Hsiao-Wei Yu1, Yu-Kang Tu2, Ya-Mei Chen3. 1. Department of Gerontology and Health Care Management, College of Nusing, Chang Gung University of Science and Technology, No. 261, Wen-Hua 1st Rd., Gui-Shan Dist., Taoyuan City, 33303, Taiwan, ROC; Healthy Aging Research Center, Chang Gung University, No. 259, Wen-Hua 1st Rd., Gui-Shan Dist., Taoyuan City, 33303, Taiwan, ROC. 2. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei City, 10055, Taiwan, ROC. 3. Institute of Health Policy and Management, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei City, 10055, Taiwan, ROC. Electronic address: chenyamei@ntu.edu.tw.
Abstract
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.
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.