Educational Attainment and Transitions in Functional Status among Older Taiwanese

Despite a considerable history of research examining the influence of socioeconomic status on health, few studies have considered this relationship as it pertains to older adults in non-western societies. Yet, a number of developing nations are aging rapidly. Here, the authors attempt to ascertain the influence of education on changes in functional status in a rapidly developing country. A key element of the study is an allowance for the plasticity that tends to characterize functional transitions. Data come from the 1989 Survey of Health and Living Status of the Elderly in Taiwan with follow-up in 1993 (N=4,049, age=60 +). Individuals are conceptualized to be in a state of independence or disability at time of origin, based on responses to activity of daily living items. The outcome at follow-up is categorized as independent, disabled or dead, allowing for six probabilities, one from each state of origin to each outcome. Probabilities are calculated using a multinomial logit model, controlling for other factors often thought to be associated with health transitions. Higher levels of educational attainment result in a decreased incidence of disability and mortality for those originating in a state of independence, however, contrary to expectations, education has little influence on those who originate disabled. This suggests that higher education plays a substantial preventive role, delaying the onset of disability and mortality, but other factors become more important once disability sets in. The discussion speculates on the reasons behind these findings, including the possibility that the results are culturally dependent.

Dataset(s): Survey of Health and Living Status of the Elderly: Taiwan, 1989 and 1993.