Cohort changes in active life expectancy in the US elderly population: Experience from the 1982-2004 National Long-Term Care Survey

Objectives. To understand declines in chronic disability prevalence in the U.S. elderly population, we examined cohort changes in active life expectancy, a health measure relating population disability and longevity dynamics. Methods. We computed active life expectancy and life expectancy using the six National Long-Term Care Surveys, done from 1982 to 2004 and linked to continuous-time Medicare service data for the same time period by sing a stochastic process model based on disability scores calculated using grade of membership analyses. We simultaneously estimated continuous-time disability dynamic and mortality functions to calculate life tables for specific disability states and for temporally changing mixtures of disability states. Results. Disability dynamics, measured as changes in grade of membership scores, showed significant variation across two birth cohorts followed for 24 years. Disability dynamics and disability-specific hazard functions were significantly improved in the younger cohort (persons aged 65-74 in 1982). Discussion. Our results, supporting the hypothesis of morbidity compression, indicate that younger cohorts of elderly persons are living longer in better health. The methods describe individual disability transitions and mortality and other factors associated with disability changes, making it possible to better evaluate interventions to promote future declines in disability.