Taiwan Longitudinal Study on Aging (TLSA) Presenter: Dr. Shih-Liang Yang Taichung Hospital, Taiwan, R.O.C.

Background In response to the potential impacts on the economic, medical, family and social aspects of population aging. Started to plan studies on the elderly since 1987. The baseline survey of Taiwan Longitudinal Study on Aging, also known as TLSA, was conducted in 1989.

Some Milestone of the Study (1/3) Utilization of administration data to improve completeness of follow-up (1996~) Household registration data linkage to trace movers Death certificate data linkage for survival status of the respondents

Some Milestone of the Study (2/3) Expanding use of instrument from questionnaire interview to physical and biochemical measurement (1998~) The NIH granted collaborative study with the Georgetown University and the Princeton University: Social Environment and Biomarkers of Aging Study

Some Milestone of the Study (3/3) From social-demographic oriented survey design to broad health, well-being and holistic prospect (2001~) Different focus and mission of the former Institute of Family Planning and the Bureau of Health Promotion

Materials and Methods Household registration data of adult residents aged 60 and above in non-aboriginal townships in 1988 were used as sampling frame for this study. A three-stage systematic random sampling method was used for the selection of an equal probability sample.

Materials and Methods Data were collected with face-to-face interview questionnaires by trained interviewers. Survival status and cause of death were obtained by linking the survey data to death certificate files managed by the Ministry of Health and Welfare

Materials and Methods The respondents were followed every three to four years. A total of 7 surveys were conducted in 1989, 1993, 1996, 1999, 2003, 2007, and 2011 (Wave I –Wave VII) respectively. 

Materials and Methods Two fresh samples were selected in 1996 and 2003 to maintain representativeness of the younger age cohort Extend representativeness of the sample to the population aged 50 and above.

Cohort Establishment and Follow-up 1989 1st wave 1993 2nd wave 1996 3rd wave 1999 3th wave 2003-2004 5th wave 2007 6th wave 2011-2012 7th wave 1990 1995 2000 2005 2010 Cohort 1: Aged ≧ 60 in 1989 Aged ≧ 67 in 1996 Aged ≧ 74 in 2003 Cohort 2: Aged 50-66 in 1996 Aged 57-73 in 2003 Cohort 3: Aged 50-56 in 2003 60 and above 50 and above National Institute of Family Planning 1965~2000 Bureau of Health Promotion 2001~

Planning and implementation units The survey was conducted by the Health Promotion Administration (HPA), Ministry of Health and Welfare. The Population and Health Research Center (PHRC) of the HPA was responsible for the survey design, fieldwork planning, fieldwork operation and supervision of the survey and subsequent data processing, analysis and reports writing.

Planning and implementation units Administrative support was provided by local health bureaus, police offices, household registration offices and local administrative offices during the fieldwork.

Contents of survey questionnaire (1/4) Background information: education, ethnicity, and marital status of the respondent and his/her spouse. Household structure, relatives and social contacts: family members, interactions with children not living at home,  relatives, and friends.

Contents of survey questionnaire (2/4) Health status, health care utilization and health behavior: self-rating health, physical functioning, illness, activity of daily living, disability, use of physical aids, depression, cognitive function, life satisfaction, health knowledge, health behavior, utilization of health care and long-term care. 

Contents of survey questionnaire (3/4) Social support and exchange: provision or acceptance of support from family members. Work history: working status of the respondent and his/her spouse, retirement planning.

Contents of survey questionnaire (4/4) Leisure, activities and attitudes: frequently engaged leisure activities, social participation and religious beliefs.  Economic status: personal and family economic status, sources of income and assets.

Result - Response Rate 1989 1 ≧ 60 4049 - 363 91.8% 1993 ≧ 64 3155 582 Year Cohort Age at Survey Respondents Deceased Non-response Response rate 1989 1 ≧ 60 4049 - 363 91.8% 1993 ≧ 64 3155 582 312 91.0% 1996 ≧ 67 2669 1047 333 88.9% 2 50-66 2462 9 570 81.2% 1999 ≧ 70 2310 1486 253 90.1% 53-69 2130 110 222 90.6% 2003 ≧ 74 1743 2133 173 57-73 2035 174 92.1% 3 50-56 1599 4 423 79.1% 2007 ≧ 78 1268 2661 120 91.4% 61-77 1864 410 188 90.8% 54-60 1402 38 159 89.8% 2011 ≧ 82 804 41 116 87.4% 65-81 1616 16 183 58-64 1307 5 196 87.0%

Conclusion (1/4) Understand the health status and wellbeing of the middle aged and the elderly in Taiwan Including physical function, disability, illness, mental health, health behavior, health and preventative care utilization.

Conclusion (2/4) Understand the social status of the middle aged and the elderly in Taiwan Including family structure, living arrangements, social support, leisure activity, socioeconomic status, life attitudes, occupation and retirement, and awareness and utilization of elder welfare provided by the government.

Conclusion (3/4) Compare the differences of health and social status among subgroups of people characterized by their social economic background. Explore the needs of the middle aged and the elderly on medical and preventive health care or the supports required for healthy living.

Conclusion (4/4) Based on the survey results of TLSA, evaluate the future needs of medical care and living support of elders served as references for policy intervention.

Take Home Messages of TLSA Study design Prospective cohort study First cohort established in 1989 and two refresh cohorts established in 1996 and 2003 Universe Elderly and middle aged in non-aboriginal townships Both institution and community dwelling covered Sampling design Stratified multi-stage probability sample National representative of aged 50 and above Data collection Face to face questionnaire interview Data linkage to national death certificate Sample size Distribution of follow-up sample 29

Collaborative institutions List of Collaborative institutions 1989 1993 1996 1999 2003 2007 2011 PSC, University of Michigan ＊ Institute of Gerontology, University of Michigan School of Public Health, Taiwan University Dept. of Demography, Georgetown University Office of Population Research, Princeton University Taiwan Provincial Institute of Family Planning Center for Population and Health Survey Research, Bureau of Health Promotion Surveillance and Research Division, Health Promotion Administration

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