Aggregate Changes in Severe Cognitive Impairment Among Older Americans: 1993 and 1998

Abstract

As a group, older persons, especially those well into their 80s, appear to have better cognitive functioning today than they did in the early 1990s.

Lifecourse Social Conditions and Racial and Ethnic Patterns of Cognitive Aging

“…Increased investments in education and improved conditions for US-born blacks may reduce the incidence of dementia and disabling cognitive impairment, offsetting increased burden expected as a consequence of population aging (Freedman et al 2001;Freedman et al 2002). Although Jim Crow laws have been eliminated and overt racial discrimination is on the decline, experiences of discrimination and inequality remain common among racial and ethnic minorities in the US.…”

Trends in the prevalence and mortality of cognitive impairment in the United States: Is there evidence of a compression of cognitive morbidity?

“…Our findings of a declining prevalence of CI between 1993 and 2002, and the strong association of education with decreased risk for CI, are consistent with similar trends found between 1982 and 1999 in a recent study using data from the National Long Term Care Survey, 3 and our findings extend those of Freedman and colleagues who also found a decline between 1993 and 1998 in "severe cognitive impairment" using HRS data. 23,41 Potential mechanisms leading from more education to better cognitive function and reserve include a direct positive effect of schooling on brain development, 3,24,26 greater mental stimulation throughout the life course due to more cognitively demanding occupations 42,43 and leisure time activities, 20,24,44 and more "brain healthy" lifestyles such as better control of cardiovascular and cerebrovascular risk factors, as well as better access to health care interventions that may help preserve cognitive function. 30,31 Our finding that the increasing prevalence of cardiovascular risks was not accompanied by an increasing prevalence of CI suggests that these risks were treated more successfully in 2002 compared to 1993.…”

Changes in Elderly Disability Rates and the Implications for Health Care Utilization and Cost

“…Using the 1993 Assets and Health of the Oldest Old and the 1998 Health and Retirement Survey (HRS), Freedman, Aykan, and Martin (2001) found a decline in the proportion of persons aged 70 or older who were cognitively impaired and speculated that the improvement in cognitive functioning may have contributed to the decline in IADL disability observed in other data sources. A more recent study, which added the 2000 HRS and used a different methodology, did not find an improvement but noted the difficulty of measuring cognitive function and the sensitivity of results to methodological decisions (Rodgers, Ofstedal, and Herzog 2003).…”