long-term care use and supply in europe: projections for germany ...

LONG-TERM CARE USE AND SUPPLY IN EUROPE | 37
BIOL: The ‘biology’ scenario is more optimistic than the DELAY scenario. It assumes a similar relative
disability incidence decline as the mortality incidence decline. DELAY assumed a same absolute
decline (in number of life years) in disability and mortality incidence. BIOL yields higher incidence
declines at younger age, but lower declines at older ages, while the reverse holds for the DELAY
scenario.
b. Risk factor scenarios
The second set of disability scenarios makes assumptions about trends in two important risk factors with
regard to disability: smoking and obesity. For all risk factor scenarios, background assumptions on
mortality and disability incidence are based on the DELAY scenario.
Smoking
The disability incidence of smokers does not differ much from that of non-smokers (see Bonneux et al.,
2011). A main cause of disability in smokers is chronic obstructive pulmonary disease (COPD), but only
a fraction of smokers is affected by (severe) COPD. As smoking strongly increases the risk of dying,
therefore, all things equal, it tends to decrease age-related disability. The scenarios with regard to trends
in smoking are the following:
SMOK: This scenario projects the (still high) prevalence of smoking of younger cohorts into the future
and assumes they will continue smoking. This is a ‘worst case’ assumption.
TREND: The ‘TREND’ scenario starts from the ‘SMOK’ scenario but adds the assumption that in future
cohorts smokers will successfully quit at a rate of 2% per year. This seems a rather realistic scenario, the
assumption of quitting being close to recent observations.
NOSMOK: This scenario modifies the ‘SMOK’ scenario by assuming that none of the future 55 year
olds will be smoking, but remaining smokers in the older population will continue smoking. In this
assumption, the large smoking cohorts will only be extinct around 2055. In 2040, many smokers still
survive at high age, which can cause paradoxical results in the disability projections.
NOSQUIT: This scenario adds high quit rates to the ‘NOSMOK’ scenario. It is an extreme ‘no smoking’
scenario, as smokers die or quit and are not replaced by new cohorts of smokers. Compared to the
‘TREND’ scenario it projects increased disability, but also decreasing smoking related mortality.
Obesity
With regard to obesity, mortality does not differ much between obese people and the non-obese, but
prevalence of disability is higher for obese persons (see Bonneux et al., 2011). Obesity causes wear and
tear of joints of knees, hips and back, leading to loss of mobility. The scenarios with regard to trends in
obesity are the following:
BMI: This scenario assumes an increased prevalence of obesity in inflowing future cohorts of older
persons. These prevalences are kept constant over the projection period.
LEAN: The ‘lean’ scenario is an extremely optimistic scenario. It halves the prevalence of obesity for all
inflowing future cohorts of 55 year old.
FAT: This is an extremely pessimistic scenario. It assumes that the prevalence of obesity for all
inflowing future cohorts of 55 year old is doubling.
4.2.3 Changing household composition scenario
The household composition of older persons is changing in many European countries, as widowhood is
postponed to higher ages, divorce rates are increasing and co-residence rates of older parents and
children are decreasing (Bernard, 2000; Herce, 2003; Lowenstein, 1999). The ‘changing household
composition’ scenario (DELAY HH) takes account of future trends in household composition of the
older population, based on existing projections of household composition (see 4.2). Therefore, for each