Trends in late-life disability in Taiwan, 1989–2007: The roles of education, environment, and technology

Abstract

This analysis offers the first strong evidence of trends in late-life disability in an emerging economy. Consistent measures of limitations in seeing, hearing, physical functions, instrumental activities of daily living (IADLs), and activities of daily living (ADLs) were available for three to six survey waves, depending on the outcome, from 1989 to 2007 for the population of Taiwan aged 65 and older. Limitations in seeing, hearing, and IADLs declined substantially, but trends were mixed for physical functions and flat for ADLs. The remarkable reduction in difficulty phoning, an IADL, may reflect changes in telecommunications infrastructure and highlights the roles of environment and technology in disability outcomes. Trends for urban residents were more advantageous than those for rural residents for seeing and hearing, but less so for physical functions and IADLs. Were it not for the substantial increase in educational attainment, trends in all outcomes would have been less favorable.

Studying Disability Trends in Aging Populations

“…For example, in the United States, IADL disability steadily declined before the early 2000s despite relatively stable levels of ADL functioning in older Americans (Freedman et al 2004(Freedman et al , 2013Lin et al 2012). A similar pattern was found in Taiwan from 1989 to 2007 (Martin et al 2011;Ofstedal et al 2007). Feng and Zeng (2014) found that the decline in IADL disability was more pronounced than the decline in ADL disability among older adults in China from 2002 to 2008 (Feng and Zeng 2014).…”

“…Any change in one item or component of disability may not necessarily indicate corresponding change in another (Crimmins 1996;Martin et al 2011). For example, declines in ADL functioning among older community-dwelling Americans were primarily attributable to declines in mild to moderate levels of functionality; reductions in the prevalence of more severe ADL disability appeared to have been smaller (Freedman et al 2004).…”

“…Nagi's tasks for physical functioning typically include standing for 15 min, crouching, squatting, kneeling, stooping, raising one's hands overhead, grasping with fingers, lifting a heavy object, climbing stairs, walking 200-300 m, walking five kilometers, and standing up from a chair Martin et al 2011;Nagi 1965;Ofstedal, et al 2007). …”

“…There is a growing body of research examining trends in physical disability (thereafter referred to as disability, unless noted otherwise) at older ages in both developed (e.g., Freedman et al 2002;Lafortune et al 2007;Schoeni et al 2006) and in developing countries (e.g., Gu et al 2009;Lima-Costa et al 2012;Martin et al 2011;Ofstedal et al 2007). More recently, some studies have begun to investigate the possible causes attributable to disability trends and the consequences of these trends (e.g., Cutler et al 2009b;Freedman et al 2007Freedman et al , 2008aFreedman et al , 2008bJagger et al 2009;Schoeni et al 2008Schoeni et al , 2009.…”

A follow-up study observing health outcomes of the care recipients in the home and community-based service of the long-term care system of Taiwan

“…As mentioned in previous research, Asian countries have not reported evidence for compression of morbidity [28] and Ku, Liu and Wen [29] carried out a study in Taiwan found that the trend in having at least one of the six ADL limitations among communitydwelling elderly people increased mildly in the past decade. The use of community services also increased over this period, not because of widespread substitution of community care for nursing home care, but because of increased use among those in the community [30].…”