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In-Depth Analysis of National Long-Term Care Survey: Survey Objectives, Design, and Results

This overview covers the National Long-Term Care Survey's history, objectives, sample design, survey content, innovations, and research results. It provides insights into chronic disability, cognitive impairment, Medicare expenditures, and potential research areas.

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In-Depth Analysis of National Long-Term Care Survey: Survey Objectives, Design, and Results

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  1. Overview of the National Long Term Care Survey (NLTCS) Conference on Chinese Healthy Aging and Socioeconomic Development Durham, NC August, 2004 Nicholas Holt

  2. Topic Guide • Survey Objectives • Background • Survey Design • Survey Content • Innovations • Research Results

  3. Objectives • NLTCS – to characterize the health and functional status of the population 65 years and older • Informal Caregiver Survey – to examine how family and social relations help chronically disabled persons function in the community

  4. Background • Established in 1982 as a cross-sectional survey • Sponsored by HCFA in 1982-1984 • Picked up by NIA and the Center for Demographic Studies in 1989 • Additional Funding from ASPE in all waves beginning in 1989

  5. Background • Has both longitudinal and cross-sectional aspects • Waves are nominally 5 years apart • Particular emphasis on functionally impaired individuals

  6. Background • Nationally representative measures of: • Longitudinal and cohort patterns of change in functional limitation • Mortality • Health care and other services, formal and informal, received by impaired • How care is paid for

  7. Design of Survey • Entire sample gets a screener interview • Disabled get a detailed interview • Community • Institutional • Disability is defined by the screener interview

  8. The Sample • A probability sample of persons aged 65 and older • Added in groups over time (healthy supplement)

  9. The Sample (1) • 1982 • a probability sample from the MEDICARE files large enough to yield 6000 community disabled people (~35,000) • conceived as a cross-sectional survey • Census Bureau drew the sample and conducted the actual interviews

  10. The Sample (2) • 1984 • Sample included all community and institutional disabled plus a probability sample of the non-disabled from 1982 sample • plus a probability sample from all who became 65 years old since 1982 • Census Bureau drew the probability sample and conducted the actual interviews

  11. The Sample (3) • 1989 - on • Sample included all disabled who were disabled in the prior wave plus some or all of the non-disabled from prior wave • plus a probability sample from all who became 65 years old since previous wave • Census Bureau drew the probability sample and conducted the actual interviews

  12. Sample Sizes

  13. Survey Content • Questionnaire content came from several sources • Questions • Disability, medical conditions, physical functioning, cognitive functioning • Caregivers • Nutrition, perceived health status • Living arrangements, income, and education

  14. Screener Interview • Primarily done by phone • Determines whether or not the subject gets a detailed interview • Determines whether subject gets a community interview or an institutional detailed interview

  15. Detailed interview questions • Medical conditions • Disability (ADL & IADL) • Range of motion and impairment • Cognitive functioning

  16. Detailed interview questions • Insurance • Income • Children and siblings • Medical providers and prescription drugs

  17. Detailed interview questions • Helpers • Caregiver selection • Nutrition and social activities • Institutional

  18. Demographic Variables • Demographic and economic characteristics age, race, sex, marital status • education, income and assets, housing and neighborhood characteristics

  19. Innovations • Added a sample of caregivers starting in in 1989 • Starting in 1994 a sample of non-disabled screen-outs were interviewed • Starting in 1994 a supplementary sample of 95+ was added

  20. Supplemental Surveys • Next-of-Kin Mortality Follow Up (1984 and 2000) • Biological Specimens • 638 bloods in 1999 • 1172 buccal washes in 1999 • 3000 bloods planned in 2004 • 1000 buccal washes planned in 2004

  21. Medicare Data • Survey data supplemented with linked Medicare claims history from CMS for each survey participant • Medicare data linked to NLTCS survey data and furnished to CMS • Researchers must obtain Medicare data directly from CMS

  22. Research Results • Chronic disability • Severe cognitive impairment • Medicare expenditures • Genetic studies

  23. Possible Research Areas • Function limitations, physical and cognitive • Patterns of change • Medical conditions • Health care services used • Caregiver assistance • Demographic and economic characteristics • Out of pocket expenditures

  24. Survey Data • Survey data can be obtained from CDS or, with some added value from Unicon, Inc. http://www.unicon.com/ • In either case the DUA will be signed with CDS http://nltcs.cds.duke.edu/index.htm

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