As populations across the globe age, the elderly face the burdens of disruptive disabilities that impact the quality of everyday life. Asia is home to the most rapidly aging populations in the world, and studying healthcare data from nations like South Korea and Singapore enables researchers to address the challenges of rapidly aging societies. To do so, it is necessary to understand how health disparities change dynamically, but previous research comparing elderly health in Asia tended to report trends without modeling the micro-dynamics of health status and sociodemographic characteristics.
A new study, published in Asian Development Review, sheds light on the dynamic evolution of the health and functional disparities of the future elderly. It employs a new model to compare projections of functional status and disability among future cohorts of older adults, including disparities in disability prevalence by educational attainment. These changes will have important implications for social protection systems, including the financing and delivery of long-term care and health care. The study highlights potential differences in the aging experience by gender and education in each country to inform social and healthcare policy and provides a common platform for international comparison to identify and compare challenges across countries.
The study’s lead author is Cynthia Chen, currently a visiting scholar with APARC’s Asia Health Policy Program (AHPP) and assistant professor at the National University of Singapore. AHPP Director and FSI Senior Fellow Karen Eggleston is a co-senior author. The study’s additional coauthors include Stanford Professor of Health Policy Jay Bhattacharya, who directs the Center on the Demography and Economics of Health and Aging. Their findings show associations between education and health in projecting the functional status and disability among future cohorts of older adults in South Korea and Singapore. They indicate that from 2015 to 2050, the elderly with high educational attainment are projected to have a lower prevalence of functional disability and chronic diseases compared to the elderly with low educational attainment.
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The study is the first to compare the progression of educational disparities in disability across South Korea and Singapore, accounting for their complex interrelationship with sociodemographic and health behaviors as covariates that evolve across time.
Studying these “top-heavy” societies in which populations are projected to have continually increasing proportions of older adults in the coming decades due to the continued increase in life expectancy coupled with low, below-replacement fertility rates, allows for a better understanding of changes in population size and demographics.
The coauthors’ model, called the Future Elderly Model (FEM) for South Korea and Singapore, is a sociodemographic and economic state-transition microsimulation model with flexibility as a key strength: it can take into account the evolving educational attainment of future elderly cohorts and competing risks when projecting functional disability outcomes for the future elderly population. The researchers used these models to project and compare functional disability across the two countries, including disparities in functional disability prevalence by educational attainment and gender, up to the year 2050.
Education plays a key role in longevity, as the model projected increasing disparities in the prevalence of activities-of-daily-living disability and other chronic diseases between those with low and high educational attainment. Yet despite overall increases in educational attainment, all elderly, including those with a college degree, experience an increased burden of functional disability and chronic diseases because of survival to older ages.
In Singapore, the disparity in functional disability prevalence, as measured by limitation in at least one activity of daily living (ADL), started at a difference of 9.5 percentage points in 2015 and climbs by 2050 to a difference of over 23 percentage points (31.9% among those with low education, compared to 8.7% among the college-educated). Functional disability as measured by instrumental activities of daily living (IADL) shows a similar pattern.
South Korea’s model projects even larger disparities by 2050, as exemplified by a difference of 41.7 percentage points in the prevalence of any functional disability between low- and high-educational attainment groups (i.e., 51.7% among those with less than high school education, compared to 10.0% among the college-educated).
These increases in disparity have significant economic and social implications, including increased medical and long-term care expenditures, and an increased caregiver burden. As demographic, economic, and social changes can affect longevity, so too can they impact the overall burden of care, financing needs, and optimal resource allocation for healthcare in the future.
Studying medical care in late adulthood, especially these evolving patterns of morbidity and disability, is an urgent task, the researchers conclude. The study complements the literature on life-protection activities, further underscoring the importance of investment in healthy aging and control of chronic disease so that added years of life can be relatively healthy ones.