Prepared by the Heartland Center on Aging, Disability, and Long Term Care. School of Public and Environmental Affairs, 801 W. Michigan St., Indianapolis IN 46202, in March, 1991.

The Illinois Needs Assessment Survey conducted random-digit telephone interviews of over 7,400 households which include persons age 55 or older. Data are available on nearly 11,000 individuals, including their demographic characteristics, health and functional status, use and awareness of elder-targeted programs, and other factors which affect their quality of life.

The survey is based on a methodology and questionnaire used in at least eight other State Panel studies, and thus is comparable to several state and national surveys of the elderly. A representative and adequate sample is available for statewide needs assessment and program planning, particularly for targeted minorities, the poor, and elders over 60 years of age. In addition, the survey design allows for tracking over time to monitor changing functional status and service needs of Illinois elderly. Further studies can also focus on Illinois care givers.

Key Demographic Findings: The literature on successful aging has emphasized the roles of household composition and family support in helping elders remain in the community when their functional status and health decline. In this elder population:

• 20% live alone, but over 85% of these have nearby family with whom they visit weekly. Those who continue to live alone after age 60 are predominately white females; over two-thirds have annual incomes of $15,000 or less. In comparison to elders who live with non-spouse others, elders who live alone are in better health and have fewer impairments in their Activities of Daily Living. When they need assistance, elderly who live alone draw more heavily on non-family care than do other elders.
• 56% of the respondents live in 2 person, married couple households which enjoy greater economic resources than other households. Couple households are predominately white, and their functional status is between that of those who live alone and more dependent elders who live with other relatives.
• 19% of the respondents are multiple elder households, while another 5% includes elders who live with other family members who are younger than 55 years of age. These multi-person households include the most functionally impaired elders, the greatest proportions of the poor and near-poor, and the greatest unmet need for additional services. Multiple elder households may include elder siblings, or even an elder couple with a co-residing parent, for example.
• 12% of the respondents are members of minorities, matching known demographic compositions for the state.

Economic Status: The aging literature also points to increasing economic vulnerability as elders age. Among the respondents of the Illinois study, 50% of those age 60-74 report less than $20,000 in total household annual income, half of the elders age 75 and older live on less than $15,000 annual income, and 64% of all minority respondents also report annual incomes of $15,000 or less.

• 29% of persons age 60-74 meet federal definitions of poverty or “near-poverty.” This percentage increases to over half of those over age 85.
• Women under age 60 are more than twice as likely to meet poverty definitions than similarly aged men. 45% of all women over age 85 meet federal poverty criteria.
• Half of all black respondents age 60-74 meet 100% of federal poverty criteria, as do one-third of other minority respondents in this age group.

In addition to declining economic resources, elders are also at risk due to insufficient medical insurance coverage for their greater medical care needs.

• While 3% of all respondents report no current source of medical insurance, black respondents were 2 to 4 times more likely to report no current medical insurance.

Functional Impairment: The Activities of Daily Living (ADL) included in this study are bathing, dressing, feeding, using the toilet, difficulties controlling bowel or bladder functions, and getting in or out of bed.

Over 8% of all respondents over age 60 have at least one ADL limitation. This matches figures from telephone survey data from the National Medical Expenditure Study for elders over age 60 who live in the North Central Division, which includes the state of Illinois. The Illinois percentage is also in line with findings from somewhat older respondents age 65 and from the 1984 Supplement on Aging to the national Health Interview Survey, where 14% reported one or more of the ADL limitations.

• Over half of the respondents who report ADL limitations only reported one ADL limitation. Illinois respondents include somewhat more individuals at this low-level ADL impairment than the older national surveys.
• 2% of Illinois respondents over age 60 report difficulty with 3 or more ADLs; this percentage more than doubles in persons over age 75. This is in agreement with age-trends in other national studies.
• Like national surveys, the most common ADL difficulty is bathing, cited by 4.4% of all persons over age 60, followed by bladder/bowel problems. Frequency of individual ADL items in the Illinois survey agrees with percentages reported for the North Central Division respondents in the National Medical Expenditure Study.
• Women are more likely to show more frequent high ADL impairment (3 or more), while men show twice the prevalence in low-level ADL impairment. Men who survive into their 70’s and 80’s, however, show the greatest frequency of high ADL impairment.
• Persons who live alone show only half to one-quarter the prevalence of 3 or more ADL impairments, depending on the age group in question.
• Elders living in multi-person households show 1.5 to 2.5 times the population average for high ADL impairment and 2 to 3 times the level of incontinence difficulties than the average for each age group.

Race and poverty have always been linked in the aging literature to greater functional limitations among the elderly.

• Black respondents, even those younger than age 60, show 1.5 to 2 times the rates of low ADL impairment in comparison to whites. In terms of high ADL impairment, inter-racial differences are most pronounced in the youngest (55-59) and eldest (85+ years) age groups.
• Prevalence of high ADL impairment among the poor is the same as that seen for black respondents generally.

Health and Functional Status: Elders, their care givers, and family physicians may not be aware that certain conditions are more likely to promote disability. For example:

• While 2 to 4.5% of all elders over age 60 reported 3 or more ADL impairments, depending on their age, those who report Alzheimer’s or Parkinson’s disease are 7 times more likely to be highly impaired.
• Persons with diabetes, severe mobility impairments, or who report frequent mental health problems show rates of high ADL impairment 2 to 3 times greater than the average for others of a similar age.
• While less than 1% of the over age 60 population report bladder or bowel control difficulties plus on other ADL, this level of impairment was 2 to 3 times more common among diabetics and those reporting frequent memory, mobility, or mental health restrictions.

Instrumental Activities of Daily Living Limitations: Instrumental Activities of Daily Living, or IADL, include out-of-home excursions and shopping, heavy yard or other chores, normal light housekeeping, cooking and laundering activities, and managing daily medications, phone calls, and business affairs.

• Over one-third of all respondents over age 60 list one or more IADL limitations. This is nearly twice the prevalence seen in other studies.
• In addition to difficulty with heavy chores, 18.3% of all respondents over age 60 report difficulties with light housekeeping. 10% have problems with shopping, and “getting around outside.” These constitute the most frequent IADL limitations.
• Among the IADL groupings, nearly 15% of persons age 60 or older report difficulties primarily with out-of-home or heavy chore activities; another 2.5% have difficulties limited to light household activities; and less than 2% report only having difficulty managing personal affairs and medications.
• However, a final 18.5% of all persons over age 60 have several IADL problems which included in-home, personal, and out-of-home activities. The rate of multi-level IADL impairment doubles among elders over age 75.
• Rates of multi-level IADL problems are twice as great in the poor and near-poor (23%) as in those who meet no current poverty standard (11%).
• Elders who live alone are more dependent than others for assistance with out-of home IADL problems like shopping, getting around, and heavy chores.

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