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

Marten Lagergren, Noriko Kurube, Yasuhiko Saito


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.


dependency; long-term care; simulation; modeling; transitions

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Béland F and Zunzunegui MV (1999). Predictors of functional status in older people living at home. Age and Ageing, 28(2): 153–159.

Branch LG and Ku L (1989). Transition probabilities to dependency, institutionalization, and death among the elderly over a decade. Journal of Aging and Health, 1(3): 370–408.

Carey E, Covinsky KE, Lui L-Y, et al. (2008). Prediction of mortality in community-living frail elderly people with long-term care needs. Journal of the American Geriatrics Society, 56(1): 68–75.

Chan A, Malhotra R, Matchar DB, et al. (2016). Gender, educational and ethnic differences in active life expectancy among older Singaporeans. Geriatrics Gerontology International, 16(4): 466–473.

Chan A, Zimmer Z and Saito Y (2011). Gender differentials in disability and mortality transitions: The case of older adults in Japan. Journal of Aging and Health, 23(8): 1285–1308.

Crimmins EM and Saito Y (1993). Getting better and getting worse: Transitions in functional status among older Americans. Journal of Aging and Health, 5(1): 3–36.

Bravell ME, Berg S and Malmberg B (2008). Health, functional capacity, formal care, and survival in the oldest old: A longitudinal study. Archives of Gerontology and Geriatrics, 46(1): 1–14.

European Commission (2015). The 2015 aging report: Economic and budgetary projections for the 28 EU member states (2013–2060). European Economy 3. Luxembourg: Publications Office of the European Union

Holstein BE, Due P, Almind G, et al. (2007). Eight-year change in functional ability among 70- to 95-year-olds. Scandinavian Journal of Public Health, 35(3): 243–249.

Katz S, Ford AB, Moskowitz RW, et al. (1963). Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. Journal of American Medical Association, 185(2): 914–919.

Keeler E, Guralnik JM, Tian H, et al. (2010). The impact of functional status on life expectancy in older persons. The Journal of Gerontology, Series A: Biological Sciences and Medical Sciences, 65A(7): 727–733.

Kemper P, Komisar HL and Alecxih L (2005). Long-term care over an uncertain future: What can current retirees expect? INQUIRY: Journal of Health Care Organization, Provision and Financing, 42(4): 335–350.

Klein BEK, Klein R, Knudtson MD, et al. (2005). Frailty, morbidity and survival. Archives of Gerontology and Geriatrics, 41(2): 141–149.

Lagergren M (2004). A longitudinal study integrating population, care and social services data. Aging Clinical and Experimental Research, 16(2): 158 - 168252–257.

Maeda N (2015). Kenko chojyu no shakaiteki kouka no shisan—2020–2050 nen no kaigo kosuto henka shyumireshon no kekka (Japanese) [Simulation of social effect of health longevity: Result of simulation of care cost changes during 2020–2050]. NLI Report. Tokyo, Japan: Nissei Fundamental Research Institute.

Manton KG (1998). A longitudinal study of functional change and mortality in the United States. Journal of Gerontology, 43(5): S153–S161.

de La Maisonneuve C and Martins JO (2013). Public spending on health and long-term care: A new set of projections. OECD Economic Policy Papers No. 06. Paris, France: OECD Publishing.

Sakai S, Sato J, Nakazawa M (2015). Kaigosouhiyo no choukisuikei (Japanese) [Total long-term estimates of LTC costs]. KIER Discussion Paper Series, No. 1504. Kyoto, Japan: Kyoto University Research Institute of Economics.

Stineman MG, Xie D, Pan Q, et al. (2012). All-cause 1-, 5-, and 10-year mortality in elderly people according to activities of daily living stage. Journal of the American Geriatrics Society, 60(3): 485–492.

Swedish Agency for Health and Care Services Analysis (2015). Hemtjänst, vård- och omsorgsboende eller mitt emellan? (Swedish) [Home help, institutional care or something in between?] Report 2015:8. Stockholm, Sweden: Swedish Agency for Health and Care Services Analysis.

Ueda J (2012). Dougakuteki kontororu ka no zaiseisesaku (Japanese) [Financial policy under dynamic control]. Tokyo, Japan: Iwanami Shoten.

Ueda J, Horiuchi Y, and Tsutsui T (2011). Iryo kaigohiyo no choukisuikei to shorai no rodo jyuyo: 2008 nendo no kokumin iryohi tou wo fumaeta suikei (Japanese) [Long-term estimates of the health and long-term care costs and demand of labour ]. KIER Discussion Paper Series No. 1017. Kyoto, Japan: Kyoto University Research Institute of Economics.

Zeng Y, Gu D, and Land KC (2004). A new method for correcting under-estimation of disabled life expectancy and application to Chinese oldest-old. Demography, 41(2): 335–361.

Zhang Z, Xie D, Kurichi JE, et al. (2012). Mortality predictive indexes for the community-dwelling elderly US population. Journal of General Internal Medicine, 27(8): 901–910.

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