Browsing by Author "Chiu, Chi-Tsun"

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    Educational differences in the compression of disability incidence in the United States.
    (SSM - population health, 2019-04) Chiu, Chi-Tsun; Hayward, Mark D; Chan, Angelique; Matchar, David B

    Objective

    To examine educational differences in the compression of disability incidence in the United States.

    Method

    We use the Health and Retirement Study and techniques of microsimulation and bootstrap to estimate the distribution of mortality and disability incidence for major education groups.

    Results

    Higher education is associated with a right shift in the age distributions of both mortality and disability incidence, and more compressed distributions above the modal ages (p<0.05). Our study also points to gender differences in the association between education and compression of mortality and disability incidence (p<0.05).

    Discussion

    To our knowledge, no prior studies have examined educational difference in compression of disability incidence and conducted formal tests for statistical significance. Educational differences in life span variation in mortality correspond closely with life span variation in disability incidence. One long-range implication of this work is growing inequality in life-span variation in disability incidence given trends in educational differences in life-span variation in mortality.
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    Projection of young-old and old-old with functional disability: does accounting for the changing educational composition of the elderly population make a difference?
    (PloS one, 2015-01) Ansah, John P; Malhotra, Rahul; Lew, Nicola; Chiu, Chi-Tsun; Chan, Angelique; Bayer, Steffen; Matchar, David B
    This study compares projections, up to year 2040, of young-old (aged 60-79) and old-old (aged 80+) with functional disability in Singapore with and without accounting for the changing educational composition of the Singaporean elderly. Two multi-state population models, with and without accounting for educational composition respectively, were developed, parameterized with age-gender-(education)-specific transition probabilities (between active, functional disability and death states) estimated from two waves (2009 and 2011) of a nationally representative survey of community-dwelling Singaporeans aged ≥ 60 years (N=4,990). Probabilistic sensitivity analysis with the bootstrap method was used to obtain the 95% confidence interval of the transition probabilities. Not accounting for educational composition overestimated the young-old with functional disability by 65 percent and underestimated the old-old by 20 percent in 2040. Accounting for educational composition, the proportion of old-old with functional disability increased from 40.8 percent in 2000 to 64.4 percent by 2040; not accounting for educational composition, the proportion in 2040 was 49.4 percent. Since the health profiles, and hence care needs, of the old-old differ from those of the young-old, health care service utilization and expenditure and the demand for formal and informal caregiving will be affected, impacting health and long-term care policy.
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    Self-Care for Older People (SCOPE): a cluster randomized controlled trial of self-care training and health outcomes in low-income elderly in Singapore.
    (Contemporary clinical trials, 2015-03) Chan, Angelique; Matchar, David B; Tsao, Mary Ann; Harding, Susana; Chiu, Chi-Tsun; Tay, Bryan; Raman, Prassanna; Pietryla, Zachary; Klein, Mara K; Haldane, Victoria Elizabeth

    Unlabelled

    Population aging is associated with a higher prevalence of chronic health conditions. Previous studies have shown that older persons, specifically those with chronic conditions, often lack sufficient knowledge about their condition and thus frequently have poor self-care skills. Efforts to increase general health screenings and improve access to chronic condition management resources are hampered by a lack of disease and health awareness. Self-Care for Older People (SCOPE) study, a cluster randomized controlled trial in Singapore, was designed to evaluate the impact of a self-care program for chronic disease awareness and management of specific health measures and quality of life of older people over eighteen months. SCOPE provided self-care education targeted at older people with low income and low education in order to improve health-related knowledge. A total of 378 low-income older people with no or minimal disability, defined as having difficulty in one or more activities of daily living (ADL), were recruited from senior activity centers. The measurements taken included self-reported health conditions, health and disease knowledge questions, and biomarkers (HbA1c, blood pressure, peak expiratory flow, lipid panel, albumin, and creatinine). SCOPE was also designed to provide information for policy makers on chronic disease burden and healthcare facility utilization among community-dwelling older adults.

    Trial registration number

    NCT01672177.
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    Trends in functional disability and cognitive impairment among the older adult in China up to 2060: estimates from a dynamic multi-state population model.
    (BMC geriatrics, 2021-06-22) Ansah, John P; Chiu, Chi-Tsun; Wei-Yan, Aloysius Chia; Min, Tessa Lui Shi; Matchar, David B

    Background

    Available evidence suggests that cognitive impairment (CI), which leads to deficits in episodic memory, executive functions, visual attention, and language, is associated with difficulties in the capacity to perform activities of daily living. Hence any forecast of the future prevalence of functional disability should account for the likely impact of cognitive impairment on the onset of functional disability. Thus, this research aims to address this gap in literature by projecting the number of older adults in China with functional disability and cognitive impairment while accounting for the impact of cognitive impairment on the onset of functional disability.

    Methods

    We developed and validated a dynamic multi-state population model which simulates the population of China and tracks the transition of Chinese older adults (65 years and older) from 2010 to 2060, to and from six health states-(i) active older adults without cognitive impairment, (ii) active older adults with cognitive impairment, (iii) older adults with 1 to 2 ADL limitations, (iv) older adults with cognitive impairment and 1 to 2 ADL limitations, (v) older adults with 3 or more ADL limitations, and (vi) older adults with cognitive impairment and 3 or more ADL limitations.

    Results

    From 2015 to 2060, the number of older adults 65 years and older in China is projected to increase, of which the number with impairment (herein referred to as individuals with cognitive impairment and/or activity of daily living limitations) is projected to increase more than fourfold from 17·9 million (17·8-18·0) million in 2015 to 96·2 (95·3-97·1) million by 2060. Among the older adults with impairment, those with ADL limitations only is projected to increase from 3·7 million (3·6-3·7 million) in 2015 to 23·9 million (23·4-24·6 million) by 2060, with an estimated annual increase of 12·2% (12·1-12·3); while that for cognitive impairment only is estimated to increase from 11·4 million (11·3-11·5 million) in 2015 to 47·8 million (47·5-48·2 million) by 2060-this representing an annual growth of 7·07% (7·05-7·09).

    Conclusion

    Our findings suggest there will be an increase in demand for intermediate and long-term care services among the older adults with functional disability and cognitive impairment.