Abstract
SummaryBackgroundExisting models for forecasting future care needs are limited in the risk factors included and in the assumptions made about incoming cohorts. We estimated the numbers of people aged 65 years or older in England and the years lived in older age requiring care at different intensities between 2015 and 2035 from the Population Ageing and Care Simulation (PACSim) model.MethodsPACSim, a dynamic microsimulation model, combined three studies (Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II) to simulate individuals' sociodemographic factors, health behaviours, 12 chronic diseases and geriatric conditions, and dependency (categorised as high [24-h care], medium [daily care], or low [less than daily] dependency; or independent). Transition probabilities for each characteristic were estimated by modelling state changes from baseline to 2-year follow-up. Years in dependency states were calculated by Sullivan's method.FindingsBetween 2015 and 2035 in England, both the prevalence of and numbers of people with dependency will fall for young-old adults (65–74 years). For very old adults (≥85 years), numbers with low dependency will increase by 148·0% (range from ten simulations 140·0–152·0) and with high dependency will almost double (increase of 91·8%, range 87·3–94·1) although prevalence will change little. Older adults with medium or high dependency and dementia will be more likely to have at least two other concurrent conditions (increasing from 58·8% in 2015 to 81·2% in 2035). Men aged 65 years will see a compression of dependency with 4·2 years (range 3·9–4·2) of independence gained compared with life expectancy gains of 3·5 years (3·1–4·1). Women aged 65 years will experience an expansion of mainly low dependency, with 3·0 years (3·0–3·6) gained in life expectancy compared with 1·4 years (1·2–1·4) with low dependency and 0·7 years (0·6–0·8) with high dependency.InterpretationIn the next 20 years, the English population aged 65 years or over will see increases in the number of individuals who are independent but also in those with complex care needs. This increase is due to more individuals reaching 85 years or older who have higher levels of dependency, dementia, and comorbidity. Health and social care services must adapt to the complex care needs of an increasing older population.FundingUK Economic and Social Research Council and the National Institute for Health Research.
Highlights
The world’s population is ageing, and many countries are finding the consequent demand on health-care services to be a challenge
Taking account of cognitive status and incontinence, both strong predictors of admission to long-term care, produces a more nuanced measure of dependency,[1] and one that is closer to the WHO’s concept of intrinsic capacity.[2]. Past trends in this dependency measure for the UK between 1991 and 2011 suggest increases in both low dependency, from 28·7% to 32·4%, and high dependency (24-h care), from 3·9% to 5·9%.3. These are consistent with trends in disability-free life expectancy in both the UK4 and the USA,[5] both of which reveal an expansion of mild disability for women
Models often fail to include risk factors other than sex, race, or education, and rarely include more than a few diseases, despite disability often being a consequence of multimorbidity[6] and despite the numbers of older people with four or more diseases being projected to more than double between 2015 and 2035.7 A further limitation is that models have to make assumptions about the disability prevalence of younger cohorts ageing into the older www.thelancet.com/public-health Vol 3 September 2018
Summary
The world’s population is ageing, and many countries are finding the consequent demand on health-care services to be a challenge. Taking account of cognitive status and incontinence, both strong predictors of admission to long-term care, produces a more nuanced measure of dependency,[1] and one that is closer to the WHO’s concept of intrinsic capacity.[2] Past trends in this dependency measure for the UK between 1991 and 2011 suggest increases in both low dependency (care required less than daily), from 28·7% to 32·4%, and high dependency (24-h care), from 3·9% to 5·9%.3 These are consistent with trends in disability-free life expectancy (as measured through ADLs) in both the UK4 and the USA,[5] both of which reveal an expansion of mild disability for women. Models often fail to include risk factors other than sex, race, or education, and rarely include more than a few diseases, despite disability often being a consequence of multimorbidity[6] and despite the numbers of older people with four or more diseases being projected to more than double between 2015 and 2035.7 A further limitation is that models have to make assumptions about the disability prevalence of younger cohorts ageing into the older www.thelancet.com/public-health Vol 3 September 2018
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
