Towards a Dynamic Understanding of the Care Needs of the Noninstitutional Elderly

The functional status profile generated from static, cross-sectional data can be misleading. The dynamic perspective generated by longitudinal data emphasize that loss of functional status is not a unidirectional, universal process. The substantial rate of turnover among community-living elders dependent in Activities of Daily Living (ADL) demonstrates that the impairments experienced by a sizable minority (one-eighth to one-third, depending on the time span and the definition of dependency) were only temporary. Alternatively, approximately one-fourth of those ADL-dependent elders living in the community entered the high-cost institutionalized or predeath cohorts within the short term of 15 months compared to the 6 to 8 percent of the ADL-independent community elders. The implications of these population-based, longitudinal data for planning health care systems are emphasized.