Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China.
Department of Gerontology, University of Southampton, Southampton, UK.
J Gerontol A Biol Sci Med Sci. 2024 Nov 7;79(Supplement_1):S50-S58. doi: 10.1093/gerona/glae140.
Mounting evidence suggests that cognitive impairment is strongly associated with disability in activities of daily living (ADL disability) and long-term care (LTC) costs. However, studies forecasting future LTC costs often overlook these relationships. Consequently, this study aims to more accurately project future LTC costs in China over the next 20 years by considering the intertwined association between disability and cognitive impairment on future LTC costs.
Data were from 10 959 adults ≥65 years from the 2005-2018 waves of the Chinese Longitudinal Healthy Longevity Surveys. We used the Markov model to project the population of China and track the transition of older adults in the next 20 years between 4 disability-cognition states. We employed a 2-part model to estimate LTC costs (direct and indirect LTC costs) per capita.
The proportion of disabled older adults with cognitive impairment was projected to increase from 1.4% in 2021 to 3.4% in 2040, while that of those without cognitive impairment was projected to decrease from 4.7% in 2021 to 4.5% in 2040. The direct and indirect LTC costs were projected to increase from 0.3% and 0.2% of gross domestic product (GDP) in 2021 to 1.4% and 0.7% in 2040 for disabled persons without cognitive impairment and from 0.1% and 0.1% of GDP in 2021 to 1.3% and 1.3% in 2040 for those with cognitive impairment, respectively.
Policy-makers could include the assessment of cognition in the LTC needs assessment and allocate more compensation to LTC insurance participants with cognitive impairment.
越来越多的证据表明，认知障碍与日常生活活动（ADL 障碍）和长期护理（LTC）费用的残疾密切相关。然而，预测未来 LTC 成本的研究往往忽略了这些关系。因此，本研究旨在通过考虑残疾和认知障碍对未来 LTC 成本的交织关联，更准确地预测未来 20 年中国的未来 LTC 成本。
数据来自于 2005-2018 年中国长寿纵向健康研究的 10959 名≥65 岁的成年人。我们使用马尔可夫模型来预测中国人口，并在未来 20 年内追踪老年人在 4 种残疾认知状态之间的转移。我们采用两部分模型来估计人均 LTC 成本（直接和间接 LTC 成本）。
预计 2021 年有认知障碍的残疾老年人比例将从 1.4%增加到 2040 年的 3.4%，而无认知障碍的残疾老年人比例将从 4.7%下降到 2040 年的 4.5%。预计 2021 年无认知障碍残疾者的直接和间接 LTC 成本将从 GDP 的 0.3%和 0.2%分别增加到 2040 年的 1.4%和 0.7%，而 2021 年有认知障碍者的直接和间接 LTC 成本将从 GDP 的 0.1%和 0.1%分别增加到 2040 年的 1.3%和 1.3%。
决策者可以在 LTC 需要评估中纳入认知评估，并为认知障碍的 LTC 保险参与者分配更多的补偿。
