Nearly 18 million older adults, or nearly half of everyone 65 and older, report that they need some assistance with routine daily activities. That’s significantly more than generally believed and suggests that the burden on families and the overall care system may be much greater than previously thought.

According to a new study by Vicki Freedman of the University of Michigan and my Urban Institute colleague Brenda Spillman, about 11 million of those 18 million seniors were getting help in some form—usually from a family member or friend and less frequently from a paid aide. Their study was published in the September, 2014 issue of the Milbank Quarterly (behind a pay wall).

The research was based on a new national survey called the National Health and Aging Trends Study (NHATS), which did in-depth, in-person interviews with more than 8,000 older adults beginning in 2011.

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