Know the Issues

Facts and Figures

Sometimes the facts speak for themselves. When it comes to our health care system and whether or not it is serving vulnerable older adults and their families the evidence is clear and compelling. The Campaign for Better Care has compiled the most up-to-date information on older adults with multiple health problems and the challenges they face in our health care system. We need to ensure that health reform actually improves our health care system so it serves these patients better.

The following resources are a guide to understanding the problem, so we can ensure that the right solutions are implemented.

View facts and figures by topic:

  • Americans Are Living Longer but Often Sicker, with Multiple, Complex Health Conditions
  • Chronic Conditions Disproportionately Affect Older Adults
    • The Impact on Older Women
    • The Impact on Low-Income Older Persons
    • The Impact on Older Racial and Ethnic Minority Populations
  • Our Health Care System Is NOT Coordinating Care
  • Coordinating Care for a Loved One with Chronic Health Conditions Places a Heavy Burden on Families
  • Costs Related to Treating Chronic Conditions Could Soon Overwhelm Our Health Care System

Or, download Fact Sheets from our series The Case for Better Care:

  • The Problem: Americans Are Living Longer but Often Sicker, with Multiple, Complex Health Conditions
  • Who’s at Risk? The Shortfalls in our Health System Have a Disproportionate Effect on Older Adults
  • A Lack of Care Coordination: The Cost to Families and Caregivers
  • Our Fragmented Health Care System: The Cost to Society

FACTS AND FIGURES BY TOPIC

Americans Are Living Longer but Often Sicker, with Multiple, Complex Health Conditions

  • In 2008 nearly 40 million Americans were age 65 or older accounting for one in every eight Americans or nearly 13 percent of the general population.1
  • The nation is aging. Researchers estimate that in 2030, when all the Baby Boomers join the ranks of the older population, about 72.1 million people or close to one in five U.S. residents - will be age 65 and older. This is nearly twice their number in 2008.2
  • Chronic conditions like heart disease, diabetes, severe arthritis or high blood pressure are health conditions expected to last at least one year and often require ongoing medical intervention.3
  • Common health conditions like hypertension, arthritis, heart disease, cancer, diabetes, stroke, obesity and depression are examples of chronic diseases and illnesses.4
  • Chronic conditions limit what an individual can do in everyday life. Approximately one out of four people living with a chronic illness experiences significant limitations in their daily activities.5
  • People with multiple chronic conditions are often significantly limited physically and can have difficulty with daily activities such as walking, eating and bathing. In addition to medical services, individuals who have chronic health conditions often need personal, social or other support services over an extended period of time.6
  • Seven in ten U.S. deaths each year are caused by chronic disease.7

Chronic Conditions Disproportionately Affect Vulnerable Older Adults

  • Older adults are more likely to have multiple chronic conditions. Nine in ten older Americans (age 65 +) have at least one chronic health condition, and 77 percent have multiple chronic conditions.8
  • The average 75-year-old has three chronic conditions and takes five prescription drugs.9
  • Among Medicare beneficiaries, nine out of 10 deaths are associated with nine specific chronic conditions: congestive heart failure, chronic lung disease, cancer, coronary artery disease, renal failure, peripheral vascular disease, diabetes, chronic liver disease, and dementia.10
  • Women, racial and ethnic minorities, and low-income persons ages 65 and older are at higher risk for having multiple chronic health conditions than others in their age group.11 12 13

The Impact on Older Women

  • Because women tend to live longer than men, older women are more likely to have chronic conditions, many of which carry multiple, significant health concerns.14
  • Often, these older women are also caregivers to spouses, other relatives or friends who are also suffering from one or more chronic health conditions.15

The Impact on Low-Income Older Persons

  • Older adults living below the poverty level are more likely than those at higher income levels to have multiple chronic conditions.16
  • In 2005, the percentage of Medicare beneficiaries who delayed care was significantly higher for poor, near-poor and middle income beneficiaries than for high-income beneficiaries.17
  • Low-income adults ages 55 to 84 were more likely than adults in the same age group who were not poor to have visited an emergency room in the past year.18

The Impact on Older Racial and Ethnic Minority Populations

  • The older population is becoming more racially and ethnically diverse. Members of minority groups are projected to represent more than 25 percent of the older population (age 65+) in 2030, up from about 16 percent in 2000.19
  • Health disparities pervade our nation. Racial and ethnic minorities experience more chronic diseases and higher mortality rates from these diseases.20
  • Among adults aged 65 and older, nearly two out of three (65 percent) African Americans have hypertension, compared with 49 percent of older Hispanics and 47 percent of the older White population.21
  • One out of four Hispanics aged 65 and older and 23 percent of older African Americans, have diabetes, compared with 14 percent of the older adult White population.22
  • Thirty-nine percent of White adults aged 65+ and older reported very good or excellent health in 2004, compared with 24 percent of non-Hispanic older African Americans and 29 percent of older Hispanics.23
  • Black and Hispanic Medicare beneficiaries are more likely than non-Hispanic White beneficiaries to delay needed care due to cost.24

Our Health Care System Is NOT Coordinating Care

  • Older adults with multiple (five or more) chronic health conditions have an average of 37 doctor visits, 14 different doctors, and 50 separate prescriptions each year.25
  • As the number of doctors and specialists involved in a patient’s care increases, patients are likely to find it more difficult to coordinate their care.26
  • Large numbers of older adults with multiple chronic health conditions report duplicate tests and procedures, conflicting diagnoses for the same set of symptoms, contradictory medical information, and not receiving adequate information about potential drug interactions when they fill prescriptions. 27
  • People with five or more chronic health conditions experience avoidable hospitalizations at 15 times the rate of those with one condition. 28
  • One in five older adults with complex chronic health conditions, like diabetes, heart disease or severe arthritis, are readmitted to the hospital within 30 days because they go home without the information and support they need to take care of themselves and they get no follow-up care.29
  • A typical primary care physician who sees Medicare patients must coordinate care for those patients with 229 other physicians who work in 117 different practices.30
  • Physicians surveyed about their perspectives on chronic care believe that quality problems are greater among their patients with multiple chronic conditions.31
  • Without concerted strategic intervention, chronic diseases and their risk factors can be expected to cause more harm and be more costly to society.32

Coordinating Care for a Loved One with Chronic Health Conditions Places a Heavy Burden on the Caregiver

  • Family members and friends who arrange or provide care for loved ones with chronic conditions known as family caregivers often have to alter their everyday lives to accommodate these health concerns.33
  • In 2007, about 34 million family caregivers provided care at any given point in time, and about 52 million provided care at some point during the year.34
  • The estimated economic value of caregivers (unpaid) contributions for example, helping with daily activities like bathing, managing medications, preparing meals, providing travel to doctors’ appointments and talking with health care providers was approximately $375 billion in 2007.35
  • Many working women are part of the ‘sandwich generation’ which means they are caring simultaneously for their children and their parents and, as a result, face extraordinary pressure balancing their caregiving, work and family responsibilities.36
  • Family caregivers are increasingly assuming health management roles in the home and managing medical tasks traditionally handled by health care providers (such as bandaging and caring for wounds, using high-tech medical equipment at the bedside, and managing complex medication schedules), with little or no preparation, training or support.37
  • Family caregiving provided mostly by wives and adult daughters can put the caregiver at increased risk of facing their own health risks and serious illness, emotional strain and mental health problems.38 39 40
  • Research suggests that some family caregivers are at increased risk of mortality.41
  • People with serious chronic conditions use a variety of methods to finance their health care including savings (38 percent); government aid (36 percent); borrowing or receiving money from another family member or friend (27 percent); and/or taking money from a retirement fund (16 percent).42
  • In 2007, family members caring for someone age 50 or older reported spending an average of $5,531 out of their own pocket to help with their loved one’s medical care.43
  • One in three caregivers used their savings (34 percent) or cut back on basic home maintenance (32 percent), and nearly one in four caregivers (23 percent) cut back on spending for their own health or dental care, to help with the expenses associated with caring for their relative or friend.44
  • Out-of-pocket spending remains high for family caregivers with extremely limited incomes. Those with the lowest income (less than $25,000 per year) report an average annual expense of more than $5,000 — or more than 20 percent of their annual income.45

Costs Related to Treating Chronic Conditions Could Soon Overwhelm Our Health Care System

  • People with chronic conditions account for 85 percent of all health care spending.46
  • The average adult aged 55-64 the “near elderly” with at least one chronic condition spent $7,377 on health care in 2006, compared to $4,951 for younger persons.47
  • Ninety-six percent of Medicare dollars is spent on patients with multiple chronic conditions.48
  • Two-thirds of Medicare dollars are spent on patients with five or more chronic conditions.49
  • People with Medicare coverage are the most likely to have high out-of-pocket costs for chronic care.50


1U.S. Administration on Aging (2008). Annual Estimates of the Resident Population by Sex and Five-Year Age Groups for the United States: July 1, 2008. Retrieved September 25, 2009, from http://www.aoa.gov/AoARoot/Aging_Statistics/Census_Population/Population/2008/docs/2008-National-Population-Estimates.xls.

2U.S. Census Bureau, National Population Projections, Table 2: Projections of the Population by Selected Age Groups and Sex for the United States: 2010 to 2050 (August 2008). Retrieved July 22, 2009, from http://www.census.gov/population/www/projections/files/nation/summary/np2008-t2.xls.

3Machlin, S., Cohen, J., & Beauregard, K. (2008). Agency for Healthcare Research and Quality. Health Care Expenses for Adults with Chronic Conditions, 2005. (Statistical Brief #203). Retrieved July 22, 2009, from http://www.meps.ahrq.gov/mepsweb/data_files/publications/st203/stat203.pdf.

4Centers for Disease Control and Prevention (2009). Chronic Diseases: The Power to Prevent, The Call to Control—At a Glance 2009. Retrieved July 23, 2009, from http://www.cdc.gov/nccdphp/publications/AAG/chronic.htm.

5Centers for Disease Control and Prevention (2009). Chronic Diseases: The Power to Prevent, The Call to Control—At a Glance 2009. Retrieved July 23, 2009, from http://www.cdc.gov/nccdphp/publications/AAG/chronic.htm.

6Partnership for Solutions (2004). Chronic Conditions: Making the Case for Ongoing Care. Baltimore, MD: Johns Hopkins University. Retrieved October 13, 2009 from, http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf.

7Kung, H-C., Hoyart, D., Xu, J., & Murphy, S. (2008). Deaths: Final Data from 2005. Centers for Disease Control and Prevention. Retrieved July 23, 2009, from http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf.

8Machlin, S., Cohen, J., & Beauregard, K. (2008). Agency for Healthcare Research and Quality. Health Care Expenses for Adults with Chronic Conditions, 2005. (Statistical Brief #203). Retrieved July 22, 2009, from http://www.meps.ahrq.gov/mepsweb/data_files/publications/st203/stat203.pdf.

9Centers for Disease Control and Prevention and the Merck Institute of Aging & Health (2004). The State of Aging and Health in America 2004. Retrieved October 2, 2009 from, http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.

10The Dartmouth Institute for Health Policy and Clinical Practice (2008). Tracking the Care of Patients with Severe Chronic Illness: The Dartmouth Atlas of Health Care 2008. The Trustees of Dartmouth College. Retrieved October 13, 2009, from http://www.dartmouthatlas.org/atlases/2008_Chronic_Care_Atlas.pdf.

11Anderson, G. (2007). Chartbook, Chronic Conditions: Making the Case for Ongoing Care. Johns Hopkins University. Retrieved October 1, 2009, from http://www.fightchronicdisease.org/news/pfcd/documents/ChronicCareChartbook_FINAL.pdf

12Centers for Disease Control and Prevention (2009). The Power of Prevention: Chronic Disease…The Public Health Challenge of the 21st Century. Retrieved July 23, 2009, from http://www.cdc.gov/nccdphp/publications/PowerOfPrevention/pdfs/2009-Power-of-Prevention.pdf.

13National Center for Healthcare Statistics (2006). Health, United States, 2006. Hyattsville, MD: U.S. Department of Health and Human Services. Retrieved October 4, 2009, from http://www.cdc.gov/nchs/hus/hus06.pdf.

14Anderson, G. (2007). Chartbook, Chronic Conditions: Making the Case for Ongoing Care. Johns Hopkins University. Retrieved October 1, 2009, from http://www.fightchronicdisease.org/news/pfcd/documents/ChronicCareChartbook_FINAL.pdf

15Anderson, G. (2007). Chartbook, Chronic Conditions: Making the Case for Ongoing Care. Johns Hopkins University. Retrieved October 1, 2009, from http://www.fightchronicdisease.org/news/pfcd/documents/ChronicCareChartbook_FINAL.pdf

16National Center for Healthcare Statistics (2006). Health, United States, 2006. Hyattsville, MD: U.S. Department of Health and Human Services. Retrieved October 4, 2009, from http://www.cdc.gov/nchs/hus/hus06.pdf.

17Agency for Healthcare Research and Quality , U.S. Department of Health and Human Services. (2008). National Healthcare Quality Report, 2008. Retrieved October 6, 2009, from http://www.ahrq.gov/qual/nhqr08/nhqr08.pdf.

18Schoenborn, C. & Heyman, K. (2009). Health Characteristics for Adults Aged 55 and Over: United States, 2004-2007. (National Health Statistics Report No. 16). Centers for Disease Control and Prevention. Retrieved July 23, 2009, from http://www.cdc.gov/nchs/data/nhsr/nhsr016.pdf.

19Agency for Healthcare Research and Quality (2008). U.S. Department of Health and Human Services. National Healthcare Quality Report, 2008. Retrieved October 6, 2009, from http://www.ahrq.gov/qual/nhqr08/nhqr08.pdf.

20Centers for Disease Control and Prevention (2009). The Power of Prevention: Chronic Disease…The Public Health Challenge of the 21st Century. Retrieved July 23, 2009, from http://www.cdc.gov/nccdphp/publications/PowerOfPrevention/pdfs/2009-Power-of-Prevention.pdf.

21Centers for Disease Control and Prevention and the Merck Institute of Aging & Health (2004). The State of Aging and Health in America 2004. Retrieved October 2, 2009, from http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.

22Centers for Disease Control and Prevention and the Merck Institute of Aging & Health (2004). The State of Aging and Health in America 2004. Retrieved October 2, 2009, from http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.

23Centers for Disease Control and Prevention (2007). Trends in Health and Aging: Major Trends and Patterns in Health of Older Hispanics in the United States. Retrieved October 5, 2009, from http://www.cdc.gov/NCHS/ppt/aging/hispanic_health.ppt#251 , 1, Trends in Health and Aging.

24Agency for Healthcare Research and Quality (2008). U.S. Department of Health and Human Services. National Healthcare Quality Report, 2008. Retrieved October 6, 2009, from http://www.ahrq.gov/qual/nhqr08/nhqr08.pdf.

25Berenson, R. & Horvath, J. (2002). The Clinical Characteristics of Medicare Beneficiaries and Implications for Medicare Reform. Prepared for: The Center for Medicare Advocacy Conference on Medicare Coordinated Care, Washington, DC. Retrieved September 24, 2009, from www.partnershipforsolutions.org.

26National Academy of Social Insurance (2003). Medicare in the 21st Century: Building a Better Chronic Care System. Washington, DC. Retrieved October 13, 2009, from http://www.nasi.org/usr_doc/Chronic_Care_Report.pdf.

27Anderson, G (2007). Chartbook, Chronic Conditions: Making the Case for Ongoing Care. Johns Hopkins University. Retrieved October 1, 2009, from http://www.fightchronicdisease.org/news/pfcd/documents/ChronicCareChartbook_FINAL.pdf

28Partnership for Solutions (2004). Chronic Conditions: Making the Case for Ongoing Care. Baltimore, MD: Johns Hopkins University. Retrieved October 13, 2009 from, http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf.

29Jencks, S., Williams, M., & Coleman, E. (2009). Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine, 360(14): 1418-1428.

30Pham, H., O’Malley, A., Bach, P., Saiontz-Martinez, C., & Schrag, D. (2009). Primary care physicians’ links to other physicians through Medicare patients: The scope of care coordination. Annals of Internal Medicine, 150(4): 236-242.

31Anderson, G. (February 2003). Physician, public, and policymaker perspectives on chronic conditions. Archives of Internal Medicine, 163, 437-442.

32Centers for Disease Control and Prevention (2007). Trends in Health and Aging: Major Trends and Patterns in Health of Older Hispanics in the United States. Retrieved October 5, 2009, from http://www.cdc.gov/NCHS/ppt/aging/hispanic_health.ppt#251 , 1, Trends in Health and Aging.

33National Academy on an Aging Society (1999). Chronic Conditions: A Challenge for the 21st Century. Washington, DC: Georgetown University. Retrieved October 1, 2009, from http://www.agingsociety.org/agingsociety/pdf/chronic.pdf.

34AARP Public Policy Institute (2008). Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update. Retrieved July 23, 2009, from http://assets.aarp.org/rgcenter/il/i13_caregiving.pdf.

35AARP Public Policy Institute (2008). Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update. Retrieved July 23, 2009, from http://assets.aarp.org/rgcenter/il/i13_caregiving.pdf, page 1.

36Talley, R. & Crews, J. (2007). Caring for the most vulnerable: Framing the public health of caregiving. American Journal of Public Health, 97(2), 224-228. Retrieved July 24, 2009, from http://www.ajph.org/cgi/reprint/97/2/224.pdf.

37Donelan, K., et al. (2002). Challenged to care: Informal caregivers in a changing health system. Health Affairs, 21(4), 222-231.

38Vitaliano, P., Zhang, P., & Scanlan, J. (2003). Is caregiving hazardous to one’s physical health?: A meta-analysis. Psychological Bulletin, 129(6): 946-972.

39Cannusico, C., et al. (2002). Reverberation of family illness: A longitudinal assessment of informal caregiver and mental health status in the nurses’ health study. American Journal of Public Health, 92(8): 1305-1311.

40Aneshensel, C., Pearlin, L., Mullan, J., Zarit, S., & Whitlach, C.J. (1995). Profiles in Caregiving: The Unexpected Career. New York: Academic Press.

41Schulz, R. & Beach, S. (1999). Caregiving as a risk factor for mortality: The caregiver health effects study. Journal of the American Medical Association, 282(23): 2215-2219.

42The Gallup Organization (2002). Serious Chronic Illness Survey. Washington, DC.

43National Alliance for Caregiving and Evercare (2007). Evercare Study of Family Caregivers—What They Spend, What They Sacrifice: The Personal Financial Tool of Caring for a Loved One. Retrieved July 23, 2009, from http://www.caregiving.org/data/Evercare_NAC_CaregiverCostStudyFINAL20111907.pdf.

44National Alliance for Caregiving and Evercare (2007). Evercare Study of Family Caregivers—What They Spend, What They Sacrifice: The Personal Financial Tool of Caring for a Loved One. Retrieved July 23, 2009, from http://www.caregiving.org/data/Evercare_NAC_CaregiverCostStudyFINAL20111907.pdf.

45National Alliance for Caregiving and Evercare (2007). Evercare Study of Family Caregivers—What They Spend, What They Sacrifice: The Personal Financial Tool of Caring for a Loved One. Retrieved July 23, 2009, from http://www.caregiving.org/data/Evercare_NAC_CaregiverCostStudyFINAL20111907.pdf.

46Anderson, G. (2007). Chartbook, Chronic Conditions: Making the Case for Ongoing Care. Johns Hopkins University. Retrieved October 1, 2009, from http://www.fightchronicdisease.org/news/pfcd/documents/ChronicCareChartbook_FINAL.pdf

47Vistnes, J., Cooper, P., Bernard, D., & Banthin, J. (2009). Near-Elderly Adults Aged 55-64: Health Insurance Coverage, Cost and Access. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved October 7, 2009, from http://www.ahrq.gov/data/meps/mepsneareld/nearelderly.pdf.

48Partnership for Solutions (2004). Chronic Conditions: Making the Case for Ongoing Care. Baltimore, MD: Johns Hopkins University. Retrieved October 13, 2009 from, http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf.

49Anderson, G. (2007). Chartbook, Chronic Conditions: Making the Case for Ongoing Care. Johns Hopkins University. Retrieved October 1, 2009, from http://www.fightchronicdisease.org/news/pfcd/documents/ChronicCareChartbook_FINAL.pdf

50Anderson, G. (2007). Chartbook, Chronic Conditions: Making the Case for Ongoing Care. Johns Hopkins University. Retrieved October 1, 2009, from http://www.fightchronicdisease.org/news/pfcd/documents/ChronicCareChartbook_FINAL.pdf