Long term trend analysis of geographical disparity in aging and disability: Taiwanese population approach

What is the degree of social disability risk in China under the background of the aging population? Social disability risk measurement index system design and evaluation research based on China

Objective

The impact of the aging population in China varies between regions. It is because regions with different resource endowments, such as those related to economy, population, and medical care, have different degrees of disability risk in the face of the increases in the disabled and semi-disabled older population caused by the overall aging of the population. This study aimed to construct an evaluation system to monitor and measure the degree of social disability risk in different regions in China and to evaluate and compare the degree of social disability risk in different regions using empirical data.

Method

This study used the Delphi method to construct a social disability risk measurement index system with macro, meso, and micro dimensions. At the same time, based on the data of CHARLS2018, an AHP-entropy method was used to calculate the index's total weight, and the standard deviation classification method was used to classify the total and criterion-level measurement scores of 28 provinces.

Results

The regional degree of social disability risk was analyzed in subdimensions. Our research indicates that China's social disability risk situation is not promising, with a general medium to high-risk level. The score of degree of social disability risk among provinces is consistent with the regional economic development level to a large extent. The risk of social disability varies significantly among the eastern and central, and western regions of China and the provinces within the three regions.

Discussion

Currently, the situation facing the degree of social disability risk in China is that the overall risk level of the country is higher, and the difference between regions is significant. It is necessary to take measures to meet better the needs of the aging population and the disabled and semi-disabled older populations in a large-range, large-scale, multilevel way.

Use of Home- and Community-Based Services in Taiwan’s National 10-Year Long-Term Care Plan

We aimed to understand the relationships between care recipients’ profiles and home- and community-based services (HCBS use patterns. Data were from the 2010 to 2013 Long-Term Care Service Management System in Taiwan ( N = 78,205). We used latent class analysis and multinomial logistic regression analyses. Three HCBS use patterns were found. Care recipients who lived alone, lived in less urbanized areas, and had instrumental activities of daily living disabilities were more likely to be in the home-based personal care group. Those in the home-based personal and medical care group were more likely than others to have a primary caregiver. Care recipients who had poorer abilities at basic activities of daily living and cognitive function, better household income, and lived in a more urbanized area were more likely to be in the non-personal care multiple services group. The findings suggest that policymakers alleviate barriers to accessing various patterns of HCBS should be encouraged.

Refeeding syndrome in Southeastern Taiwan: Our experience with 11 cases

AIM: To present our experience with refeeding syndrome in southeastern Taiwan.

METHODS: We conducted a retrospective study during a 2-year period at the Mackay Memorial Hospital, Taitung Branch. We enrolled patients with very little or no nutrition intake for more than 10 d, a high risk group of refeeding syndrome, including those suffering from alcohol abuse, cancerous cachexia, chronic malnutrition, and prolonged starvation.

RESULTS: A total of 11 patients (7 males, 4 females) with nasogastric feeding were included as having refeeding syndrome. Most of them had the symptoms of diarrhea, lethargy, and leg edema. The initial nutritional supplement was found to be relatively high in calories (1355.1 ± 296.2 kcal/d), high in protein (47.3 ± 10.4 gm/d), low in vitamin B1 (2.0 ± 0.5 mg/d), low in potassium (1260.4 ± 297.7 mg/d), and low in phosphorus (660.1 ± 151.8 mg/d). Furthermore, hypophosphatemia (2.4 ± 0.9 mg/dL) was noted during follow-up. Based on the suggestions of a dietician and a gastroenterologist, the clinical disorders of diarrhea, malaise and leg edema were significantly improved. The level of phosphate was also increased (3.3 ± 0.6 mg/dL).

CONCLUSION: Refeeding syndrome is an overlooked and risky disorder that has some potentially fatal complications. Nasogastric feeding in nursing homes is an important risk factor for patients and deserves greater attention based on the initial results of this study.

Comparison of population pyramid and demographic characteristics between people with an intellectual disability and the general population

The purposes of this study were to measure disparities of age structure between people with an intellectual disability and general population, and to explore the difference of demographic characteristics between these two populations by using data from a population based register in Taiwan. Data were analyzed by SPSS 20.0 statistical software. Results found that the gender and mean age were significantly different between people with an intellectual disability and general population (mean age: 28.86 years vs. 35.26 years; p<0.001). The shape of the pyramid in general population tended to be fatty in the middle age, and intellectual disability population was more populous in the younger age. Furthermore, there were very few people with an intellectual disability can live more than 65 years old (3%) while there were nearly 10% of the general population were the elderly. The results also showed that two groups were different in marital status, educational levels, family status of veteran and aborigine (p<0.001). As the premature aging and short life span of people with an intellectual disability, this study suggested that the government authority should initiate necessary assistance for this group of people in the future.

Reported numbers of patients with rare diseases based on ten-year longitudinal national disability registries in Taiwan

This paper aims to describe a general demographic picture of patients with rare diseases in Taiwan and particularly focuses on the prevalence of rare diseases over time, age and gender distributions. We analyzed data mainly from the national disability registry from 2002 to 2011 in Taiwan, Republic of China. The results showed that the number of rare diseases increased from 93 to 193 between 2002 and 2011 and that the prevalence of rare diseases increased from 0.02 to 0.74 per 10,000 people in this time period. The gender ratio (male/female) was between 1.02 and 1.13 during this time period, with male cases representing a higher percentage than female cases in the rare disease population. The occurrence of rare diseases was significantly increased in children 3-5 years of age and elementary school children 6-14 years of age. The data also revealed that the occurrence of rare diseases in Taiwan was attributed primarily to pathogenic diseases and secondarily to genetic diseases. To obtain precise epidemiological data on rare diseases for future healthcare planning, this study highlights the importance of the cooperation of healthcare authorities with the social welfare department to strengthen the ability of the public healthcare system to regularly monitor and measure the occurrence of rare diseases in the community.

Comparison of outpatient services between elderly people with intellectual disabilities and the general elderly population in Taiwan

This study aims to analyze the ambulatory visit frequency and medical expenditures of the general elderly population versus the elderly with intellectual disabilities in Taiwan, while examining the effects of age, gender, urbanization and copayment status on ambulatory utilization. A cross-sectional study was conducted to analyze data from 103,183 national health insurance claimants aged 65 or older. A total of 1469 had a principal diagnosis of mental retardation (intellectual disability) and claimed medical outpatient services in 2007. The average number of ambulatory visits was 30.1 ± 23.1, which is much higher than in the United States and other developed countries, and the mean annual visits of the elderly with intellectual disabilities was significantly higher than the general population in Taiwan (35.2 ± 28.7 vs. 30.0 ± 23.1). Age and copayment status affected outpatient visit frequency. The mean medical expenditure per visit and the mean annual outpatient cost were 1146.5 ± 4497.7 NT$ and 34,533.7 ± 115,891.7 NT$, respectively. Male beneficiaries tended to have higher average annual medical expenses and mean medical expenses per visit than female beneficiaries. The three most frequent principal diagnoses at ambulatory visits were circulatory system diseases, musculoskeletal system and connective tissue diseases and digestive system diseases. We conclude that the elderly with intellectual disabilities had higher demand than the general population for healthcare services, and the NHI program lowers the barrier to care for populations with special needs.