Institute of Health & Society and Newcastle University Institute for Ageing, Newcastle University, Newcastle, UK.
Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
Lancet Public Health. 2018 Sep;3(9):e447-e455. doi: 10.1016/S2468-2667(18)30118-X. Epub 2018 Aug 31.
Existing models for forecasting future care needs are limited in the risk factors included and in the assumptions made about incoming cohorts. We estimated the numbers of people aged 65 years or older in England and the years lived in older age requiring care at different intensities between 2015 and 2035 from the Population Ageing and Care Simulation (PACSim) model.
PACSim, a dynamic microsimulation model, combined three studies (Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II) to simulate individuals' sociodemographic factors, health behaviours, 12 chronic diseases and geriatric conditions, and dependency (categorised as high [24-h care], medium [daily care], or low [less than daily] dependency; or independent). Transition probabilities for each characteristic were estimated by modelling state changes from baseline to 2-year follow-up. Years in dependency states were calculated by Sullivan's method.
Between 2015 and 2035 in England, both the prevalence of and numbers of people with dependency will fall for young-old adults (65-74 years). For very old adults (≥85 years), numbers with low dependency will increase by 148·0% (range from ten simulations 140·0-152·0) and with high dependency will almost double (increase of 91·8%, range 87·3-94·1) although prevalence will change little. Older adults with medium or high dependency and dementia will be more likely to have at least two other concurrent conditions (increasing from 58·8% in 2015 to 81·2% in 2035). Men aged 65 years will see a compression of dependency with 4·2 years (range 3·9-4·2) of independence gained compared with life expectancy gains of 3·5 years (3·1-4·1). Women aged 65 years will experience an expansion of mainly low dependency, with 3·0 years (3·0-3·6) gained in life expectancy compared with 1·4 years (1·2-1·4) with low dependency and 0·7 years (0·6-0·8) with high dependency.
In the next 20 years, the English population aged 65 years or over will see increases in the number of individuals who are independent but also in those with complex care needs. This increase is due to more individuals reaching 85 years or older who have higher levels of dependency, dementia, and comorbidity. Health and social care services must adapt to the complex care needs of an increasing older population.
UK Economic and Social Research Council and the National Institute for Health Research.
现有的未来护理需求预测模型在纳入的风险因素和对新入队列的假设方面存在局限性。我们使用人口老龄化和护理模拟（Population Ageing and Care Simulation，PACSim）模型，估计了 2015 年至 2035 年期间英格兰 65 岁及以上人口数量以及不同护理强度的老年人口数量。
PACSim 是一种动态微观模拟模型，结合了三项研究（理解社会、英国老龄化纵向研究和认知功能与老龄化研究 II），以模拟个体的社会人口因素、健康行为、12 种慢性疾病和老年疾病以及依赖程度（分为高（24 小时护理）、中（日常护理）或低（少于日常）依赖；或独立）。通过对从基线到 2 年随访的状态变化进行建模，估计了每个特征的转移概率。通过 Sullivan 方法计算依赖状态下的年数。
在 2015 年至 2035 年期间，英格兰年轻老年人（65-74 岁）的依赖人数和患病率都将下降。对于非常老的老年人（≥85 岁），低依赖人数将增加 148.0%（10 次模拟范围为 140.0-152.0），高依赖人数将几乎翻倍（增加 91.8%，范围为 87.3-94.1），尽管患病率变化不大。中或高依赖和痴呆症的老年患者更有可能同时患有至少两种其他疾病（从 2015 年的 58.8%增加到 2035 年的 81.2%）。65 岁的男性将获得 4.2 年（范围 3.9-4.2）的独立期，与预期寿命增加 3.5 年（3.1-4.1）相比，依赖性得到压缩。65 岁的女性将主要获得低依赖期，与预期寿命增加 3.0 年（3.0-3.6）相比，低依赖期增加 1.4 年（1.2-1.4），高依赖期增加 0.7 年（0.6-0.8）。
在未来 20 年，英格兰 65 岁及以上人口数量将增加，其中包括更多独立的人群，但也包括更多有复杂护理需求的人群。这一增长是由于更多的人达到 85 岁或以上，他们的依赖性、痴呆症和合并症水平更高。医疗和社会保健服务必须适应不断增长的老年人口的复杂护理需求。
英国经济和社会研究理事会和国家健康研究所。
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