Sociodemographic characteristics, disability trajectory, and health care and long-term care utilization among middle-old and older adults in Taiwan

Objectives: To understand whether disability trajectories mediated the association between sociodemographic characteristics and later health care and long-term care services use. Methods: Data were from the Taiwan Longitudinal Study on Aging Survey, 1996-2007 (N = 3429). Latent class growth curves modeling and structural equation modeling were applied to examine the effect of disability trajectory as mediator on sociodemographic characteristics and on later services use. Results: Respondents were identified in three trajectories: maintained disability (1.92%), progressive disability (10.56%), and functional independence trajectories (87.52%). The progressive disability trajectory partially and fully mediated the effects of age on later use of health care and long-term care services (the partially mediating effect on age and long-term care service use: beta = 0.047, p < 0.001, for example). With the progressive disability trajectory in the model, higher education had a direct effect on greater use of long-term care services (beta = 0.020, p = 0.020), but through the mediating effect of the disability trajectory, education had an indirect effect on lower use of long-term care services(beta = -0.025, p < 0.001). Education had fully mediating effects on the later use of inpatient (beta = -0.016, p < 0.001) and emergency services (beta = -0.012, p < 0.001). Conclusions: Preventing older adults from developing a fast-growing disability trajectory could be an effective way to decrease use of health care and long-term care services and related expenditures in late life.