Sociodemographic characteristics, disability trajectory, and health care and long-term care utilization among middle-old and older adults in Taiwan.

OBJECTIVES

To understand whether disability trajectories mediated the association between sociodemographic characteristics and later health care and long-term care services use.

METHODS

Data were from the Taiwan Longitudinal Study on Aging Survey, 1996-2007 (N =3429). Latent class growth curves modeling and structural equation modeling were applied to examine the effect of disability trajectory as mediator on sociodemographic characteristics and on later services use.

RESULTS

Respondents were identified in three trajectories: maintained disability (1.92%), progressive disability (10.56%), and functional independence trajectories (87.52%). The progressive disability trajectory partially and fully mediated the effects of age on later use of health care and long-term care services (the partially mediating effect on age and long-term care service use: β = 0.047, p < 0.001, for example). With the progressive disability trajectory in the model, higher education had a direct effect on greater use of long-term care services (β = 0.020, p =0.020), but through the mediating effect of the disability trajectory, education had an indirect effect on lower use of long-term care services(β = -0.025, p < 0.001). Education had fully mediating effects on the later use of inpatient (β = -0.016, p < 0.001) and emergency services (β= -0.012, p < 0.001).

CONCLUSIONS

Preventing older adults from developing a fast-growing disability trajectory could be an effective way to decrease use of health care and long-term care services and related expenditures in late life.