A Dynamic Microsimulation Model for Aging and Health in Taiwan: The Taiwan Future Elderly Model: Forecasting Future Population with Dementia and Functional Limitations and Its Implications for Formal Long-Term Care Capacity

Table of Contents

• A Dynamic Microsimulation Model for Aging and Health in Taiwan The Taiwan Future Elderly Model 1
• Abstract 3
• Contents 5
• Figures and Tables 7
• Figures 7
• Tables 8
• Acknowledgements 11
• 1. Introduction 13
• 1.1 Demographic and Health Trends in Taiwan 14
• 1.2 Caregiving in Taiwan 16
• 1.3 Microsimulation modelling 18
• 1.3.1 Introduction of modelling methods 18
• 1.3.2 Advantages of microsimulation models 19
• 1.3.3 Limitations of microsimulation models 20
• 1.3.4 Prediction vs. causation 21
• 1.4 Research Objectives and Policy Questions 22
• 2. Data and Variables 23
• 2.1 Data 23
• 2.1.1 Taiwan Longitudinal Study on Aging 23
• 2.1.2 Weights in TLSA 24
• 2.2 Variables 25
• 2.2.1 Mortality 25
• 2.2.2 Demographic variables and educational levels 25
• 2.2.3 Chronic diseases and risk factors 26
• 2.2.4 Functional limitations 26
• 2.2.5 Cognitive impairment 28
• 2.2.6 Imputation of missing data in TLSA 31
• 2.3 Descriptive Statistics 32
• 2.3.1 Demographic variables and educational levels 33
• 2.3.2 Risk factors and chronic diseases 34
• 2.3.3 Functional limitations 35
• 2.3.4 Cognitive impairment 36
• 2.4 Comparison with external data 41
• 2.4.1 Compare prevalences of overweight hypertension diabetes with the Nutrition and 41
• Health Survey in Taiwan 41
• 2.4.2 Compare prevalences of dementia by age groups with estimates from Taiwan 43
• Alzheimers Disease Association 43
• 3. Design of Taiwan Future Elderly Model 46
• 3.1 Taiwan Future Elderly Model Overview 46
• 3.2 Transition models 47
• 3.2.1 Variable parameterization 47
• 3.2.2 Overview of transitioned variables 48
• 3.2.3 To use weights or not when estimating transition models 51
• 3.2.4 Model selection 53
• 3.2.5 Final transition models 59
• 3.3 Cohort simulation 68
• 3.4 Population simulation 68
• 3.4.1 Assumptions about replenishing cohorts 69
• 3.5 Calibration 71
• 4. Validation of Taiwan Future Elderly Model 72
• 4.1 Internal validation 72
• 4.1.1 Methodology 72
• 4.1.2 Population level internal validation results 75
• 4.1.3 Individual level internal validation results 79
• 4.1.4 Summary of internal validation 82
• 4.2 Comparison of Taiwan Future Elderly Model projections with external 85
• 4.2.1 Methodology 85
• 4.2.2 Compare population size with official data 2003-2015 88
• 4.2.3 Compare population size with official projections 2015-2043 89
• 4.2.4 Compare number of dementia patients with projections from TADA 2019-2043 90
• 4.3 Limitations of Taiwan Future Elderly Model 95
• 4.3.1 Summary 95
• 4.3.2 Uncertainty in simulated results from TFEM 95
• 4.3.3 Limitations of TFEM related to TLSA 97
• 5. Application of Taiwan Future Elderly Model Forecasting dementia and disability trends in Taiwan 99
• 5.1 Introduction 99
• 5.2 Methods 100
• 5.2.1 Baseline scenario 100
• 5.2.2 Intervention 100
• 5.2.3 Outcomes 102
• 5.3 Results 106
• 5.3.1 Baseline scenario 106
• 5.3.2 Compare 3 policy scenarios to the baseline 115
• 5.3.3 Sensitivity analysis 116
• 5.4 Discussion 119
• 5.4.1 Summary 119
• 5.4.2 Limitations 120
• 5.4.3 Policy implications 123
• 6. Budget and Sources of Funding 126
• 7. Ethical Considerations 127
• Appendix A. Receiver Operating Characteristic curves 128
• References 133