Projection of young-old and old-old with functional disability: does accounting for the changing educational composition of the elderly population make a difference?

PLoS One. 2015 May 14;10(5):e0126471. doi: 10.1371/journal.pone.0126471. eCollection 2015.

Abstract

This study compares projections, up to year 2040, of young-old (aged 60-79) and old-old (aged 80+) with functional disability in Singapore with and without accounting for the changing educational composition of the Singaporean elderly. Two multi-state population models, with and without accounting for educational composition respectively, were developed, parameterized with age-gender-(education)-specific transition probabilities (between active, functional disability and death states) estimated from two waves (2009 and 2011) of a nationally representative survey of community-dwelling Singaporeans aged ≥ 60 years (N=4,990). Probabilistic sensitivity analysis with the bootstrap method was used to obtain the 95% confidence interval of the transition probabilities. Not accounting for educational composition overestimated the young-old with functional disability by 65 percent and underestimated the old-old by 20 percent in 2040. Accounting for educational composition, the proportion of old-old with functional disability increased from 40.8 percent in 2000 to 64.4 percent by 2040; not accounting for educational composition, the proportion in 2040 was 49.4 percent. Since the health profiles, and hence care needs, of the old-old differ from those of the young-old, health care service utilization and expenditure and the demand for formal and informal caregiving will be affected, impacting health and long-term care policy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging*
  • Disability Evaluation*
  • Educational Status
  • Female
  • Forecasting / methods
  • Health Expenditures
  • Health Services Needs and Demand / economics
  • Health Surveys
  • Humans
  • Long-Term Care / economics
  • Male
  • Middle Aged
  • Singapore

Grants and funding

This work was supported by the Singapore Ministry of Health’s National Medical Research Council under its STaR Award Grant (grant number NMRC|STaR|0005|2009) as part of the project “Establishing a Practical and Theoretical Foundation for Comprehensive and Integrated Community, Policy and Academic Efforts to Improve Dementia Care in Singapore.” DM received the funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.