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

Iegor Rudnytskyi,Joël Wagner

doi:10.3390/risks7030092

Iegor Rudnytskyi, Joël Wagner

Open Access

https://doi.org/10.3390/risks7030092

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Journal: Risks	Publication Date: Aug 26, 2019
Citations: 5	License type: CC BY 4.0

Affiliation: University of Lausanne, Swiss Finance Institute

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.

Highlights

The population is aging in many countries in the world and the speed of the process is expected to increase in the future (Lutz et al 2008)
The aim of the present study is to investigate the drivers of old-age dependence and long-term care (LTC) usage in a structural equation modeling (SEM) framework
We investigate and analyze the factors associated with dependence and the usage of formal and informal LTC

Summary

Introduction

The population is aging in many countries in the world and the speed of the process is expected to increase in the future (Lutz et al 2008). The dramatic growth of the number of elderly triggers a higher demand for long-term care (LTC) services. The latter are defined by the International Labour Office as the “support that is needed by older persons with limited ability to care for themselves due to physical or mental conditions, including chronic diseases and multimorbidity” Informal care, coming at a cost to the caregivers, is an important alternative to formal care (Weaver and Weaver 2014). Investigating the link between formal and informal care is of particular importance (see for example, Fuino and Wagner 2019)

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