NBER Publications by Mary Beth Landrum

This paper examines the pathways by which individuals transition from healthy to disabled. Because of the high prevalence and costs associated with disability, understanding these pathways is critical to developing interventions to prevent or minimize disability. We compare two estimates of disabling conditions: those observed in medical claims and conditions indicated by the disabled individual. A small number of conditions explain about half of incident disability: arthritis, infectious disease, dementia, heart failure, diabetes, and stroke. These conditions show up in medical claims and self reports. A large number of elderly also attribute disability to old age and various symptoms. Because so many of the most disabling conditions do not have clear medical treatments, the outlook for m...

There is little empirical evidence to explain why disability declined among the elderly over the past 20 years. In this paper, we explore the role of improved medical care for cardiovascular disease on health status improvements over time. We show that the incidence of cardiovascular disease hospitalizations remained relatively constant between 1984 and 1999 at the same time that post-event survival improved and disability declined. We find that use of appropriate therapies, including pharmaceuticals such as beta-blockers, aspirin, and ace-inhibitors, and invasive procedures, explains up to 50% and 70% of the reductions in disability and death over time, respectively. Elderly patients living in regions with high use of appropriate medical therapies had better health outcomes than patients ...

There is a pronounced gradient in disability across socioeconomic groups, with better educated and higher income groups reporting substantially less disability. In this paper, we consider why that is the case, focusing on impairments in basic physical and cognitive aspects of living for the elderly. Our empirical work has two parts. First, we consider how much of this gradient in disability is a result of underlying differences in functioning versus the ability to cope with impairments. We show differences in functioning are the major part of the difference in disability, but both are important. Second, we consider how the better educated elderly cope with disability. Better educated people use substantially more assistive technology than the less educated and are more likely to use paid h...