Projection of Young-Old and Old-Old with Functional Disability: Does Accounting for the Changing Educational Composition of the Elderly Population Make a Difference?

Abstract

This study compares projections, up to year 2040, of young-old (aged 60-79) and old-old (aged 80+) with functional disability in Singapore with and without accounting for the changing educational composition of the Singaporean elderly. Two multi-state population models, with and without accounting for educational composition respectively, were developed, parameterized with age-gender-(education)-specific transition probabilities (between active, functional disability and death states) estimated from two waves (2009 and 2011) of a nationally representative survey of community-dwelling Singaporeans aged ≥60 years (N=4,990). Probabilistic sensitivity analysis with the bootstrap method was used to obtain the 95% confidence interval of the transition probabilities. Not accounting for educational composition overestimated the young-old with functional disability by 65 percent and underestimated the old-old by 20 percent in 2040. Accounting for educational composition, the proportion of old-old with functional disability increased from 40.8 percent in 2000 to 64.4 percent by 2040; not accounting for educational composition, the proportion in 2040 was 49.4 percent. Since the health profiles, and hence care needs, of the old-old differ from those of the young-old, health care service utilization and expenditure and the demand for formal and informal caregiving will be affected, impacting health and long-term care policy.

Projecting the Number of Elderly with Cognitive Impairment in China Using a Multi‐State Dynamic Population Model

“…The dynamic multi-state population model is a system dynamics (SD) model with explicit health states ( Figure 1). It was constructed on Vensim DSS (Ventana Systems, Harvard, MA, USA) (Lutz and Goujon, 2001;Samir and Lentzner, 2010;Lutz et al, 2014;Ansah et al, 2015). SD models have been widely used to investigate the burden of chronic illnesses such as cardiovascular disease , diabetes (Jones et al, 2006) and in population health (Homer et al, 2004;Milstein et al, 2010).…”

Investigating Discontinuity of Age Relations in Cognitive Functioning, General Health Status, Activity Participation, and Life Satisfaction between Young-Old and Old-Old Age

“…For a sample selection, researchers have often to return to “practical” strategies such as splitting the available old age sample into two halves. Therefore, in most studies comparing young-old and old-old adults, the decision had to remain rather arbitrary and the old-old age group was stratified to be at least 75 years [7,16,17,18,19], 80 years [10,20,21,22,23,24], or 81 years [25,26], with the young-old age group being respectively below this age. Yet, in comparison to that, in some studies the old-old age group was relatively young, stratified to be at least 70 years [27] or 71 years [28].…”

Assessment of health, functioning and disability of a population aged 60–70 in south-eastern Poland using the WHO Disability Assessment Schedule (WHODAS 2.0)

“…The study revealed a highly statistically significant relationship between the age and the rate of occurrence and level of disability. This has been confirmed by studies carried out in other countries using the WHODAS [38,39] and other questionnaires intended for measuring disability [40,41]. As life expectancy is increasing, a quickly growing number of disabled elderly people can be expected in the forthcoming decades.…”

“…In many countries, particularly those that are developing, very high significant differences in disability level were noticed between the inhabitants of urban and rural areas. The inhabitants of rural areas show a significantly higher level of disability, which is connected with restricted access to health care and other services, and difficulties with transport [38].…”