: In the Medicare claims data (Indicator 28), skilled nursing facility stays refer to admission to and discharge from a skilled nursing facility, regardless of the length of stay. See also Skilled nursing facility (Indicator 28).Standard population: A population in which the age and sex composition is known precisely, as a result of a census. A standard population is used as a comparison group in the procedure for standardizing mortality rates. Supplemental health insurance: Designed to fill gaps in the original Medicare plan coverage by paying some of the amounts that Medicare does not pay for covered services and may pay for certain services not covered by Medicare. Private Medigap is supplemental insurance that individuals purchase themselves or through organizations such as AARP or other professional organizations. Employer- or union-sponsored supplemental insurance policies are provided through a Medicare enrollee’s former employer or union. For dual-eligible beneficiaries, Medicaid acts as a supplemental insurer to Medicare. Some Medicare beneficiaries enroll in Health Maintenance Organizations (HMOs) and other managed care plans that provide many of the benefits of supplemental insurance, such as low copayments and coverage of services that Medicare does not cover. Supplemental Poverty Measure: Since 2011, the U.S. Census Bureau has published poverty estimates using the Supplemental Poverty Measure (SPM). The SPM creates a more complex statistical picture, incorporating additional items such as tax payments, work expenses, and medical out-of-pocket expenditures in its family resource estimates. The resource estimates also take into account the value of noncash benefits, including nutritional, energy, and housing assistance. Thresholds used in the new measure are derived from Consumer Expenditure Survey expenditure data on basic necessities (food, shelter, clothing, and utilities) and are adjusted for geographic differences in the cost of housing.TRICARE: The Department of Defense’s regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors.

161TRICARE for Life: TRICARE’s Medicare wraparound coverage (similar to traditional Medigap coverage) for Medicare-eligible uniformed services beneficiaries and their eligible family members and survivors. Veteran: People who served on active duty in the Army, Navy, Air Force, Marines, Coast Guard, uniformed Public Health Service, or uniformed National Oceanic and Atmospheric Administration; Reserve Force and National Guard called to Federal active duty; and those disabled while on active duty training. Excluded are those dishonorably discharged and those whose only active duty was for training or State National Guard service. Veterans’ health care: Health care services provided by the Veterans Health Administration (Indicator 34) includes preventive care, ambulatory diagnosis and treatment, inpatient diagnosis and treatment, and medications and supplies. This includes home- and community-based services (e.g., home health care) and long-term care institutional services (for those eligible to receive these services).

 

2001—September 11: Terrorists attack United States; War on Terror declared and invasion of Afghanistan ….20152020The Historical Experience of Three Cohorts of Older Americans: A Timeline of Selected Events 1935–20201941—Pearl Harbor; United States enters WWII1944—D-Day landings in Normandy1945—Yalta Conference; Cold War begins; Atomic bombings of Hiroshima and Nagasaki; 1946—Baby boom begins1950—United States enters Korean War1955—Nationwide polio vaccination program begins1962—Cuban Missile Crisis 1973—Roe v. Wade 1963—March on Washington; Assassination of PresidentJohn F. Kennedy; 1964—baby boom ends; New York World’s Fair1953—Korean Armistice Agreement signed1968—Assassination of Martin Luther King, Jr.1969—First man on the moon; Stonewall uprising1970—Kent State shootings1989—Berlin Wall falls1990—United States enters Persian Gulf War 1992—Maastricht Treaty creates European Union 1980—First AIDS case is reported to the Centers for Disease Control and Prevention1987—Development of HyperText MarkupLanguage (HTML), giving rise to the World Wide Web1997—WiFi first released for consumers1998—Launch of International Space Station2007—Economic downturn begins December 20072008—First Baby Boomers begin to turn 62 years old and become eligible for Social Security retired worker benefits; Historical EventsYear1935 CohortBorn5 years old15 years old25 years old55 years old65 years old75 years old85 years old35 years old45 years oldBorn5 years old15 years old45 years old55 years old65 years old75 years old1945 Cohort25 years old35 years oldBorn5 years old15 years old25 years old35 years old45 years old55 years old65 years old1955 Cohort1935—Social Security Act passed1937—U.S. Housing Act passed, establishing Public Housing1956—Women ages 62–64 eligible for reduced SocialSecurity benefits; 1957—Social Security Disability Insurance implemented; 1959—Section 202 of the Housing Act established, providing assistance to older adults with lowincome1961—Men ages 62–64 eligible for reduced Social Security benefits; 1962—Self-Employed Individual Retirement Act (Keogh Act) passed; 1964—Civil Rights Act passed1965—Medicare and Medicaid established; Older Americans Act passed1967—Age Discrimination in Employment Act passed 1972—Formula for Social Security cost-of-living adjustment established; Social Security Supplemental Security Income legislation passed; 1974—Employee Retirement Income Security Act passed; IRAs established; 1975—Age Discrimination Act passed1978—401(k)s established 1983—Social Security eligibility age increased for full benefits; 1984—Widows entitled to pension benefits if spouse was vested; 1986—Mandator

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