Abstract
Objectives
This study aimed to identify the heterogeneous disability trajectories among older
Chinese adults and examine the association between disability trajectories and health
care service utilization.
Design
Prospective cohort study.
Setting and Participants
A community-based study including older adults aged ≥65 years from the Chinese Longitudinal
Healthy Longevity Survey.
Methods
Disability was assessed by the difficulties in activities of daily living and instrumental
activities of daily living between 2002 and 2018. Health care utilization was measured
by the expenditures on outpatient and inpatient services in 2018. Growth mixture modeling
was conducted to estimate heterogeneous disability trajectories. A 2-part model was
used to analyze the association of disability trajectories and health care utilization.
Covariates were included based on Andersen's behavioral model.
Results
Three classes of disability trajectories were identified: the progressive (7.9%),
late-onset (13.7%), and normal classes (78.4%). Older adults who followed the late-onset
trajectory of disability were more likely to use inpatient services compared with
the normal class (odds ratio = 1.47, P < .010), after controlling potential confounders. Compared with the normal class,
the progressive class on average spent US$145.94 more annually (45.2% higher) on outpatient
services (P < .010) and $738.99 more annually (72.6% higher) on inpatient services (P < .001); the late-onset class reported higher annual expenditures on outpatient and
inpatient services of $215.94 (66.9% higher) and $1405.00 (138.0% higher), respectively
(all P < .001).
Conclusions and Implications
Heterogeneous disability trajectories exhibited distinct health care service utilization
patterns among older Chinese adults. Older adults affected by late-onset disability
incurred the highest health care needs. These findings provide valuable policy-relevant
evidence for reducing health care burden among older adults.
Keywords
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References
- Mobility, disability, and social engagement in older adults.J Aging Health. 2013; 25: 617-637
- Mortality following trajectories of mobility limitations: The modifying impact of social factors.J Aging Health. 2020; 32: 134-142
- Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the global burden of disease study 2017.Lancet. 2018; 392: 1789-1858
- Depression, functional disability and quality of life among Nigerian older adults: Prevalences and relationships.Arch Gerontol Geriatr. 2018; 74: 39-43
- Living longer, with or without disability? A global and longitudinal perspective.J Gerontol A Biol Sci Med Sci. 2019; 75: 162-167
- Dynapenic abdominal obesity as a risk factor for worse trajectories of ADL disability among older adults: The ELSA Cohort Study.J Gerontol A Biol Sci Med Sci. 2018; 74: 1112-1118
- Heterogeneous long-term trajectories of dependency in older adults: The PAQUID cohort, a population-based study over 22 years.J Gerontol A Biol Sci Med Sci. 2020; 75: 2396-2403
- Disability trajectories and associated disablement process factors among older adults in Taiwan.Arch Gerontol Geriatr. 2015; 60: 272-280
- Trajectories of disability among older persons before and after a hospitalization leading to a skilled nursing facility admission.J Am Med Dir Assoc. 2016; 17: 225-231
- Functioning and primary healthcare utilization in older adults: A 1-year follow-up study.Physiother Theory Pract. 2019; 35: 278-287
- Disability and care needs among older Americans.Milbank Q. 2014; 92: 509-541
- Effects of physical function trajectories on later long-term care utilization among the Taiwanese elderly.Geriatr Gerontol Int. 2013; 13: 751-758
- Medicare spending and the adequacy of support with daily activities in community-living older adults with disability.Ann Intern Med. 2019; 170: 837-844
- Re-revisiting Andersen's behavioral model of health services Use: A systematic review of studies from 1998–2011.Psychosoc Med. 2012; 9: Doc11
- Revisiting the behavioral model and access to medical care: Does it matter?.J Health Soc Behav. 1995; 36: 1-10
- Sociodemographic characteristics, disability trajectory, and health care and long-term care utilization among middle-old and older adults in Taiwan.Arch Gerontol Geriatr. 2019; 82: 161-166
- Psychological correlates of multimorbidity and disability accumulation in older adults.Age Ageing. 2019; 48: 789-796
- Socioeconomic status and improvement in functional ability among older adults in Japan: A longitudinal study.BMC Public Health. 2019; 19: 209
- Childhood socioeconomic circumstances and disability trajectories in older men and women: A European cohort study.Eur J Public Health. 2019; 29: 50-58
- Cardiovascular risk factors and the risk of disability in older adults: Variation by age and functional status.J Am Med Dir Assoc. 2019; 20: 208-212.e3
- The role of intervening hospital admissions on trajectories of disability in the last year of life: Prospective cohort study of older people.BMJ. 2015; 350: h2361
Yi Z, James V, Zhenyu X, et al. Chinese Longitudinal Healthy Longevity Survey (CLHLS), 1998-2014. Inter-university Consortium for Political and Social Research [distributor], 2017.
- Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: A cohort study.Lancet. 2017; 389: 1619-1629
- Reliability of age reporting among the Chinese oldest-old in the CLHLS datasets.in: Yi Z. Poston D.L. Vlosky D.A. Gu D. Healthy Longevity in China: Demographic, Socioeconomic, and Psychological Dimensions. Springer, Netherlands2008 (p. 61-78.)
- Disability trajectories and mortality in older adults with different cognitive and physical profiles.Aging Clin Exp Res. 2020; 32: 1007-1016
- Comparisons between older men and women in the trajectory and burden of disability over the course of nearly 14 years.J Am Med Dir Assoc. 2013; 14: 280-286
- Integrating person-centered and variable-centered analyses: Growth mixture modeling with latent trajectory classes.Alcohol Clin Exp Res. 2000; 24: 882-891
- An introduction to latent class growth analysis and growth mixture modeling.Soc Personal Psychol Compass. 2008; 2: 302-317
- Higher-Order Growth Curves and Mixture Modeling with Mplus: A Practical Guide.Routledge, New York2016
- Trajectories of aging among U.S. older adults: Mixed evidence for a Hispanic paradox.J Gerontol B Psychol Sci Soc Sci. 2018; 75: 601-612
- Ethnicity and changing functional health in middle and late life: A person-centered approach.J Gerontol B Psychol Sci Soc Sci. 2009; 65: 470-481
- Physical health, depression and cognitive function as correlates of disability in an older Korean population.Int J Geriatr Psychiatry. 2005; 20: 160-167
- Disability in older adults across the continuum of cognitive decline: Unique contributions of depression, sleep disturbance, cognitive deficits and medical burden.Int Psychogeriatr. 2019; 31: 1611-1625
- Association between activities of daily living disability and depression symptoms of middle-aged and older Chinese adults and their spouses: A community based study.J Affect Disord. 2019; 242: 135-142
- Temporal and reciprocal relationship between IADL/ADL disability and depressive symptoms in late life.J Gerontol B Psychol Sci Soc Sci. 2002; 57: P338-P347
- Cognitive functioning as a predictor of functional disability in later life.Am J Geriatr Psychiatry. 2006; 14: 36-42
- Ageing, genes, environment and epigenetics: What twin studies tell us now, and in the future.Age Ageing. 2012; 41: 581-586
- Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports.BMJ. 2018; 360: j5855
- Smoking and stroke: A mendelian randomization study.Ann Neurol. 2019; 86: 468-471
- Association of trajectories of higher-level functional capacity with mortality and medical and long-term care costs among community-dwelling older Japanese.J Gerontol A Biol Sci Med Sci. 2018; 74: 211-218
- Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs.J Psychosom Res. 2018; 104: 1-8
- Hospitalization, restricted activity, and the development of disability among older persons.JAMA. 2004; 292: 2115-2124
- Medicaid cost savings of a preventive home visit program for disabled older adults.J Am Geriatr Soc. 2018; 66: 614-620
Article info
Publication history
Published online: February 09, 2021
Footnotes
Jian Xiao and Zaixing Shi contributed equally to this work.
The authors declare no conflicts of interest.
This work was supported by the National Natural Science Foundation of China, China (Grant number 81973144).
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
