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Rate of disability slows in elderly, study says

America's elderly are in better health than just a decade ago, and the trend may be gaining strength, according to a new report with implications for all sides in the debate over Medicare, Medicaid and Social Security.

The report by demographer Kenneth Manton of Duke University found that long-term disability rates among the elderly dropped almost 15 percent from 1982 to 1994.

In the '90s, the most significant improvements were among people age 85 or over and among the severely disabled.

The paper is to be published today by the National Academy of Sciences.

Previous studies by Manton and his team of researchers have documented a steady drop in disability among the elderly, as well as a decline in some illnesses, such as arthritis, hardening of the arteries and high blood pressure.

Manton credits the health improvements to everything from better personal health habits to medical innovation to public health efforts.

The study was based on data from more than 35,000 people, collected through the Census Bureau's National Long Term Care Surveys. It found that 21.3 percent of the elderly had some long-term disability in 1994. Disability was defined as being unable to do at least one basic task of daily living, such as dressing yourself or shopping for groceries, for a period of 90 days or more.

The findings cut both ways in the debate over financing federal programs for the elderly, which account for about 40 percent of government spending. (Social Security provides inflation-protected income; Medicare pays health care bills; and Medicaid covers nursing home costs.)

On the one hand, the report signals that Medicare's future may not be quite as bleak, which pleases groups representing the elderly. On the other hand, if the elderly are healthier, why not increase the retirement age?

"Disability declines may have important implications for national health care costs," wrote Manton and his team. They calculated that if disability rates had not gone down between 1982 and 1994, 400,000 more people would have been in nursing homes, at a cost of $17-billion in 1994.

But the report also raises a curious question: Why haven't improvements in the overall health of the elderly shown up on the balance sheet already? Medicare costs kept climbing through the '80s and '90s, and the program's hospital fund is headed for bankruptcy in 2001.

Part of the answer may be that better health also costs money. More heart surgeries, more hip replacements and more high-tech diagnostic tests help to drive down disability rates _ at a price.

Sen. Edward Kennedy, D-Mass., called Manton's report a breakthrough in the debate over the future of Medicare, which usually revolves around the equally controversial alternatives of cutting spending or raising taxes.

"We have paid too little attention to a third alternative for saving Medicare _ improving the health of senior citizens," Kennedy said in what was billed as a major policy address keyed to the study. "Healthier senior citizens mean healthier Medicare."

He urged more attention to preventive care and healthy lifestyle choices, more spending on medical research and improved Medicare benefits.

Kennedy said improvements in the health of the elderly would save billions and "could be enough to solve Medicare's long-term financial problem."

But economist Robert Reischauer, a former head of the Congressional Budget Office, called that "a wish and prayer."

Gail Wilensky, a former head of Medicare, said healthier retirees won't magically solve the cost crunch. "It may make it slightly less overwhelming, but that doesn't mean we're out of the woods," Wilensky said.

Whether or not the elderly are healthier, their growing numbers are projected to swamp the financing for retirement programs once baby boomers begin reaching 65.

However, the Duke study could help cement a growing bipartisan consensus for better Medicare coverage of preventive services like colon cancer screening, diabetes management, flu and hepatitis shots, and annual mammograms.

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