Planning for the Future: Mid-life Demographic, Economic, Health, and Lifestyle Risk Factors Associated with Developing Disability and Using Long-Term Care Among Older Adults

Long-term Care;Disability;Predictors;Nursing Home Use;Older Adults;not listed

Willink, AmberBandeen-Roche, Karen J. ;

Johns Hopkins University

关键词: Long-term Care;    Disability;    Predictors;    Nursing Home Use;    Older Adults;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39528/WILLINK-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

The continued aging of the population and increasing prevalence of chronic diseases and disabilities are expected to increase the demand for long-term care (LTC) services. Costs associated with LTC can be substantial and overwhelm the resources available to most individuals and families of older adults with LTC needs (Alkema, 2013). Very few Americans plan for their future LTC use through the purchase of long-term care insurance or earmarking savings, and when they need the services they often do not have sufficient savings to fund both their retirement and LTC needs (Chernof et al., 2013). Many elderly adults exhaust their financial resources to the point where they become eligible for Medicaid, placing substantial financial pressure on this public program. Studies suggest that a reason for not planning ahead is a low perceived risk for future LTC need (Merrill Lynch, 2013; Tell, 2013). There are no models that predict the likelihood of future LTC need based on one’s own particular circumstances, and while individuals may know that approximately 70% of Americans will require some LTC after the age of 65, they might not think it applies to them (Kemper, Komisar, & Alecxih, 2006). Providing more detailed information concerning their future risk of disability is necessary to facilitate planning for their care needs and costs. This must be done at a time when they are still in a position to take action. Using the Health and Retirement Study (HRS) longitudinal, panel data from 1994-2012, this study explores the demographic, socioeconomic, health status and lifestyle risk factors of individuals at mid-life that may be associated with the development of disability and long-term care use later in life, and examines whether changes in these factors after mid-life contribute to a change in the risk of developing a disability. The data from the HRS are weighted to represent the US population aged 53-63 years old. The discrete-time survival models (complementary log-log regressions) suggest that several variables at mid-life are informative of developing a disability. An individual’s economic position, like their employment status, annual household income, household assets, health insurance status, and a measure of community-level socio-economic status at mid-life, was associated with developing a subsequent disability. The most predominant health factors include: the number of chronic conditions, as well as specific conditions like stroke, arthritis, lung disease, diabetes, cancer, psychiatric conditions, and depression. Mid-life lifestyle characteristics such as one’s body mass index, engagement in physical activity, smoking status and average alcohol intake were strongly associated with developing a disability.Changes to some of the health and lifestyle characteristics over the follow-up period were associated with the likelihood of developing a disability. These included change in the number of chronic conditions, diagnosis of specific conditions during the follow-up period such as lung disease, cancer, stroke, arthritis, psychiatric problems and depression. Changing body mass index, engagement in physical activity, and average alcohol intake over the follow-up period were associated with subsequently developing disability as well.The results for mid-life indicators of long-term nursing home stays highlighted the increased risk of institutionalization among those who were not married or partnered. Other mid-life characteristics associated with subsequent long-term nursing home stays were stroke, diabetes, severe obesity, and being a current smoker. When changes to health and lifestyle characteristics were included in the analysis, the change in the number of chronic conditions, having a stroke, developing depression, changing body mass index, and alcohol habits over the follow-up period, were linked to subsequent long-term nursing home stays. These results suggest that there is more information that can be used at mid-life to determine the risk of future disability and long-term care use by individuals, private insurers, and the government to improve the financial protection from the high costs of care and plan for long-term care service delivery demands and workforce requirements in the future.