Childhood cognitive ability and the use of long-term care in later life

Abstract

Background
As the population ages the demand for care is predicted to increase. Previous studies have reported that individuals with poorer post-morbid cognitive ability are at higher risk of entering long-term care, both institutionalised care and home-based care. Given that post-morbid cognitive ability is sensitive to the type and severity of morbidity, it remains unclear whether higher cognitive ability, as a trait-level measure of individual differences, contributes to care usage. Some success has been observed using non-cognitive early-life circumstances such as socioeconomic circumstances as pre-morbid predictors of care risk. However, the contribution of early-life cognitive ability has yet to be examined.

Main Aim
We investigate the association between early-life circumstances, particularly cognitive ability, and the risk of entry into long-term care in later life (age 65+).

Methods
Veterans were identified using the South London and Maudsley Biomedical Research Centre (SLaM) case register – a database holding secondary mental health care electronic records for the South London and Maudsley National Health Service Trust of 300,000 patients. We developed two methods. An NLP and machine learning tool were developed to automatically evaluate personal history statements written by clinicians.

Results
This study uses a large sample of individuals born in Scotland in 1936 and who took part in the Scottish Mental Survey 1947. It links research data from childhood to routinely-collected administrative and healthcare records from across the life course.

Conclusion
We demonstrate the importance of early-life factors for predicting care usage in later life and how this role differs between types of long-term care. The implications of the results for research and policy will be discussed.

Background

As the population ages the demand for care is predicted to increase. Previous studies have reported that individuals with poorer post-morbid cognitive ability are at higher risk of entering long-term care, both institutionalised care and home-based care. Given that post-morbid cognitive ability is sensitive to the type and severity of morbidity, it remains unclear whether higher cognitive ability, as a trait-level measure of individual differences, contributes to care usage. Some success has been observed using non-cognitive early-life circumstances such as socioeconomic circumstances as pre-morbid predictors of care risk. However, the contribution of early-life cognitive ability has yet to be examined.

Main aim

We investigate the association between early-life circumstances, particularly cognitive ability, and the risk of entry into long-term care in later life (age 65+).

Methods

This study uses a large sample of individuals born in Scotland in 1936 and who took part in the Scottish Mental Survey 1947. It links research data from childhood to routinely-collected administrative and healthcare records from across the life course.

Results

Using survival analyses, we report the associations between early-life predictors and the risk of entry into long-term care. Risk is further broken down by the type of long-term care received: formal institutionalised care, formal care services and informal at-home care. Finally, we report the contribution of geographical variations in the provision of long-term care services.

Conclusion

We demonstrate the importance of early-life factors for predicting care usage in later life and how this role differs between types of long-term care. The implications of the results for research and policy will be discussed.