A Joint Study of Disability and Dementia Trajectories in China's Elderly Population——Optimizing Disability Evaluation of the Long-Term Care Insurance
The concomitance in disability and dementia trajectories calls for an efficient policy design of the long-term care insurance by taking dementia into consideration.Using data from the 2002-2018 CLHLS and the Group-Based Trajectory Extension Model considering nonrandom participant attrition,this study estimates the trajectories of activities of daily living(ADL)and cognitive-perceptual abilities(MMSE score)of older population in China,as well as the joint probabilities of the two trajectories,and explores their proximate determinants.We find that:(1)the trajectories of ADL fall into three categories,including late-onset and stable type,late-onset and rising type,and early-onset and rising type;the trajectories of cognitive-perceptual ability fall into two types,namely late-onset and stable type and early-onset and rising type.(2)In terms of the factors affecting trajectory types,unhealthy life style in adulthood such as smoking predicts to a poorer trajectory,while education and medical insurance have significant protective effects on the trajectories,and factors such as birth cohort,occupation,childhood experiences,pension resources and regular exercises in adulthood have different effects on the two trajectories.(3)In terms of factors affecting the degree of disability,serious diseases predicts a severe disability in each trajectory,while social activity participation mitigates the deterioration of both abilities.Older adults with severer disability are more likely to live in urban areas.(4)Under current evaluation criteria of the long-term care insurance,27.9％of older adults with moderate to severe dementia are unable to receive appropriate services or treatments due to their intact ability to perform activities of daily living.Therefore,it is crucial to consider both the interdependence of disability and dementia processes in the policy design of the long-term care insurance.
Disablement Process TheoryGroup-Based Trajectory ModelActivities of Daily LivingCognitive-Perceptual AbilityJoint Test
NETL
NSTL
万方数据
