Health status profiles in community-dwelling elderly using self-reported health indicators: a latent class analysis
- 525 Downloads
Latent class analysis (LCA), a statistical method for identifying latent classes within a population using multiple indicators, has been used to study the heterogeneity of health among the elderly. We aim to identify health status profiles of older adults using LCA and examine the socio-demographic characteristics associated with each profile.
A community health survey of residents ≥60 years was conducted in Marine Parade, Singapore. We performed LCA on seven health indicators (number of chronic conditions, activities of daily living (ADL) dependency, pain, depression, cognition, social isolation, and frequency of socialising) to identify distinct classes of health status profiles. Multivariable logistic regression was conducted to examine the socio-demographic characteristics associated with each profile.
Of the 2,444 elderly interviewed, we identified two health status profiles: “Health at risk” (n = 465, 19.0 %), and “Relatively healthy” (n = 1,979, 81.0 %). The “Health at risk” profile was characterised by high probabilities of 3+ chronic conditions (λ = 0.63), at least one basic/instrumental ADL dependency (λ = 0.56), moderate/extreme pain (λ = 0.55), cognitive impairment (λ = 0.29), depressive symptoms (λ = 0.29), social isolation (λ = 0.27), and infrequent socialisation (λ = 0.61). Individuals who were older (65–74, 75–84, and 85+ years), females, of non-Chinese ethnicity (Indian, Malay, and Others), had primary and lower education, and were unemployed/not employed were more likely to be “Health at risk”.
Using LCA, we identified two distinct health status profiles which accounted for the heterogeneity of the elderly population. Selected socio-demographic characteristics were associated with different profiles and provide implications for the structuring of future public health interventions targeting the older population.
KeywordsHealth status Elderly Latent class analysis Asia
This study was part of the Marine Parade Elderly Needs Survey Project, which was commissioned by the Agency for Integrated Care, Singapore.
- 2.MCYS. (2006). Committee on ageing issues: Report on the ageing population. Singapore: MCYS. app.msf.gov.sg/Portals/0/Summary/research/CAI_report.pdf.
- 3.Orrell, M., & Hancock, G. A. (Eds.). (2004). CANE: The Camberwell assessment of need for the elderly. London: Gaskell.Google Scholar
- 4.WHO. (2003). WHO definition of Health. Geneva: WHO (25 February 2013). http://www.who.int/about/definition/en/print.html.
- 5.Fried, L. P., Ferrucci, L., Darer, J., Williamson, J. D., & Anderson, G. (2004). Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59(3), 255–263.CrossRefGoogle Scholar
- 9.Lafortune, L., Beland, F., Bergman, H., & Ankri, J. (2009). Health status transitions in community-living elderly with complex care needs: A latent class approach. BMC Geriatrics, 9(6), 1–14.Google Scholar
- 10.Mackenbach, J. P. (2006). Health inequalities: Europe in profile. http://www.who.int/social_determinants/resources/european_inequalities.pdf.
- 11.Wickrama, K. A. S., Mancini, J. A., Kwag, K., & Kwon, J. (2013). Heterogeneity in multidimensional health trajectories of late old years and socioeconomic stratification: A latent trajectory class analysis. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 68(2), 290–297.CrossRefGoogle Scholar
- 12.Humphreys, E. (2008). Health inequalities and ageing in the community. Limerick, Ireland: University of Limerick & Mid-western Regional Hospital Limerick. http://www.hsyrc.com/Images/Updates/January2009/Ageing_FinalRpt.pdf.
- 15.George, P. P., Heng, B. H., Molina, J. A. D., Wong, L. Y., Ng, C. W. L., & Cheah, J. T. S. (2012). Self-reported chronic diseases and health status and health service utilisation—Results from a community health survey in Singapore. International Journal for Equity in Health, 11, 44.PubMedCentralPubMedCrossRefGoogle Scholar
- 16.Wee, L. E., Yeo, W. X., Yang, G. R., Hannan, N., Lim, K., Chua, C., et al. (2012). Individual and area level socioeconomic status and its association with cognitive function and cognitive impairment (low MMSE) among community-dwelling elderly in Singapore. Dementia and Geriatric Cognitive Disorders Extra, 2, 529–542.PubMedCentralPubMedCrossRefGoogle Scholar
- 19.Schuz, B., Wurm, S., Warner, L. M., & Tesch-Romer, C. (2009). Health and subjective well-being in later adulthood: Different health states—Different needs? Applied Psychology: Health and Well-Being, 1(1), 23–45.Google Scholar
- 20.The Pennsylvania State University. (2012). Latent transition analysis (LTA). Pennsylvania, USA: The Pennsylvania State University (25 February 2013). http://methodology.psu.edu/ra/lta.
- 22.Ministry of Community Development Youth and Sports. (2005). National Survey of Senior Citizens 2005. Singapore: Ministry of Community Development Youth and Sports.Google Scholar
- 23.Ministry of Health. (2007). National Health Surveillance Survey 2007. Singapore: Ministry of Health.Google Scholar
- 25.Rabin, R., Oemar, M., Oppe, M., & EuroQol Group Executive Office on behalf of the EuroQOL Group. (2011). EQ-5D-3L user guide: Basic information on how to use EQ-5D-3L instrument (Version 4.0). EuroQol Group. http://www.euroqol.org/fileadmin/user_upload/Documenten/PDF/Folders_Flyers/UserGuide_EQ-5D-3L.pdf.
- 27.Chin, J. J. (2002). Screening for cognitive impairment in primary care: The role of objective cognitive tests. The Singapore Family Physician, 28(4), 62–68.Google Scholar
- 32.Singapore Department of Statistics. (2011). Key household characteristics and household income trends. Singapore: Singapore Department of Statistics.Google Scholar
- 33.Muthen, L. K., & Muthen, B. O. (1998–2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Muthen & Muthen.Google Scholar
- 40.Hagenaars, J. A., & McCutcheon, A. L. (Eds.). (2002). Applied latent class analysis. Cambridge: Cambridge University Press.Google Scholar