Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 108CH APTER 1 21 Caregiving in the home for older adults with cognitive impairment places a substantial burden on families. Using HRS data, the total national cost has been estimated at $18 billion, and the annual cost of caring for a family member with dementia at about $18,000. The rate of severe depression rises with age. Severe depression is evident in about 20 percent of people age 85 and older, compared with 15 percent among people age 84 or younger. There are considerable differences in use of the health care system, in health expenditures, and in the availability of insurance by age and by race and ethnicity. For example, racial and ethnic differences in health insurance coverage persist among older adults not yet eligible for Medicare. One in 14 Whites and 1 in 8 Blacks lack private health insurance, and about 1 in 4 Hispanics do not have private coverage. Hispanics have the highest probability of not visiting a physician at least once in a given 2-year period. Older people use alternative medicines and supplements to a surprising degree. Among HRS respondents in the year 2000, more than half say they had used some kind of dietary or herbal supplement. Nearly half had seen a chiropractor, and 20 percent had used massage therapy. White Americans ages 55 to 64 are less healthy than their British counterparts, despite higher overall incomes and higher levels of health care spending. A comparison of data from the HRS and a parallel study, the English Longitudinal Study of Ageing, showed that the healthiest middle-aged Americans in the study—those in the highest income and education levels—had rates of diabetes and heart disease similar to the least healthy in England—those in the lowest income and education levels. FIG. 1-1 HEALTH STATUS, by age: 2002 (Percent in each health category) 55-64 65-74 75-84 85+ Excellent Very Good Good Fair Poor 0% 20% 40% 60% 80% 100% Health Status and Specific Conditions The HRS data on health are based largely on what respondents report about themselves. While self- reported evaluations are inherently subjective— and related to individual personality, outlook, and context—research in a wide variety of cultures and contexts suggests that self-reported health status is a very good predictor of more objective health measures such as chronic illness, hospital- ization, and longevity. Individuals’ beliefs about their own health status also have been found to influence their expectations of retirement and the retirement process itself. Figure 1-1 suggests that HRS participants who live in the community consider themselves to be in reasonably good health and that self-reported health status decreases with age. Almost half of HRS participants ages 55 to 64, compared with 42 percent of participants ages 65 to 74, 32 percent ages 75 to 84, and 25 percent age 85 and older, say they are in very good or excellent