Projecting Long-term Care Costs among Older Adults with ADL Disability and Cognitive Impairment in China

Abstract Background Mounting evidence suggests that cognitive impairment is strongly associated with difficulties in performing activities of daily living (ADL disability). This study aims to estimate and project the trend in the number of older adults in China with ADL disability and cognitive impairment and the associated long-term care (LTC) costs in the next 20 years. Methods We used data from 37,942 adults aged ≥ 65 years from waves 2005-2018 of the Chinese Longitudinal Healthy Longevity Surveys (CLHLS). We used the Markov model to simulate the population of China and track the transition of Chinese older adults in the next 20 years between four disability-cognition states. We employed a two-part model to project direct and indirect LTC costs per capita. Results The proportion of disabled older adults without cognitive impairment (from 4.0% in 2022 to 4.3% in 2040) was projected to be slightly higher than that of those disabled and cognitively impaired (from 3.5% in 2022 to 4.1% in 2040). The indirect LTC cost was projected to increase from 316 billion yuan in 2022 to 4,399 billion yuan in 2040 for disabled older adults with cognitive impairment and from 197 billion yuan in 2022 to 1,697 billion yuan in 2040 for disabled older adults without cognitive impairment. Conclusions Policymakers could include the assessment of cognition in the LTC needs assessment and allocate more compensation to LTC insurance participants with cognitive impairment.