Modeling trajectories of long-term care needs at old age: A Japanese-Swedish comparison

A simulation model has been developed, which looks at the future state of functional limitations and provision of long-term care from the individual’s point of view and compares the prospects of Japanese and Swedish old persons. The model calculates the distribution on level of functional limitations combined with level of long-term care (LTC) for a 78-year-old man or woman after 3, 6, 9, 12 and 15 years given the initial state expressed in those terms. Longitudinal data for the model has been taken from the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) study, two waves three years apart, and the Swedish National Study of Aging and Care (SNAC) study, baseline and three-year follow up. Transition probabilities are calculated by relating individual states between waves. Changes over time are then calculated in the model by matrix multiplication using the Markov assumption. The results are in most respects similar for Japan and Sweden. A difference is that institutional care in Sweden is a much more definite stage reflecting differences in end-of-life care policy. Future state and mortality depends to a great degree on the initial state, both in terms of dependency and level of LTC. Thus, 78-year-old people who have no functional dependency and no LTC have a much higher probability of surviving the coming 10–15 years than people of the same age who already are dependent and in need of LTC services. Not a few of the initially independent 78-year-old persons will retain that state even after 15 years. However, the effect of the initial state seems to decrease over time.