Transition Probabilities by Sight Issues

Transition Probabilities to and from Different States

Results – By Age

Results – All Respondents

How does social care need amongst older adults change over time in the UK?

Andrew Amos Channon, Joe Viana, Sally Brailsford and Stuart Rossiter

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Females 2004/5 2006/7 2008/9 2010/11No care need 1.8 4.9 7.5 10.9

Moderate need 9.7 19.0 26.3 33.7

High Need 8.3 18.0 25.7 34.3Male <60

Male 60-69

Male 70-79

Male 80+

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Macular Degeneration Destination ….Initial None Moderate High Death CensoredNone 0.74 0.08 0.15 0.03 0.05Moderate 0.27 0.31 0.37 0.11 0.05High 0.16 0.07 0.64 0.12 0.04

Glaucoma DestinationInitial None Moderate High Death CensoredNone 0.82 0.04 0.08 0.03 0.08Moderate 0.32 0.29 0.25 0.12 0.08High 0.19 0.07 0.59 0.14 0.08

No Eye Condition Destination ….Initial None Moderate High Death CensoredNone 0.85 0.03 0.06 0.03 0.09Moderate 0.35 0.29 0.20 0.13 0.10High 0.21 0.07 0.56 0.13 0.10

IntroductionIn the context of an ageing population, understanding care need states over time feeds into policy and planning. In the UK provision of state funded social care is driven by the concept of need. Using Activities of Daily Living (ADL) to ascertain care need this study assesses change in need over time in England. As part of a larger study investigating links between health and social care in the UK the study also investigated care need for different eye conditions.

DataFive waves of the English Longitudinal Study of Ageing (ELSA) from 2002/3 until 2010/11 were used. In Wave 1 all participants were aged over 50 years and then interviewed every two years. Deaths were provided mainly from vital registration.MethodsCare need was estimated using ADLs and iADLs and placed into three categories – no need, moderate need and high need. Two other groups – death and censored (left the survey, cause unknown) were also formed.Multistate life tables were used to estimate the probability of transition between care need states between survey waves. Only respondents with at least two observations were included. Last observation carried forward was used for participants with missing data between two observed care need states.

Care Need Trajectories

Probability of Death by Initial State

Care need state in Wave 1 is closely related to the probability of death at each subsequent wave. Males are much more likely to die than females, with those with no care need the least likely. However there is no difference in chances of death between those with moderate and high need.

Ages 50-59 at Wave 1 Ages 60-69 at Wave 1

Ages 70-79 at Wave 1

Ages 80+ at Wave 1

There are large differences by age in care need trajectories, as expected, with respondents more likely to be in a higher care need state and transition to death at older ages.The probability of moving to a higher care need state increases through the waves. Those in the high care need state are more likely to remain in that state compared to those in the moderate care need state.

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Males 2004/5 2006/7 2008/9 2010/11No care need 3.1 8.0 11.9 16.9

Moderate need 11.7 26.5 37.2 45.3

High Need 13.3 24.6 32.7 40.5

Probability of Transitions from High Care Need

Male <60

Male 60-69

Male 70-79

Male 80+

Female <60

Female 60-69

Female 70-79

Female 80+

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Probability of Transition to Death

For those individuals in the high care need state there is a high probability of staying in the same state between waves. However a sizeable proportion transfer to having no need in the next wave. There is a clear relationship between care need, age, sex and death.

Cataract DestinationInitial None Moderate High Death CensoredNone 0.84 0.03 0.06 0.03 0.09Moderate 0.35 0.28 0.22 0.13 0.10High 0.20 0.07 0.57 0.13 0.09

There are few differences between individuals with no eye condition and those with an eye condition and the probability of dying in the next wave. However individuals with macular degeneration are more likely to progress to a higher care need state than those with glaucoma or cataracts.One reason for the difference between eye conditions and care need state is the high prevalence of co-morbidities in individuals with macular degeneration, with two thirds having at least one other sight issue. The age profile of macular degeneration sufferers is also higher than for other sight conditions within ELSA.

ConclusionsClear movement is seen between care need states – with common transitions to both higher and lower care need states. Recovery is common, even amongst those with a high care need, although individuals are more likely to die if they have a care need. The relationship between care need and death is not as expected, with those with moderate care need as likely to die as those in a high care need. Sight issues related to care need transitions, albeit not strongly.These results have implications for the assessment of care need by providers in the UK, highlighting the fluidity of care requirements. How long does someone have to be needing a high level of care before they receive it? However this fluidity may also indicate a lack of consistency in reporting issues with ADLs.

This study was funded by the EPSRC Care Life Cycle Project – ref EP/H021698/1

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