Functional disability with systematic trends and uncertainty: a comparison between China and the US

2021 ◽  
pp. 1-30
Author(s):  
Yu Fu ◽  
Michael Sherris ◽  
Mengyi Xu
Keyword(s):  
Systematic Uncertainty ◽  
Functional Disability ◽  
Long Term Care ◽  
The Elderly ◽  
Aged Care ◽  
Term Care ◽  
Healthy Longevity ◽  
The Us ◽  
Long Term Care Insurance

Abstract China and the US are two contrasting countries in terms of functional disability and long-term care. China is experiencing declining family support for long-term care and developing private long-term care insurance. The US has a more developed public aged care system and private long-term care insurance market than China. Changes in the demand for long-term care are driven by the levels, trends and uncertainty in mortality and functional disability. To understand the future potential demand for long-term care, we compare mortality and functional disability experiences in China and the US, using a multi-state latent factor intensity model with time trends and systematic uncertainty in transition rates. We estimate the model with the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the US Health and Retirement Study (HRS) data. The estimation results show that if trends continue, both countries will experience longevity improvement with morbidity compression and a declining proportion of the older population with functional disability. Although the elderly Chinese have a shorter estimated life expectancy, they are expected to spend a smaller proportion of their future lifetime functionally disabled than the elderly Americans. Systematic uncertainty is shown to be significant in future trends in disability rates and our model estimates higher uncertainty in trends for the Chinese elderly, especially for urban residents.

scholarly journals Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zijing Wang ◽  
Wenjia Peng ◽  
Mengying Li ◽  
Xinghui Li ◽  
Tingting Yang ◽  
...  
Keyword(s):  
Older People ◽  
Functional Disability ◽  
Long Term Care ◽  
Strong Association ◽  
Binary Logistic Regression ◽  
Term Care ◽  
Logistic Regression Models ◽  
Disease Pattern ◽  
Long Term Care Insurance

Abstract Background Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability. Methods We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity. Results Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16–1.41) and IADL (OR 1.41, 95%CI 1.19–1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40–1.72). Conclusions Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.

scholarly journals Impact of Frailty on Medical and Long-Term Care Expenditures for the Elderly Age 75 or Over in Japan

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 176-176
Author(s):  
Hiroto Yoshida ◽  
Yuriko Kihara
Keyword(s):  
Long Term Care ◽  
The Elderly ◽  
Elderly Age ◽  
Term Care ◽  
Intentional Weight Loss ◽  
Long Term Care Insurance ◽  
And Gender ◽  
The Impact

Abstract This study examined the impact of frailty on medical and long-term care expenditures in an older Japanese population. The subjects were those aged 75 years and over who responded to the survey (March 2018) in Bibai, Hokkaido, Japan (n=1,203) and have never received certification of long-term care insurance at the survey. We followed up 867 individuals (72.1%) until the end of December 2018 (10 month-period). We defined frailty as a state in performing 4 items and over of 15 items which were composed of un-intentional weight loss, history of falls, etc. Among 867 subjects, 233 subjects (26.9%) were judged to be frailty group, and 634 subjects (73.1%) non-frailty group. We compared period to the new certification of long-term care insurance (LTCI), accumulated medical and long-term care expenditures adjusted for age and gender between the two groups during the follow-up period. Cox proportional hazard models were used to examine the association between baseline frailty and the new certification of LTCI. The relative hazard ratio (HR) was higher in frailty group than non-frailty group (HR=3.51, 95% CI：1.30-9.45, P=.013). The adjusted mean accumulated medical and long-term care expenditures per capita during the follow-up were significantly (P=.002) larger for those in the frailty group (629,699 yen), while those in the non-frailty group were 450,995 yen. We confirmed strong economic impact of frailty in the elderly aged 75 or over in Japan.

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