New Evidence on the Risk of Requiring Long-Term Care

Friedburg, Leora; Hou, Wenliang; Sun, Wei; Webb, Anthony; Li, Zhenyu

doi:10.2139/ssrn.2542572

Cited by 22 publications

(17 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Median overall estimates of lifetime use of RAC for people aged 65+ varied substantially: 39% (range 22%–47%) for decedent cohorts, 34% (26%–53%) for lifetables and 53% for simulations (35%–60%). Of the 12 studies from the US, decedent cohort studies in general yielded lower estimates than other studies, but there was wide variation, from 35% 26 to 60% 29,30 . Likelihoods for women aged 65+ were on average 1.6 times that of men (unadjusted for age).…”

Section: Resultsmentioning

confidence: 83%

“…Lifetable studies estimated likelihoods for Australia, 14,15 USA 23 and UK 24 . Six simulation models were from the US 25–30 and one from Finland 31 …”

Section: Resultsmentioning

confidence: 99%

“…That most reports were from the US possibly reflects the comparatively larger role of the insurance industry in long‐term care, with corresponding interest and capacity to conduct complex studies. Some aspects of decision‐making around use of insurance are included in the recent paper by Freidburg et al 30 Greater use of RAC for restorative or ‘step‐down’ care in the US will also lead to higher lifetime risk of RAC.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Likelihood of residential aged care use in later life: a simple approach to estimation with international comparison

Broad

Ashton

Gott

et al. 2015

Australian and New Zealand Journal of Public Health

View full text Add to dashboard Cite

L ong-term residential aged care (RAC) is used at any one time by about 4-6% of those aged 65 years or over in many developed countries, including NZ. [1][2][3] This figure -usually derived from research adopting cross-sectional methods such as censuses and surveys -sometimes leads to the erroneous assumption that only few people use RAC during their lifetimes. 4 Inappropriate use of cross-sectional figures for estimating the likelihood of use of RACwhich Kastenbaum and Candy referred to as "the four per cent fallacy" 5,6 -may suggest that the sector is small and affects few people. To avoid such misunderstandings, and for policy and planning purposes, estimates are needed of the likelihood people aged 65 and over will use residential care at any time before they die, hereafter termed 'lifetime use' .Studies of place of death have been used to answer this question. 5,[7][8][9] Deaths in RAC are widely available, based on death certificate information. For example, a large international comparison of 21 populations aged 65+ years showed RAC was the place of death for a median of 18% (inter-quartile range 14-29 %) of decedents 10 . In the US the proportion was 29% and in Australia and Canada 32%, but in Iceland and NZ the proportion was higher at 38%. However, deaths in RAC underestimate total RAC use wherever a proportion of RAC residents die in an acute hospital.Other than place of death, three methodologies have previously been used to assess lifetime use. These include 1) assembling a population-representative cohort and following it either prospectively until death or from death retrospectively; 2) using the lifetable method as used in demographic projections; and 3) modelling transition probabilities between residence at home, residence in RAC and death, and then simulating lifetime risk. All these methods require the assembly of large or long cohorts. In countries where there are no such cohorts, including NZ, another method of estimation is required. The need for simple methods to estimate lifetime use has previously been recognised. 9 This paper describes a simple method of estimation of lifetime use of RAC for people who reach the age of 65 years. Administrative data for place of death obtained from death certificates are obtained first for the NZ population, derived from all death certificates over a five-year period. To that figure is added an estimate of the number of RAC residents who die, not in RAC, but in acute hospital. It then compares NZ estimates to published reports for other countries. Methods: Deaths of RAC residents in acute hospitals were estimated for NZ from four separate studies and added to deaths occurring in RAC, to derive the likelihood of using RAC after age 65 years. Academic and other sources were searched for comparative reports. Likelihood of residential agedResults: An estimated 18% of RAC residents died in acute hospital in NZ. When added to those who died in RAC, the proportion using RAC for late-life care was estimated at over 47% (66% if aged 85+ years). Of 12 US reports,...

show abstract

Section: Resultsmentioning

confidence: 83%

“…Lifetable studies estimated likelihoods for Australia, 14,15 USA 23 and UK 24 . Six simulation models were from the US 25–30 and one from Finland 31 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Likelihood of residential aged care use in later life: a simple approach to estimation with international comparison

Broad

Ashton

Gott

et al. 2015

Australian and New Zealand Journal of Public Health

View full text Add to dashboard Cite

show abstract

“…Another widely used estimation methodology for health transition process is the Robinson model (Friedberg et al., ; Fong, Shao, and Sherris, ). However, as Fong, Shao, and Sherris () point out, the Poisson generalized linear model (GLM) better captures retirees’ health dynamics in the HRS data than the Robinson model.…”

mentioning

confidence: 99%

Health State Transitions and Longevity Effects on Retirees’ Optimal Annuitization

Ai¹,

Brockett²,

Golden³

et al. 2016

J of Risk & Insurance

View full text Add to dashboard Cite

The interplay between longevity risk and health state transitions for retirees' optimal annuitization decisions is investigated. Using a life-cycle framework incorporating wealth levels, bequest motives, and consumption floors created by government subsidies, we examine how increased longevity in conjunction with an individual's health state transition process impacts annuity purchase decisions. Health state transition matrices are estimated from the Health and Retirement Survey (HRS) data. The effects of increased longevity on annuitization decisions are considered when longevity is both accompanied by increased time spent in healthier states (morbidity compression) or experienced by more time in unhealthy states (morbidity expansion). We find that retirees' annuity demand is affected by wealth, initial health status, and expansion or compression of morbidity. Wealthier retirees have higher annuity demand when health shocks are considered, and increased longevity increases demand even more when retirees expect an expansion or

show abstract

“…They estimated the probabilities that a 65-year-old man or woman will be in various "care states" at subsequent five-year age points. Friedberg et al [2014] estimated that 56% of men at age 65 will never use a nursing home. Although nearly half of those still living at age 95 might be using home health care or nursing-home care services, the overwhelming majority of the original group will already have died by then.…”

Section: Catastrophic Long-term Care Expense Risksmentioning

confidence: 99%