西班牙的长期护理与认知障碍
Long Term Care and Cognitive Impairment in Spain
NBER Working Papers · 2026 · [{"name": "Joan Costa-i-Font", "affiliation": []}, {"name": "Sergi Jimenez-Martin", "affiliation": []}, {"name": "Juan Oliva", "affiliation": []}, {"name": "Cristina Vilaplana-Prieto", "affiliation": []}, {"name": "Analía Viola", "affiliation": []}]
中文摘要
认知障碍（CI）患病率的持续上升是与年龄相关的健康和长期护理（LTC）需求的主要驱动因素之一。在西班牙，据估计认知障碍影响18.5%的65岁以上人群，以及45.3%的85岁及以上人群。本文利用新冠疫情前65岁以上个体纵向样本的合并数据，考察认知障碍和身体限制对健康及长期护理利用的影响，并估算其成本与经济负担。我们报告了四组发现。第一，我们发现老年时期的社会经济地位是认知障碍最强的预测因素。第二，虽然认知障碍和身体限制都会增加成年人的健康及护理使用，但身体障碍是总体护理利用（73%，而仅认知障碍为55%）和养老院居住（2.0%对比0.9%）更强的预测因素。第三，非正式照料构成了痴呆症成本的绝大部分，占总成本的69%至81%。最后，我们估算，非正式照料的替代成本将耗尽西班牙长期护理系统（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).