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

2. 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.

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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. 

10. 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.

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

12. 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.

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

14. 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.

15. 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. 

16. 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.

17. 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.

18. 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%

25. 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.

26. 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.

27. 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.

28. 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.

29. 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

30. 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

32. Thanks for Your Attention !