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Open AccessArticle

Drivers of Old-Age Dependence and Long-Term Care Usage in Switzerland—A Structural Equation Model Approach

by Iegor Rudnytskyi 1,† and Joël Wagner 1,2,*,†
1
Department of Actuarial Science, Faculty HEC, University of Lausanne, Extranef, 1015 Lausanne, Switzerland
2
Swiss Finance Institute, University of Lausanne, Extranef, 1015 Lausanne, Switzerland
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Risks 2019, 7(3), 92; https://doi.org/10.3390/risks7030092
Received: 16 July 2019 / Revised: 19 August 2019 / Accepted: 19 August 2019 / Published: 26 August 2019
Long-term care (LTC) encompasses a set of services provided to impaired and dependent elderly people. To assess the level of the dependence several scales are used, including activities of daily living (ADL), instrumental ADL (IADL) and functional limitations. Once an elderly person fails to perform these activities independently, he or she requires special assistance. Help can be provided as informal care by relatives and as formal care by professionals. The aim of this research is to study individual characteristics that relate to the demand of LTC and to analyze the relation between formal and informal care. We base our study on data from the Swiss Health Survey focusing on respondents aged over 65 years. Using the structural equation modeling technique, we develop a statistical model that considers the dependence concept as a latent variable. This hidden dependence variable combines three indices linked to the limitations in ADL, in IADL and functional limitations. Accounting for causality links between covariates enables us to include the indirect effect of pathologies on the receipt of LTC mediated via dependence. In our model, we do not assume a causal relationship between formal and informal care. From our results, we observe a significant impact of pathologies as well as of the socio-demographic factors on the demand for LTC. The relationship between formal and informal care is found to be of both a complementary and substitutional nature. View Full-Text
Keywords: old-age dependence; long-term care (LTC); structural equation model; pathology old-age dependence; long-term care (LTC); structural equation model; pathology
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Rudnytskyi, I.; Wagner, J. Drivers of Old-Age Dependence and Long-Term Care Usage in Switzerland—A Structural Equation Model Approach. Risks 2019, 7, 92.

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