Clinical Pathways to Disability
Mary Beth Landrum, Kate A. Stewart, and David M. Cutler
While disability declined over the course of the 1980s and 1990s (Crimmins, Saito, and Reynolds 1997; Freedman and Martin 1998; Waidmann and Liu 2000; Cutler 2001; Manton and Gu 2001; Schoeni, Freedman, and Wallace 2001; Freedman, Martin, and Schoeni 2002; Freedman, Crimmons et al. 2004; Spillman 2004), the prevalence of disability among the elderly remains high (Waidmann and Liu 2000; Schoeni, Freedman, and Wallace 2001; Manton, Gu, and Lamb 2006). Moreover, disability is associated with poor quality of life (Lamb 1996), high medical spending (Komisar, Hunt-McCool, and Feder 1997; Liu, Wall, and Wissoker 1997; Fried et al. 2001; Guralnik et al. 2002; Chernew et al. 2005), and increased mortality (Manton 1988; Guralnik et al. 1991; Ferrucci et al. 1996). Thus, it is critical to understand the major clinical pathways through which the health of the elderly declines to be able to develop effective interventions to prevent or minimize disability in the elderly population.
In this paper, we analyze data from the National Long Term Care Survey (NLTCS)—a longitudinal survey on a nationally representative sample of Medicare beneficiaries that has been linked to Medicare administrative
Mary Beth Landrum is an associate professor of biostatistics in the Department of Health
Care Policy at Harvard Medical School. Kate A. Stewart is a researcher at Mathematica Pol-
icy Research, Inc., and was a PhD candidate in Health Policy at Harvard Medical School
when this research was completed. David M. Cutler is the Otto Eckstein Professor of Applied
Economics and Dean for the Social Sciences at Harvard University and an affiliate of the Na-
tional Bureau of Economic Research.
This work was funded by the National Institute of Aging (P30 AG12810 and R01
AG19805) and the Mary Woodard Lasker Charitable Trust and Michael E. DeBakey Foun-