The Mediating Effect of Disability Trajectory on Disablement Factors and Long-Term Care Use in Taiwan

Abstract

(the Republic of)This study aims to (1) estimate the trajectory of self-rated health (SRH) among Korean older adults with disabilities, (2) examine its associated factors including sociodemographic, health behaviors, and environmental factors (3) test whether there are differences between aging with disability and disability with aging in the health trajectory and its associated factors. Sample includes 341 older adults with disabilities who participated in the Korea Social Welfare Panel Study (KSWPS), which is a nationally representative data. We used KSWPS data from 2006 to 2015. In order to address the research objectives, we used (1) latent growth curve modeling to estimate the trajectory and its associated factors and (2) multi-group analysis to examine differences between aging with disability and disability with aging. The model fits were solid and major findings are as follows. (1) Korean older adults with disabilities presented increasing SRH trajectory with time. (2) Age, education, income, employment status, number of outpatient visits & physical checkup, amount of alcohol consumption, social support and residential environment were associated with the SRH trajectory. (3) The SRH trajectory and its associated factors differed between aging with disability and disability with aging. The findings suggest that (1) older adults with disabilities tend to increase SRH with time, (2) SRH trajectory is associated with sociodemographic, health behaviors, and environmental factors, and (3) SRH trajectory and its associated factors differed between aging with disability and disability with aging. Based on these findings, we will discuss implications on practice/policy for health of older adults with disabilities. Social engagement and social support have been associated with disability onset and severity (Mendes De Leon, 2003; Seeman et al., 1996). However, the context in which support is experienced can affect its impact on health outcomes. In married couples, for example, the benefit to health status of support from friends was diminished the greater the strain in friendships (Walen & Lachman, 2000). In the present research, we consider the impact of combinations of baseline support and strain on changes in the ability to conduct activities of daily living. We use two waves of data, five years apart, from the National Social Life, Health and Aging Study (N=2,261). Social support and social strain are each dichotomized to contrast high and low support, and high and low strain, in relationships with friends and family separately. Regression models, run separately for men and women (Seeman et al., 1996), are adjusted for age, race/ethnicity, education, income, marital status, and social activity. In women only, respondents with distressed relationships with friends (high strain embedded in low support) exhibited a larger increase in disabilities over a five-year period than respondents with ambivalent relationships with friends and family (high strain embedded in high support). Contrary to expectations, women wi...