THE ELDER CARE MARKET: PRODUCTS AND SERVICES

Transcription

1 THE ELDER CARE MARKET: PRODUCTS AND SERVICES HLC062B January 2014 Peggy Lehr Project Analyst ISBN: BCC Research 49 Walnut Park, Building 2 Wellesley, MA USA (toll-free within the USA), or (+1) information@bccresearch.com

2 TABLE OF CONTENTS CHAPTER 1 INTRODUCTION 2 STUDY GOALS AND OBJECTIVES 2 REASONS FOR DOING THE STUDY 2 SCOPE OF REPORT 2 INTENDED AUDIENCE 3 INFORMATION SOURCES 3 ANALYST CREDENTIALS 3 RELATED BCC RESEARCH REPORTS 4 BCC RESEARCH ONLINE SERVICES 4 DISCLAIMER 4 CHAPTER 2 SUMMARY 6 EMPHASIS OF THE REPORT 6 HEALTHCARE 6 HOUSING 7 ASSISTIVE TECHNOLOGY 7 SUMMARY TABLE PROJECTED NEEDS OF THE U.S. ELDERLY, THROUGH 2018 ($ MILLIONS) SUMMARY FIGURE PROJECTED NEEDS OF THE ELDERLY BY TYPE OF NEED, 2013 AND 2018 (%) 8 9 CHAPTER 3 OVERVIEW OF GLOBAL ELDERLY POPULATION 11 DEFINITIONS 11 TRENDS IN GLOBAL AGING 11 HEALTHCARE AND AGING 11 HOUSING AND AGING 12 THE GLOBAL ENVIRONMENT FOR THE ELDERLY 12 GLOBAL SOCIAL ENVIRONMENT 12 Intergenerational Living Issues in Developing Countries 13 Intergenerational Living Issues in Developed Countries 13 GLOBAL HOUSING REALITY FOR THE ELDERLY 13 Europe 13 China 13 GLOBAL ECONOMIC REALITY FOR THE ELDERLY 14 Economic Trends for Elderly Outside the U.S. 14 Europe 14 India 14 Japan 15 Economic Trends for U.S. Elderly 15 GLOBAL DEMOGRAPHIC TRENDS, BY COUNTRY 15 TABLE 1 PERCENT OF POPULATION AGE 65 AND OLDER IN SELECTED COUNTRIES, 2012 (MILLIONS/%) THE ELDERLY IN THE U.S. 16 DEMOGRAPHICS IN THE U.S. 16 TABLE 2 ELDERLY POPULATIONS COMPARED WITH OVERALL POPULATIONS BY STATE,

3 TABLE 3 U.S. ELDERLY POPULATION, BY STATE, AS A PERCENTAGE OF THE OVERALL STATE POPULATION, 2010 (%) HEALTH OF THE U.S. ELDERLY 19 U.S. Health Trends 19 Discrepancies in Minority Health Status 19 Elderly Living with Chronic Health Conditions 20 SHIFTING DEMOGRAPHICS IN THE U.S. 20 Racial and Ethnic Changes 20 FIGURE 1 U.S. POPULATION OVER 65 BY RACE, 2010 (%) 20 GOVERNMENT LEGISLATION AND PROGRAMS AIMED AT THE ELDERLY 21 THE AMERICANS WITH DISABILITIES ACT 21 ADA and Employee Rights 22 THE TELECOMMUNICATIONS ACT OF THE FAIR HOUSING ACT 22 AIR CARRIER ACCESS ACT 23 VOTING ACCESSIBILITY FOR THE ELDERLY AND HANDICAPPED ACT OF 1984 ARCHITECTURAL BARRIERS ACT OF MEDICAL DEVICE LEGISLATION 23 THE AMERICAN RECOVERY AND REINVESTMENT ACT OF U.S. GOVERNMENT SPONSORED NUTRITION PROGRAMS 24 NON-GOVERNMENTAL NUTRITION PROGRAMS 24 END-OF-LIFE CONSIDERATIONS 25 LEGAL MATTERS CHAPTER 4 INDUSTRY TRENDS BY SECTOR-HEALTHCARE 27 U.S. HEALTHCARE FOR THE ELDERLY 27 TABLE 4 PROJECTED U.S. MARKET FOR ELDERCARE HEALTHCARE MEDICATIONS, PRODUCTS AND SURGICAL PROCEDURES, HOSPITALIZATIONS FOR HEALTHCARE PROBLEMS OF THE ELDERLY 28 TABLE 5 NUMBER OF DISCHARGES FROM NONFEDERAL U.S. HOSPITALS FOR INDIVIDUALS 65 OR OLDER, 2010 (THOUSANDS) ARTHRITIS 29 CURRENT TREATMENTS 29 Medications 29 Rheumatoid Arthritis 30 COX2 Inhibitor 30 Disease-modifying Antirheumatic Drugs 30 Biologics to Treat RA 30 Corticosteroids 31 NSAIDs 31 Osteoarthritis 31 THE FUTURE BURDEN OF ARTHRITIS IN THE U.S. 31 FIGURE 2 FUTURE BURDEN OF ARTHRITIS FOR THOSE OVER 65 IN THE U.S. BY GENDER, ($ MILLIONS) ARTHRITIS TREATMENT MARKET PROJECTIONS 32 TABLE 6 PROJECTED U.S. MARKET FOR PRESCRIPTION ARTHRITIS MEDICATIONS FOR CARDIOVASCULAR DISEASES

4 CARDIOVASCULAR DISEASE IN THE U.S. 33 Risk Factors 34 Current Treatments for Heart Disease 34 TABLE 7 SELECTED LISTING OF HEART DISEASE MEDICATIONS BY BRAND NAME AND MANUFACTURER Surgical Options 37 CARDIOVASCULAR TREATMENT MARKET ANALYSIS 37 TABLE 8 U.S. MARKET FOR CARDIOVASCULAR DISEASE MEDICATIONS AND SURGERY, TABLE 9 PROJECTED U.S. MARKET FOR CARDIOVASCULAR DRUGS AND SURGERY FOR CANCER 38 TYPES OF CANCER 39 GLOBAL RISK FACTORS 39 FIGURE 3 ESTIMATED NEW CASES OF CANCER, GLOBALLY, 2008 (%) 39 CANCER RATES IN THE U.S. ELDERLY 40 CANCER TREATMENT MARKET ANALYSIS 41 TABLE 10 LEADING CANCER DRUGS, WITH PRODUCT, MANUFACTURER AND INDICATION, 2012 MARKET ANALYSIS FOR U.S. CANCER DRUGS 42 TABLE 11 PROJECTED U.S. MARKET FOR CANCER TREATMENT DRUGS, THROUGH TABLE 12 PROJECTED MARKET FOR CANCER DRUGS FOR U.S. ELDERLY PATIENTS, DIABETES 43 TYPE 2 DIABETES INTERNATIONALLY 43 Type 2 Diabetes in Asia 43 PREVALENCE OF TYPE 2 DIABETES IN THE U.S. 44 TABLE 13 PREVALENCE OF DIABETES IN THE U.S., THROUGH 2018 (CASES IN MILLIONS) CURRENT TREATMENT OF DIABETES 44 TYPE 1 DIABETES 44 Insulin 44 Insulin Administration Devices 45 TYPE 2 DIABETES 45 Sulfonylureas 45 TABLE 14 SULFONYLUREAS 46 Biguanides 46 Alpha-Glucosidase Inhibitor 46 Glitazones 47 Prandial Glucose Regulators 47 GLP-1 Analogs/Incretin Mimetics 47 Amylin Mimetic 47 TABLE 15 ORAL HYPOGYCEMICS 48 MONITORING DEVICES FOR DIABETES 48 DIABETES THERAPY MARKET LEADERS 49 DIABETES MARKET ANALYSIS 49 TABLE 16 PROJECTED U.S. MARKET FOR ORAL DIABETES MEDICATIONS AND MONITORING PRODUCTS,

5 TABLE 17 PROJECTED U.S. MARKET FOR ORAL DIABETES MEDICATIONS AND MONITORING PRODUCTS FOR THE ELDERLY, SENSORY IMPAIRMENTS 50 TABLE 18 PROJECTED U.S. MARKET FOR SENSORY IMPAIRMENT PHARMACEUTICALS, SURGERY AND PRODUCTS FOR INDIVIDUALS OVER 65, THROUGH 2018 ($ MILLIONS) SPEECH IMPAIRMENT 51 WRITING DIFFICULTY 51 VISION IMPAIRMENT 51 TABLE 19 ESTIMATED NUMBER OF CASES BY VISION PROBLEM FOR INDIVIDUALS OVER 40, 2010 Macular Degeneration 52 TABLE 20 PROJECTED GLOBAL MARKET FOR PRODUCTS TO TREAT AMD, THROUGH TABLE 21 PROJECTED U.S. MARKET FOR PRODUCTS TO TREAT AMD FOR Cataracts 53 TABLE 22 PROJECTED COSTS OF CATARACT SURGERY FOR THE U.S. ELDERLY, Glaucoma 54 Ethnic Disparities 54 Glaucoma Prescription Market 55 TABLE 23 PROJECTED U.S. ELDERLY MARKET FOR GLAUCOMA PRESCRIPTION MEDICATIONS, Eyewear 55 TABLE 24 PROJECTED U.S. EYEWEAR SALES, 56 Market for Eyewear Products for Seniors 56 TABLE 25 PROJECTED U.S. MARKET FOR EYEWEAR FOR INDIVIDUALS OVER 65, HEARING IMPAIRMENT 57 Causes of Hearing Loss 57 Market Analysis for Hearing Aid Products 57 TABLE 26 PROJECTED U.S. MARKET FOR HEARING AID PRODUCTS, THROUGH 2018 ($ MILLIONS) TABLE 27 PROJECTED U.S. MARKET FOR HEARING AID PRODUCTS FOR THE ELDERLY, NEUROLOGICAL DISEASES 58 TABLE 28 PROJECTED MARKET IN THE U.S. FOR DEMENTIA AND DEPRESSION MEDICATIONS FOR ALZHEIMER'S DISEASE 59 FIGURE 4 CAUSES OF DEMENTIA IN INDIVIDUALS OVER 65 (%) 60 Economic Burden 60 Current Treatments for Alzheimer's 61 TABLE 29 COMMON PRESCRIPTION MEDICATIONS FOR ALZHEIMER'S DISEASE, 2013 Market Analysis for Dementia Costs 62 TABLE 30 PROJECTED MARKET IN THE U.S. FOR DEMENTIA MEDICATIONS FOR DEPRESSION 63 Origins of the Disease

6 Genetic Factors 63 Biological Factors 64 Sociological Factors 64 Psychological Factors 64 Costs of Depression 64 Market Analysis for Depression in the Elderly 65 TABLE 31 PROJECTED U.S. MARKET FOR DEPRESSION MEDICATIONS FOR THE ELDERLY, ORTHOPEDIC 65 TABLE 32 PROJECTED U.S. MARKET FOR ORTHOPEDIC MEDICATIONS AND SURGERIES FOR OSTEOPOROSIS 66 TABLE 33 UNCONTROLLABLE AND CONTROLLABLE RISK FACTORS FOR OSTEOPOROSIS Osteoporosis Medications 67 TABLE 34 OSTEOPOROSIS MEDICATIONS BY TYPE 67 Market Analysis for Osteoporosis Medications 67 TABLE 35 PROJECTED U.S. MARKET FOR OSTEOPOROSIS MEDICATIONS, THROUGH TABLE 36 PROJECTED U.S. MARKET FOR OSTEOPOROSIS MEDICATIONS FOR FALLS AND THE ELDERLY 68 JOINT REPLACEMENT 68 Market Analysis 69 TABLE 37 PROJECTED U.S. COST OF SELECTED ORTHOPEDIC SURGERY, THROUGH TABLE 38 PROJECTED U.S. COST OF SELECTED ORTHOPEDIC SURGERY FOR Market Leaders 70 FIGURE 5 MARKET LEADERS FOR RECONSTRUCTIVE IMPLANT PRODUCTS (%) 70 RESPIRATORY 71 TABLE 39 PROJECTED U.S. MARKET FOR RESPIRATORY MEDICATIONS AND PRODUCTS FOR ALLERGIES 72 Current Treatments for Allergies 72 TABLE 40 CURRENT ALLERGY TREATMENTS 73 Allergy Market Analysis 74 TABLE 41 PROJECTED MARKET FOR PRESCRIPTION ALLERGY MEDICATIONS IN THE U.S., TABLE 42 PROJECTED U.S. MARKET FOR PRESCRIPTION ALLERGY MEDICATIONS FOR ASTHMA 75 Treatments 76 TABLE 43 PROJECTED U.S. MARKET FOR ASTHMA MEDICATIONS FOR INDIVIDUALS COPD 76 TABLE 44 PROJECTED U.S. MARKET FOR COPD MEDICATIONS FOR INDIVIDUALS COPD Treatment Options 77 TABLE 45 CURRENT TREATMENT OPTIONS FOR ASTHMA/COPD IN U.S

7 Emphysema 79 Chronic Bronchitis 79 OXYGEN THERAPY 79 TABLE 46 PROJECTED U.S. MARKET FOR HOME OXYGEN AND RESPIRATORY SUPPLIES FOR LOSS OF PATENT PROTECTION 80 TABLE 47 MAJOR ASTHMA/COPD DRUGS LOSING PATENT PROTECTION BETWEEN OTHER CHRONIC CONDITIONS 81 DENTAL HEALTH 81 UROLOGICAL PROBLEMS 81 Incontinence Medications 81 TABLE 48 PROJECTED U.S. MARKET FOR INCONTINENCE MEDICATIONS FOR BENIGN PROSTATIC HYPERPLASIA (BPH) 82 TABLE 49 SELECTED MEDICATIONS FOR BPH 82 TABLE 50 PROJECTED U.S. MARKET FOR BPH MEDICATIONS FOR INDIVIDUALS OBESITY CHAPTER 5 INDUSTRY TRENDS BY SECTOR-HOUSING 85 UNPAID CAREGIVERS 85 TOLL ON CAREGIVERS 85 LONG-TERM CARE 86 FIGURE 6 PROJECTED LIFETIME LONG-TERM CARE NEEDS FOR INDIVIDUALS OVER 65 (%) U.S. HOUSING FOR ELDERLY 87 MARKET ANALYSIS 87 TABLE 51 PROJECTED U.S. MARKET FOR SENIOR HOUSING AND DAY SERVICES FOR AT-HOME REMODELING 88 TABLE 52 PROJECTED U.S. MARKET FOR HOME REMODELING FOR INDIVIDUALS HOME HEALTHCARE SERVICES 89 TABLE 53 PROJECTED U.S. MARKET FOR HOME HEALTH SERVICES FOR ADULT DAY CENTERS 90 TABLE 54 PROJECTED U.S. MARKET FOR ADULT DAY CARE SERVICES FOR COMPETITIVE LANDSCAPE FOR HOME HEALTHCARE SERVICES 91 HOUSING FOR LOWER INCOME INDIVIDUALS 91 INSTITUTIONAL CARE ALTERNATIVES FOR SENIORS 92 DEMOGRAPHICS OF INDIVIDUALS IN INSTITUTIONAL SETTINGS 92 ASSISTED LIVING, SKILLED NURSING, MEMORY CARE PROVIDERS 93 TABLE 55 PROJECTED U.S. MARKET FOR SENIOR ASSISTED LIVING AND SKILLED NURSING FACILITIES FOR TOP INDUSTRY PROVIDERS 93 TABLE 56 TOP 10 ASSISTED LIVING PROVIDERS IN U.S. BY CAPACITY, FIGURE 7 PERCENT RANKING OF ASSISTED LIVING PROVIDERS BY CAPACITY IN THE U.S., 2012 (%)

8 TABLE 57 TOP 10 INDEPENDENT LIVING PROVIDERS BY CAPACITY, FIGURE 8 PERCENT RANKING OF INDEPENDENT LIVING PROVIDERS BY CAPACITY IN THE U.S., 2012 (%) TABLE 58 TOP FIVE MEMORY CARE LIVING PROVIDERS IN THE U.S., ASSISTED LIVING 97 NURSING HOMES 97 MEMORY CARE 98 MARKET CONSTRAINTS 98 RESTRICTED SUPPLY OF NURSING BEDS 98 COST CONTAINMENT EFFORTS BY GOVERNMENT PAYERS 99 IMPLICATIONS OF THE AFFORDABLE CARE ACT (ACA) 99 Care Coordination 99 REIMBURSEMENT ISSUES 100 Medicaid Reimbursement 100 LACK OF FINANCIAL RESOURCES BY SENIORS 100 INDUSTRY COMPETITION 100 RETAINING COMPETENT STAFF 101 CREDIT AND MODERNIZATION FOR SKILLED NURSING FACILITIES 101 INDEPENDENT LIVING 101 ACTIVE ADULT COMMUNITIES 102 RECREATIONALLY BASED RETIREMENT COMMUNITIES 102 SENIOR HOUSING MARKET OPPORTUNITIES 103 MEMORY CARE FACILITIES 103 HOME HEALTHCARE 103 U.S. REGIONAL ANALYSIS 103 NEW FACILITY CONSTRUCTION 103 ACQUISITIONS AND MERGERS IN THE ELDERCARE HOUSING INDUSTRY 103 TABLE 59 SELECTED ACQUISITIONS AND MERGERS IN THE ELDERCARE MARKET, 2011 TO 2013 ($ MILLIONS) CHAPTER 6 INDUSTRY TRENDS, BY SECTOR-ASSISTIVE TECHNOLOGIES 106 PROJECTED ASSISTIVE TECHNOLOGIES MARKET ANALYSIS FOR ELDERS 106 TABLE 60 PROJECTED U.S. ASSISTIVE TECHNOLOGY MARKET FOR INDIVIDUALS FIGURE 9 PROJECTED U.S. MARKET FOR ASSISTIVE TECHNOLOGY FOR INDIVIDUALS OVER 65, 2013 AND 2018 (%) MEDICAL AND PERSONAL MONITORING AIDS 108 ACTIVITY LOCATION/PERSONAL MONITORING AIDS 108 Activity/Emergency Location Monitors 108 Remote Medical Monitors 108 Market Fragmentation 109 TABLE 61 SELECTED MEDICAL/PERSONAL MONITORING AID MANUFACTURERS 109 MEDICAL/PERSONAL MONITORING AIDS MARKET GROWTH 109 TABLE 62 PROJECTED U.S. SALES OF MEDICAL/PERSONAL MONITORING AIDS FOR MARKET DRIVERS FOR MEDICAL AND PERSONAL MONITORING AIDS 110 ACCESS AIDS 110 HOME ELEVATORS

9 WHEELCHAIR LIFTS 110 STAIR CLIMBERS 111 ACCESSIBLE BATHS AND SHOWERS 111 TRANSFER LIFTS 111 DOOR OPENERS 111 ACCESS AIDS MANUFACTURERS 111 TABLE 63 ACCESS AIDS MANUFACTURERS 112 DAILY LIVING AIDS 112 TABLE 64 SELECTED MANUFACTURERS OF DAILY LIVING AIDS 113 PROJECTED MARKET FOR DAILY LIVING AIDS FOR SENIORS 113 TABLE 65 PROJECTED MARKET FOR DAILY LIVING AIDS FOR SENIORS, THROUGH MOBILITY AIDS 114 TABLE 66 PROJECTED U.S. MARKET FOR MOBILITY PRODUCTS FOR INDIVIDUALS WHEELCHAIRS, SCOOTERS AND ACCESSORIES 114 Wheelchairs 114 TABLE 67 WHEELCHAIR MANUFACTURERS 115 Scooters 116 TABLE 68 SCOOTER MANUFACTURERS 116 AMBULATORY AIDS 116 TABLE 69 PROJECTED U.S. MARKET FOR AMBULATORY AIDS FOR INDIVIDUALS TABLE 70 AMBULATORY AID MANUFACTURERS 117 MOTOR VEHICLE MODIFICATIONS 117 TABLE 71 PROJECTED U.S. MARKET FOR MOTOR VEHICLE MODIFICATIONS FOR TABLE 72 VEHICLE ASSESS CONVERSION KIT MANUFACTURERS 118 NAVIGATION AIDS 118 TABLE 73 PROJECTED U.S. MARKET FOR NAVIGATION AIDS FOR INDIVIDUALS OVER 65, OTHER AIDS 119 TABLE 74 PROJECTED U.S. MARKET FOR OTHER AIDS FOR INDIVIDUALS OVER 65, BEDS 120 ERGONOMIC AIDS 120 COMMUNICATION AIDS 120 TABLE 75 PROJECTED U.S. ELDERLY MARKET FOR COMMUNICATION AIDS, Speech Aids 121 Writing Aids/Computer Access 121 Input Devices 121 Output Devices 121 Software Products 121 Telephony Accessories 122 Text Telephones 122 Amplified Telephones 122 Vision/Reading Aids

10 CHAPTER 7 DEVELOPMENTAL PIPELINE FOR ELDERCARE PHARMACEUTICALS 124 TABLE 76 MEDICINES IN DEVELOPMENT FOR SELECTED THERAPEUTIC AREAS, 2012 CANCER 124 BREAST 124 TABLE 77 MAJOR PRODUCT PIPELINES FOR BREAST CANCER 125 COLORECTAL CANCER 125 TABLE 78 MAJOR PRODUCT PIPELINES FOR COLORECTAL CANCER 126 DIABETES 126 TABLE 79 MAJOR PRODUCT PIPELINES FOR DIABETES 126 HEART DISEASE/STROKE 128 TABLE 80 MAJOR PRODUCT PIPELINES FOR HEART DISEASE/STROKE 128 KIDNEY DISEASE 128 TABLE 81 MAJOR PRODUCT PIPELINES FOR KIDNEY DISEASE 128 MUSCULOSKELETAL 129 OSTEOARTHRITIS 129 TABLE 82 MAJOR PRODUCT PIPELINES FOR OSTEOARTHRITIS 129 OSTEOPOROSIS 129 TABLE 83 MAJOR PRODUCT PIPELINES FOR OSTEOPOROSIS 129 Pain 130 TABLE 84 MAJOR PRODUCT PIPELINES FOR PAIN 130 Rheumatoid Arthritis 130 TABLE 85 MAJOR PRODUCT PIPELINES FOR RHEUMATOID ARTHRITIS 131 NEUROLOGICAL 131 DEPRESSION PRODUCT PIPELINE 131 TABLE 86 MAJOR PRODUCT PIPELINES FOR DEPRESSION 132 DEMENTIA PRODUCT PIPELINE 132 TABLE 87 MAJOR PRODUCT PIPELINE FOR DEMENTIA PHARMACEUTICALS 133 RESPIRATORY 133 ASTHMA 133 TABLE 88 MAJOR PRODUCT PIPELINES FOR ASTHMA 133 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 134 TABLE 89 MAJOR PRODUCT PIPELINES FOR COPD CHAPTER 8 COMPANY DIRECTORY 136 PHARMACEUTICALS 136 ABBOTT LABORATORIES 136 Business Overview 136 Products 136 ASTRAZENECA PLC 137 Business Overview 137 Products 137 BRISTOL-MYERS SQUIBB 137 Business Overview 137 Products 137 CENTOCOR 138 Business Overview 138 Products 138

11 COVIDIEN 138 Business Overview 138 Products 138 DJO GLOBAL, INC. 138 Business Overview 139 Products 139 ELI LILLY 139 Business Overview 139 Products 139 ENDO PHARMACEUTICALS, INC. 139 Business Overview 139 Products 140 FOREST PHARMACEUTICALS 140 Business Overview 140 Products 140 GLAXOSMITHKLINE PLC 140 Business Overview 140 Products 140 JANSSEN PHARMACEUTICALS, INC. 141 Business Overview 141 Products 141 JOHNSON & JOHNSON 141 Business Overview 141 Products 141 MERCK 142 Business Overview 142 Products 142 NOVARTIS INTERNATIONAL AG 142 Business Overview 142 Products 142 NOVO NORDISK 143 Business Overview 143 Products 143 PFIZER 143 Business Overview 143 Products 143 PURDUE PHARMACEUTICALS LP 144 Business Overview 144 Products 144 ROCHE PHARMACEUTICALS 144 Business Overview 144 Products 144 SANOFI-AVENTIS 145 Business Overview 145 Products 145 SERVIER LABORATORIES, LTD 145 Business Overview 145

12 Products 145 TAKEDA PHARMACUETICALS 146 Business Overview 146 Products 146 VECTURA GROUP PLC 146 Business Overview 146 MEDICAL DEVICES 146 BOSTON SCIENTIFIC 146 Business Overview 147 Products 147 MEDTRONIC, INC. 147 Business Overview 147 Products 147 ST. JUDE MEDICAL, INC. 147 Business Overview 148 Products 148 HOUSING OPTIONS 148 ASSISTED LIVING CONCEPTS, LLC 148 Business Overview 148 Products 148 BROOKDALE SENIOR LIVING 148 Business Overview 149 Products 149 CAPITAL SENIOR LIVING CORP. 149 Business Overview 149 Products 149 EMERITUS CORP. 149 Business Overview 150 Products 150 FIVE STAR QUALITY CARE, INC. 150 Business Overview 150 Products 150 LIFE CARE CENTERS OF AMERICA 150 Business Overview 150 Products 150 LIVHOME, INC. 151 Business Overview 151 Products 151 HCR MANOR CARE 151 Business Overview 151 Products 151 SUNRISE SENIOR LIVING, INC. 151 Business Overview 152 Products 152 ASSISTIVE DEVICES 152 A&D MEDICAL/LIFESOURCE 152 Business Overview 152

13 Products 152 ALIMED INC. 152 Business Overview 152 Products 153 ALLIED HEALTHCARE PRODUCTS, INC. 153 Business Overview 153 Products 153 AMERICAN MEDICAL ALERT CORP. 153 Business Overview 153 Products 153 ANALOGIC INC. 154 Business Overview 154 Products 154 BAXTER INTERNATIONAL, INC. 154 Business Overview 154 Products 154 BAYER AG (MILES-BAYER) 155 Business Overview 155 Products 155 BLUE CHIP MEDICAL PRODUCTS 155 Business Overview 155 Products 155 BRUNO INDEPENDENT LIVING AIDS INC. 155 Business Overview 156 Products 156 CARD GUARD AG 156 Business Overview 156 Products 156 CARETRENDS 156 Business Overview 156 Products 157 COBOLT SYSTEMS LTD. 157 Business Overview 157 Products 157 DOLPHIN COMPUTER ACCESS LTD. 157 Business Overview 157 Products 158 DUXBURY SYSTEMS INC. 158 Business Overview 158 Products 158 ECHO THERAPEUTICS 158 Business Overview 158 Products 158 EXACT DYNAMICS B.V. 159 Business Overview 159 Products 159 FREEDOM SCIENTIFIC INC. 159

14 Business Overview 159 Products 159 FRESENIUS MEDICAL CARE AG & CO. KGAA 160 Business Overview 160 Products 160 GRAHAM-FIELD HEALTH PRODUCTS 160 Business Overview 160 Products 160 GW MICRO INC. 160 Business Overview 161 Products 161 HEALTH FRONTIER, INC. 161 Business Overview 161 Products 161 HONEYWELL HOMMED 161 Business Overview 161 Products 162 HUMANWARE 162 Business Overview 162 Products 162 INCLINATOR COMPANY OF AMERICA 162 Business Overview 162 Products 162 INVACARE CORP. 163 Business Overview 163 Products 163 JOHNSON & JOHNSON 163 Business Overview 163 Products 163 KIMBERLY CLARK 163 Business Overview 164 Products 164 KROWN MANUFACTURING 164 Business Overview 164 Products 164 LIFE ALERT EMERGENCY RESPONSE 164 Business Overview 164 Products 164 LIFE GUARDIAN LLC 165 Business Overview 165 Products 165 LIFESCAN, INC. 165 Business Overview 165 Products 165 LIFTAVATOR INC. 165 Business Overview 166 Products 166

15 MEDLINE INDUSTRIES INC. 166 Business Overview 166 Products 166 MEDTRONIC MINIMED 166 Business Overview 166 Products 166 NIPRO DIAGNOSTICS INC. 167 Business Overview 167 Products 167 NXSTAGE MEDICAL, INC. 167 Business Overview 167 Products 167 OBS MEDICAL 167 Business Overview 168 Products 168 OMRON HEALTHCARE, INC. 168 Business Overview 168 Products 168 OPTELEC 168 Business Overview 169 Products 169 OTTO BOCK HEALTHCARE GMBH 169 Business Overview 169 Products 169 PARI PHARMA 169 Business Overview 169 Products 170 PHILIPS LIFELINE SYSTEMS INC. 170 Business Overview 170 Products 170 PRIDE MOBILITY PRODUCTS CORP. 170 Business Overview 170 Products 170 PULSE METRIC INC. 171 Business Overview 171 Products 171 RESMED, INC. 171 Business Overview 171 Products 171 ROCHE DIAGNOSTICS 171 Business Overview 172 Products 172 SAVARIA CORP. 172 Business Overview 172 Products 172 SCOTTCARE CORP. 172 Business Overview 172

16 Products 173 SIEMENS HEARING INSTRUMENTS INC. 173 Business Overview 173 Products 173 STARKEY LABORATORIES 173 Business Overview 173 Products 173 SUNRISE MEDICAL INC. 174 Business Overview 174 Products 174 SVENSKA CELLULOSA AKTIEBOLAGET SCA 174 Business Overview 174 Products 174 THORNDIKE PRESS 174 Business Overview 175 Products 175 THYSSENKRUPP ACCESS 175 Business Overview 175 Products 175 TYCO INTERNATIONAL 175 Business Overview 175 Products 175 WIDEX 176 Business Overview 176 Products 176 REHABILITATION 176 DJO GLOBAL, INC. 176 Business Overview 176 Products 176 KINDRED HEALTHCARE 177 Business Overview 177 Products 177 CHAPTER 9 GLOSSARY 179 ACTIVITIES OF DAILY LIVING (ADLS) 179 ALZHEIMER'S DISEASE 179 ARTHRITIS 179 ASSISTED LIVING 179 ASSISTIVE TECHNOLOGY 179 BABY BOOMER 180 CARDIOVASCULAR DISEASE 180 CAREGIVERS 180 CONGESTIVE OBSTRUCTIVE PULMONARY DISEASE (COPD) 180 DEMENTIA 180 DIABETES 180 DURABLE MEDICAL EQUIPMENT 181 ELDER/SENIOR 181

17 GERONTOLOGY 181 HOSPICE CARE 181 INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) 181 LONG-TERM CARE 181 PROSTHETICS AND ORTHOTICS 181

18 LIST OF TABLES TABLE HEADING SUMMARY TABLE PROJECTED NEEDS OF THE U.S. ELDERLY, THROUGH 2018 ($ MILLIONS) TABLE 1 PERCENT OF POPULATION AGE 65 AND OLDER IN SELECTED COUNTRIES, 2012 (MILLIONS/%) TABLE 2 ELDERLY POPULATIONS COMPARED WITH OVERALL POPULATIONS BY STATE, 2009 TABLE 3 U.S. ELDERLY POPULATION, BY STATE, AS A PERCENTAGE OF THE OVERALL STATE POPULATION, 2010 (%) TABLE 4 PROJECTED U.S. MARKET FOR ELDERCARE HEALTHCARE MEDICATIONS, PRODUCTS AND SURGICAL PROCEDURES, TABLE 5 NUMBER OF DISCHARGES FROM NONFEDERAL U.S. HOSPITALS FOR INDIVIDUALS 65 OR OLDER, 2010 (THOUSANDS) TABLE 6 PROJECTED U.S. MARKET FOR PRESCRIPTION ARTHRITIS MEDICATIONS FOR TABLE 7 SELECTED LISTING OF HEART DISEASE MEDICATIONS BY BRAND NAME AND MANUFACTURER TABLE 8 U.S. MARKET FOR CARDIOVASCULAR DISEASE MEDICATIONS AND SURGERY, TABLE 9 PROJECTED U.S. MARKET FOR CARDIOVASCULAR DRUGS AND SURGERY FOR TABLE 10 LEADING CANCER DRUGS, WITH PRODUCT, MANUFACTURER AND INDICATION, 2012 TABLE 11 PROJECTED U.S. MARKET FOR CANCER TREATMENT DRUGS, THROUGH TABLE 12 PROJECTED MARKET FOR CANCER DRUGS FOR U.S. ELDERLY PATIENTS, TABLE 13 PREVALENCE OF DIABETES IN THE U.S., THROUGH 2018 (CASES IN MILLIONS) TABLE 14 SULFONYLUREAS 46 TABLE 15 ORAL HYPOGYCEMICS 48 TABLE 16 PROJECTED U.S. MARKET FOR ORAL DIABETES MEDICATIONS AND MONITORING PRODUCTS, TABLE 17 PROJECTED U.S. MARKET FOR ORAL DIABETES MEDICATIONS AND MONITORING PRODUCTS FOR THE ELDERLY, TABLE 18 PROJECTED U.S. MARKET FOR SENSORY IMPAIRMENT PHARMACEUTICALS, SURGERY AND PRODUCTS FOR TABLE 19 ESTIMATED NUMBER OF CASES BY VISION PROBLEM FOR INDIVIDUALS OVER 40, 2010 TABLE 20 PROJECTED GLOBAL MARKET FOR PRODUCTS TO TREAT AMD, THROUGH TABLE 21 PROJECTED U.S. MARKET FOR PRODUCTS TO TREAT AMD FOR TABLE 22 PROJECTED COSTS OF CATARACT SURGERY FOR THE U.S. ELDERLY, TABLE 23 PROJECTED U.S. ELDERLY MARKET FOR GLAUCOMA PRESCRIPTION MEDICATIONS, TABLE 24 PROJECTED U.S. EYEWEAR SALES, 56 TABLE 25 PROJECTED U.S. MARKET FOR EYEWEAR FOR INDIVIDUALS OVER 65, TABLE 26 PROJECTED U.S. MARKET FOR HEARING AID PRODUCTS, THROUGH 2018 ($ MILLIONS)

19 TABLE HEADING TABLE 27 PROJECTED U.S. MARKET FOR HEARING AID PRODUCTS FOR THE ELDERLY, TABLE 28 PROJECTED MARKET IN THE U.S. FOR DEMENTIA AND DEPRESSION MEDICATIONS FOR TABLE 29 COMMON PRESCRIPTION MEDICATIONS FOR ALZHEIMER'S DISEASE, TABLE 30 PROJECTED MARKET IN THE U.S. FOR DEMENTIA MEDICATIONS FOR TABLE 31 PROJECTED U.S. MARKET FOR DEPRESSION MEDICATIONS FOR THE ELDERLY, TABLE 32 PROJECTED U.S. MARKET FOR ORTHOPEDIC MEDICATIONS AND SURGERIES FOR TABLE 33 UNCONTROLLABLE AND CONTROLLABLE RISK FACTORS FOR OSTEOPOROSIS TABLE 34 OSTEOPOROSIS MEDICATIONS BY TYPE 67 TABLE 35 PROJECTED U.S. MARKET FOR OSTEOPOROSIS MEDICATIONS, THROUGH TABLE 36 PROJECTED U.S. MARKET FOR OSTEOPOROSIS MEDICATIONS FOR TABLE 37 PROJECTED U.S. COST OF SELECTED ORTHOPEDIC SURGERY, THROUGH TABLE 38 PROJECTED U.S. COST OF SELECTED ORTHOPEDIC SURGERY FOR TABLE 39 PROJECTED U.S. MARKET FOR RESPIRATORY MEDICATIONS AND PRODUCTS FOR TABLE 40 CURRENT ALLERGY TREATMENTS 73 TABLE 41 PROJECTED MARKET FOR PRESCRIPTION ALLERGY MEDICATIONS IN THE U.S., TABLE 42 PROJECTED U.S. MARKET FOR PRESCRIPTION ALLERGY MEDICATIONS FOR TABLE 43 PROJECTED U.S. MARKET FOR ASTHMA MEDICATIONS FOR INDIVIDUALS TABLE 44 PROJECTED U.S. MARKET FOR COPD MEDICATIONS FOR INDIVIDUALS TABLE 45 CURRENT TREATMENT OPTIONS FOR ASTHMA/COPD IN U.S. 78 TABLE 46 PROJECTED U.S. MARKET FOR HOME OXYGEN AND RESPIRATORY SUPPLIES FOR TABLE 47 MAJOR ASTHMA/COPD DRUGS LOSING PATENT PROTECTION BETWEEN TABLE 48 PROJECTED U.S. MARKET FOR INCONTINENCE MEDICATIONS FOR TABLE 49 SELECTED MEDICATIONS FOR BPH 82 TABLE 50 PROJECTED U.S. MARKET FOR BPH MEDICATIONS FOR INDIVIDUALS OVER 65, TABLE 51 PROJECTED U.S. MARKET FOR SENIOR HOUSING AND DAY SERVICES FOR TABLE 52 PROJECTED U.S. MARKET FOR HOME REMODELING FOR INDIVIDUALS TABLE 53 PROJECTED U.S. MARKET FOR HOME HEALTH SERVICES FOR INDIVIDUALS TABLE 54 PROJECTED U.S. MARKET FOR ADULT DAY CARE SERVICES FOR

20 TABLE HEADING TABLE 55 PROJECTED U.S. MARKET FOR SENIOR ASSISTED LIVING AND SKILLED NURSING FACILITIES FOR TABLE 56 TOP 10 ASSISTED LIVING PROVIDERS IN U.S. BY CAPACITY, TABLE 57 TOP 10 INDEPENDENT LIVING PROVIDERS BY CAPACITY, TABLE 58 TOP FIVE MEMORY CARE LIVING PROVIDERS IN THE U.S., TABLE 59 SELECTED ACQUISITIONS AND MERGERS IN THE ELDERCARE MARKET, 2011 TO 2013 ($ MILLIONS) TABLE 60 PROJECTED U.S. ASSISTIVE TECHNOLOGY MARKET FOR INDIVIDUALS TABLE 61 SELECTED MEDICAL/PERSONAL MONITORING AID MANUFACTURERS 109 TABLE 62 PROJECTED U.S. SALES OF MEDICAL/PERSONAL MONITORING AIDS FOR TABLE 63 ACCESS AIDS MANUFACTURERS 112 TABLE 64 SELECTED MANUFACTURERS OF DAILY LIVING AIDS 113 TABLE 65 PROJECTED MARKET FOR DAILY LIVING AIDS FOR SENIORS, THROUGH TABLE 66 PROJECTED U.S. MARKET FOR MOBILITY PRODUCTS FOR INDIVIDUALS TABLE 67 WHEELCHAIR MANUFACTURERS 115 TABLE 68 SCOOTER MANUFACTURERS 116 TABLE 69 PROJECTED U.S. MARKET FOR AMBULATORY AIDS FOR INDIVIDUALS OVER 65, TABLE 70 AMBULATORY AID MANUFACTURERS 117 TABLE 71 PROJECTED U.S. MARKET FOR MOTOR VEHICLE MODIFICATIONS FOR TABLE 72 VEHICLE ASSESS CONVERSION KIT MANUFACTURERS 118 TABLE 73 PROJECTED U.S. MARKET FOR NAVIGATION AIDS FOR INDIVIDUALS OVER 65, TABLE 74 PROJECTED U.S. MARKET FOR OTHER AIDS FOR INDIVIDUALS OVER 65, TABLE 75 PROJECTED U.S. ELDERLY MARKET FOR COMMUNICATION AIDS, THROUGH TABLE 76 MEDICINES IN DEVELOPMENT FOR SELECTED THERAPEUTIC AREAS, TABLE 77 MAJOR PRODUCT PIPELINES FOR BREAST CANCER 125 TABLE 78 MAJOR PRODUCT PIPELINES FOR COLORECTAL CANCER 126 TABLE 79 MAJOR PRODUCT PIPELINES FOR DIABETES 126 TABLE 80 MAJOR PRODUCT PIPELINES FOR HEART DISEASE/STROKE 128 TABLE 81 MAJOR PRODUCT PIPELINES FOR KIDNEY DISEASE 128 TABLE 82 MAJOR PRODUCT PIPELINES FOR OSTEOARTHRITIS 129 TABLE 83 MAJOR PRODUCT PIPELINES FOR OSTEOPOROSIS 129 TABLE 84 MAJOR PRODUCT PIPELINES FOR PAIN 130 TABLE 85 MAJOR PRODUCT PIPELINES FOR RHEUMATOID ARTHRITIS 131 TABLE 86 MAJOR PRODUCT PIPELINES FOR DEPRESSION 132 TABLE 87 MAJOR PRODUCT PIPELINE FOR DEMENTIA PHARMACEUTICALS 133 TABLE 88 MAJOR PRODUCT PIPELINES FOR ASTHMA 133 TABLE 89 MAJOR PRODUCT PIPELINES FOR COPD

21 LIST OF FIGURES FIGURE TITLE SUMMARY FIGURE PROJECTED NEEDS OF THE ELDERLY BY TYPE OF NEED, 2013 AND 2018 (%) FIGURE 1 U.S. POPULATION OVER 65 BY RACE, 2010 (%) 20 FIGURE 2 FUTURE BURDEN OF ARTHRITIS FOR THOSE OVER 65 IN THE U.S. BY GENDER, ($ MILLIONS) FIGURE 3 ESTIMATED NEW CASES OF CANCER, GLOBALLY, 2008 (%) 39 FIGURE 4 CAUSES OF DEMENTIA IN INDIVIDUALS OVER 65 (%) 60 FIGURE 5 MARKET LEADERS FOR RECONSTRUCTIVE IMPLANT PRODUCTS (%) 70 FIGURE 6 PROJECTED LIFETIME LONG-TERM CARE NEEDS FOR INDIVIDUALS OVER 65 (%) FIGURE 7 PERCENT RANKING OF ASSISTED LIVING PROVIDERS BY CAPACITY IN THE U.S., 2012 (%) FIGURE 8 PERCENT RANKING OF INDEPENDENT LIVING PROVIDERS BY CAPACITY IN THE U.S., 2012 (%) FIGURE 9 PROJECTED U.S. MARKET FOR ASSISTIVE TECHNOLOGY FOR INDIVIDUALS OVER 65, 2013 AND 2018 (%)