Abstract
BackgroundObesity is a known predictor of disability and functional limitations, and, in turn, of health care use. In this study, we aim to explore whether obesity is also a significant risk factor for future long-term care use, overall and by type of care.MethodsWe use multinomial logistic regression analysis on data from the English Longitudinal Study of Ageing (ELSA) for individuals aged 65 and older between 2002 and 2011. Selection issues are tackled using the rich set of control variables, exploiting the data’s longitudinal structure and accounting for loss to follow-up (including death). Control factors include health-related behaviours (physical activity, alcohol and tobacco consumption), functional limitations (related to ADLs, iADLs and mobility) and specific existing health conditions, notably diabetes, high blood pressure and cardio-vascular diseases.ResultsWe find that obese older people are 25% (p < 0.01) more likely to receive informal or privately-paid care in the future, but this does not hold for formal care. This is an additional direct effect after controlling for a wide range of health conditions and functional limitations. We document some evidence that this effect is due to the development of new functional limitations. Sensitivity analyses suggest that the results are robust to controlling for prediabetes, subjective health, depression, or unobserved heterogeneity.ConclusionsThis study provides new evidence of a positive direct effect of obesity on the future use of long-term care services. Accordingly, it adds evidence of further economic benefits to any overall evaluation of policies to promote a healthy weight in the population, particularly in the older population.
Highlights
Obesity is a known predictor of disability and functional limitations, and, in turn, of health care use
In the whole sample we used, 30% of respondents receive some type of care in the future, of which 1% are in care homes, 27% receive informal care, 2% receive formal care and 4% paid for care privately
The obesity prevalence is highest for those receiving informal care (36% compared to 27% in the whole sample; p < 0.01)
Summary
Obesity is a known predictor of disability and functional limitations, and, in turn, of health care use. There is evidence that obesity is directly associated with functional limitations (e.g. mobility) and disability in old age; including from physical disabilities, increased cognitive impairment and reduced psychological wellbeing among older people [13,14,15,16]. This evidence, along with findings of an upward shift in the age at which body
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