Drivers of Old-Age Dependence and Long-Term Care Usage in Switzerland—A Structural Equation Model Approach

Abstract

Long-term care (LTC) encompasses a set of services provided to impaired and dependent elderly people. To assess the level of the dependence several scales are used, including activities of daily living (ADL), instrumental ADL (IADL) and functional limitations. Once an elderly person fails to perform these activities independently, he or she requires special assistance. Help can be provided as informal care by relatives and as formal care by professionals. The aim of this research is to study individual characteristics that relate to the demand of LTC and to analyze the relation between formal and informal care. We base our study on data from the Swiss Health Survey focusing on respondents aged over 65 years. Using the structural equation modeling technique, we develop a statistical model that considers the dependence concept as a latent variable. This hidden dependence variable combines three indices linked to the limitations in ADL, in IADL and functional limitations. Accounting for causality links between covariates enables us to include the indirect effect of pathologies on the receipt of LTC mediated via dependence. In our model, we do not assume a causal relationship between formal and informal care. From our results, we observe a significant impact of pathologies as well as of the socio-demographic factors on the demand for LTC. The relationship between formal and informal care is found to be of both a complementary and substitutional nature.

On the characteristics of reporting ADL limitations and formal LTC usage across Europe

“…On the one hand, if a longer observation period is available, the nature of the relationship could be partially clarified by identifying which of the characteristics appear first [ 22 ]. On the other hand, additional research could use instrumental variables to eliminate some of the endogeneity arising from the simultaneous determination of ADL limitations and mental diseases [ 93 ].…”

Modelling the burden of long-term care for institutionalised elderly based on care duration and intensity

“…As a consequence, different pathologies affect both mortality and the dependence, directly affecting the duration of stay, and the intensity of care, respectively. Furthermore, the influence of pathologies on LTC needs is widely studied by, for example Boult et al (1994), Guccione et al (1994), Tomiak et al (2000), Pritchard (2006), Callahan et al (2012), Biessy (2017) and Rudnytskyi & Wagner (2019). Finally, research suggests accounting for the number of diseases, that is, multimorbidity (Marengoni et al, 2011;Barnett et al, 2012).…”

On the drivers of potential customers' interest in long‐term care insurance: Evidence from Switzerland

“…Demographic factors such as sex and houshold size are often relevant. Women are more likely than men to buy insurance owing to their higher life expectancy (Brown & Finkelstein, 2008, 2009; He & Chou, 2020; Rudnytskyi & Wagner, 2019); however, household composition matters, as the partner can influence decision‐making and is likely to be the first care provider (Barnett & Stum, 2013; Pinquart & Sörensen, 2011). Having relatives may also play an important role (Cramer & Jensen, 2006) as older adults living with children may feel that paying for an insurance policy is unnecessary as they could have easy access to informal help (Zhou‐Richter et al, 2010).…”