NBER Working Papers · 2026 · Joan Costa-i-Font、Sergi Jimenez-Martin、Juan Oliva、Cristina Vilaplana-Prieto、Analía Viola
中文摘要
认知障碍（CI）患病率不断上升，是推动与年龄相关的医疗和长期照护（LTC）需求的主要因素之一。据估计，在西班牙，认知障碍影响着18.5%的65岁以上人群，以及45.3%的85岁及以上人群。本文利用一个由65岁及以上个体构成的纵向样本所汇集的新冠疫情前数据，考察认知障碍和身体受限对健康与长期照护利用的影响，并估算其成本和经济负担。我们报告四组研究发现。第一，我们发现老年期的社会经济地位是认知障碍最强的预测因子。第二，尽管认知障碍和身体受限都会增加医疗和成人照护服务的使用，但身体受损对总体照护利用（身体受损为73%，相比之下仅有认知障碍者为55%）和入住养老院（分别为2.0%与0.9%）的预测作用更强。第三，非正式照护构成痴呆症成本的绝大部分，占总成本的69%–81%。最后，我们估计，非正式照护的替代成本将耗尽西班牙长期照护体系（SAAD）的全部预算。
Abstract
The growing prevalence of cognitive impairment (CI) is one of the main drivers of age-related demand for health and long-term care (LTC). In Spain, CI is estimated to affect 18.5% of Spaniards over 65, and 45.3% in those aged 85 and above. This paper draws on a pooled pre-COVID data from a longitudinal sample of individuals aged 65+ to examine the effect of CI and physical limitations on health and long-term care utilisation, estimates its costs, and financial burden. We report four sets of findings. First, we find that socioeconomic status at older age to be the strongest predictor of CI. Second, while both CI and physical limitations increase health and care adult care use, physical impairment is a stronger predictor of overall care utilisation (73% versus 55% for CI alone) and nursing home residence (2.0% versus 0.9%). Third, informal caregiving constitutes the overwhelming majority of dementia costs, accounting for 69–81% of the total. Finally, we estimate that the replacement cost of informal care would exhaust the full budget of Spain’s LTC system (SAAD).