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Korhonen K, Moustgaard H, Murphy M, Martikainen P. Trends in Life Expectancy in Residential Long-Term Care by Sociodemographic Position in 1999-2018: A Multistate Life Table Study of Finnish Older Adults. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae067. [PMID: 38629853 PMCID: PMC11157624 DOI: 10.1093/geronb/gbae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVES Residential long-term care (LTC) use has declined in many countries over the past years. This study quantifies how changing rates of entry, exit, and mortality have contributed to trends in life expectancy in LTC (i.e., average time spent in LTC after age 65) across sociodemographic groups. METHODS We analyzed population-register data of all Finns aged ≥65 during 1999-2018 (n = 2,016,987) with dates of LTC and death and sociodemographic characteristics. We estimated transition rates between home, LTC, and death using Poisson generalized additive models, and calculated multistate life tables across 1999-2003, 2004-2008, 2009-2013, and 2014-2018. RESULTS Between 1999-2003 and 2004-2008, life expectancy in LTC increased from 0.75 (95% CI: 0.74-0.76) to 0.89 (95% CI: 0.88-0.90) years among men and from 1.61 (95% CI: 1.59-1.62) to 1.83 (95% CI: 1.81-1.85) years among women, mainly due to declining exit rates from LTC. Thereafter, life expectancy in LTC decreased, reaching 0.80 (95% CI: 0.79-0.81) and 1.51 (95% CI: 1.50-1.53) years among men and women, respectively, in 2014-2018. Especially among women and nonmarried men, the decline was largely due to increasing death rates in LTC. Admission rates declined throughout the study period, which offset the increase in life expectancy in LTC attributable to declining mortality in the community. Marital status differences in life expectancy in LTC narrowed over time. DISCUSSION Recent declines in LTC use were driven by postponed LTC admission closer to death. The results suggest that across sociodemographic strata older adults enter LTC in even worse health and spend a shorter time in care than before.
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Affiliation(s)
- Kaarina Korhonen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck—University of Helsinki Center for Social Inequalities in Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Heta Moustgaard
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Helsinki Institute for Social Sciences and Humanities (HSSH), University of Helsinki, Helsinki, Finland
| | - Michael Murphy
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Pekka Martikainen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck—University of Helsinki Center for Social Inequalities in Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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Nordaunet OM, Gjevjon ER, Olsson C, Aagaard H, Borglin G. What about the fundamentals of nursing-its interventions and its continuity among older people in need of home- or facility-based care: a scoping review. BMC Nurs 2024; 23:59. [PMID: 38254154 PMCID: PMC10801980 DOI: 10.1186/s12912-023-01675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
AIM This scoping review investigated and descriptively summarised previous research about fundamental nursing, its focus (what care needs are described, how is it described and by whom is it described), continuity of care (is it described in relation to fundamental nursing) and possible nursing interventions or activities targeting older people's fundamentals of care needs in home- or facility-based care. METHODS This scoping review was carried out following the steps of Arksey and O'Malley's methodology and PRISMA-ScR reporting guidelines. Searches were conducted in PubMed via NIH, CINAHL via EBSCO and PsycInfo via ProQuest for the time period between January 2002 and May 2023. RESULTS Forty-two studies were included where the majority had been conducted in a facility-based care context. Nutrition-or rather nutritional care activities targeting eating and drinking-was the most frequently described fundamental care needs addressed. After this came personal care such as cleansing, dressing, oral care, skin, and foot care. Few studies addressed more than one fundamental care need at the time. The nursing staff described fundamental nursing as complex, comprehensive, and demanding. Older people and relatives described a gap between the fundamental nursing provided and their perceived need for support. Less attention was given to older peoples relational and psychosocial needs. Identified nursing interventions mainly targeted physical care needs. Our findings also implied that interventions focusing on fundamental nursing were described as feasible in practice with favourable or moderate results, while long-term effects were difficult to detect. No studies were identified focusing on fundamental nursing in relation to outcomes such as continuity of care. CONCLUSION Fundamental nursing was mainly described in relation to physical care needs, which were essentially conducted within facility-based care contexts. Interventions and activities primarily focused on one fundamental need at the time, mainly within the physical domain. No nursing interventions were identified focusing on relational and psychosocial needs where continuity of care can be viewed as a relevant outcome. Such limited focus are especially concerning as research has highlighted the importance of that older people with complex care needs can benefit from a holistic and person-centred approach i.e. fundamental nursing. TRIAL REGISTRATION Open Science Framework https://doi.org/10.17605/OSF.IO/XJ39E Protocol: http://dx.doi.org/10.1136/bmjopen-2022-069798.
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Affiliation(s)
- O M Nordaunet
- Department of Bachelor Education (Nursing), Lovisenberg Diaconal University College, Lovisenberggata 15B, NO-0456, Oslo, Norway.
- Institute of Health Sciences, Department of Nursing, Karlstad University, Universitetsgatan 2, 651 88, Karlstad, Sweden.
| | - E R Gjevjon
- Department of Bachelor Education (Nursing), Lovisenberg Diaconal University College, Lovisenberggata 15B, NO-0456, Oslo, Norway
- UiT The Arctic University of Norway, Havnegata 5, 9404, Harstad, Norway
| | - C Olsson
- Department of Bachelor Education (Nursing), Lovisenberg Diaconal University College, Lovisenberggata 15B, NO-0456, Oslo, Norway
- Institute of Health Sciences, Department of Nursing, Karlstad University, Universitetsgatan 2, 651 88, Karlstad, Sweden
| | - H Aagaard
- Department of Bachelor Education (Nursing), Lovisenberg Diaconal University College, Lovisenberggata 15B, NO-0456, Oslo, Norway
| | - G Borglin
- Department of Bachelor Education (Nursing), Lovisenberg Diaconal University College, Lovisenberggata 15B, NO-0456, Oslo, Norway
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Tang Y, Chen T, Zhao Y, Taghizadeh-Hesary F. The Impact of the Long-Term Care Insurance on the Medical Expenses and Health Status in China. Front Public Health 2022; 10:847822. [PMID: 35646763 PMCID: PMC9130047 DOI: 10.3389/fpubh.2022.847822] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/21/2022] [Indexed: 11/23/2022] Open
Abstract
Based on the panel data of China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2015, and 2018, this paper used the difference-in-difference (DID) method to evaluate the implementation effect how the Long-Term Care Insurance (LTCI) policy impacted on the medical expenses and the health status of the middle-aged and elder population. The empirical results show that LTCI has reduced the outpatient and inpatient quantity by 0.1689 and 0.1093 per year, and cut the outpatient and inpatient expenses by 23.9% and 19.8% per year. Moreover, the implementation of LTCI has improved the self-rated health, the activity of daily living (ADL), as well as the mental health. These conclusions verify the implementation value of LTCI system and provide policy implications for the medical reform and the further LTCI implementation in a larger scale.
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Affiliation(s)
- Yao Tang
- School of Public Administration, Zhejiang University of Finance and Economics, Hangzhou, China
| | - Tianran Chen
- School of Public Administration, Zhejiang University of Finance and Economics, Hangzhou, China
| | - Yuan Zhao
- School of International Business, Southwestern University of Finance and Economics, Chengdu, China
- *Correspondence: Yuan Zhao
| | - Farhad Taghizadeh-Hesary
- School of Global Studies, Tokai University, Hiratsuka, Japan
- TOKAI Research Institute for Environment and Sustainability (TRIES), Hiratsuka, Japan
- Farhad Taghizadeh-Hesary
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Lisko I, Kulmala J, Annetorp M, Ngandu T, Mangialasche F, Kivipelto M. How can dementia and disability be prevented in older adults: where are we today and where are we going? J Intern Med 2021; 289:807-830. [PMID: 33314384 PMCID: PMC8248434 DOI: 10.1111/joim.13227] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ageing of the population, together with population growth, has brought along an ample increase in the number of older individuals living with dementia and disabilities. Dementia is the main cause of disability in old age, and promoting healthy brain ageing is considered as a key element in diminishing the burden of age-related disabilities. The World Health Organization recently launched the first risk reduction guidelines for cognitive impairment and dementia. According to recent estimates, approximately 40% of dementia cases worldwide could be attributable to 12 modifiable risk factors: low education; midlife hypertension and obesity; diabetes, smoking, excessive alcohol use, physical inactivity, depression, low social contact, hearing loss, traumatic brain injury and air pollution indicating clear prevention potential. Dementia and physical disability are closely linked with shared risk factors and possible shared underlying mechanisms supporting the possibility of integrated preventive interventions. FINGER trial was the first large randomized controlled trial indicating that multidomain lifestyle-based intervention can prevent cognitive and functional decline amongst at-risk older adults from the general population. Within the World-Wide FINGERS network, the multidomain FINGER concept is now tested and adapted worldwide proving evidence and tools for effective and easily implementable preventive strategies. Close collaboration between researchers, policymakers and healthcare practitioners, involvement of older adults and utilization of new technologies to support self-management is needed to facilitate the implementation of the research findings. In this scoping review, we present the current scientific evidence in the field of dementia and disability prevention and discuss future directions in the field.
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Affiliation(s)
- I. Lisko
- From theDivision of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Faculty of Sport and Health Sciences and Gerontology Research CenterUniversity of JyväskyläJyväskyläFinland
| | - J. Kulmala
- From theDivision of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Public Health Promotion UnitFinnish Institute for Health and WelfareHelsinkiFinland
- School of Health Care and Social WorkSeinäjoki University of Applied SciencesSeinäjokiFinland
| | - M. Annetorp
- Karolinska University Hospital, Theme AgingStockholmSweden
| | - T. Ngandu
- From theDivision of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Public Health Promotion UnitFinnish Institute for Health and WelfareHelsinkiFinland
| | - F. Mangialasche
- From theDivision of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Aging Research CenterDepartment of Neurobiology, Care Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
| | - M. Kivipelto
- From theDivision of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Karolinska University Hospital, Theme AgingStockholmSweden
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandHelsinkiFinland
- Ageing and Epidemiology (AGE) Research UnitSchool of Public HealthImperial College LondonLondonUK
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Barbera M, Kulmala J, Lisko I, Pietilä E, Rosenberg A, Hallikainen I, Hallikainen M, Laatikainen T, Lehtisalo J, Neuvonen E, Rusanen M, Soininen H, Tuomilehto J, Ngandu T, Solomon A, Kivipelto M. Third follow-up of the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) cohort investigating determinants of cognitive, physical, and psychosocial wellbeing among the oldest old: the CAIDE85+ study protocol. BMC Geriatr 2020; 20:238. [PMID: 32650731 PMCID: PMC7350760 DOI: 10.1186/s12877-020-01617-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The oldest old is the fastest growing age group worldwide and the most prone to severe disability, especially in relation to loss of cognitive function. Improving our understanding of the predictors of cognitive, physical and psychosocial wellbeing among the oldest old can result in substantial benefits for the individuals and for the society as a whole. The Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study investigated risk factors and determinants of cognitive impairment in a population-based longitudinal cohort, which was first examined between 1972 and 1992, when individuals were in their midlife, and re-assessed in 1998 and 2005-2009. Most of the study participants are currently aged 85 years or older. We aim to re-examine the cohort's survivors and gain further insights on the mechanisms underlying both cognitive and overall healthy ageing at old age. METHODS CAIDE85+ is the third follow-up of the CAIDE study participants. All individuals still alive and living in the Kuopio and Joensuu areas of Eastern Finland, from the original CAIDE cohort (two random samples, N = 2000 + ~ 900), will be invited to a re-examination. The assessment includes self-reported data related to basic demographics and lifestyle, as well as psychosocial and physical health status. Cognitive and physical evaluations are also conducted. Blood biomarkers relevant for dementia and ageing are assessed. Primary outcomes are the measurements related to cognition and daily life functioning (CERAD, Trail Making Test-A, Letter-Digit Substitution Test, Clinical Dementia Rating and Activities of Daily Living). Secondary endpoints of the study are outcomes related to physical health status, psychosocial wellbeing, as well as age-related health indicators. DISCUSSION Through a follow-up of more than 40 years, CAIDE85+ will provide invaluable information on the risk and protective factors that contribute to cognitive and physical health, as well as ageing and longevity. STUDY REGISTRATION The present study protocol has been registered at https://clinicaltrials.gov/ (registration nr NCT03938727 , date 03.05.2019).
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Affiliation(s)
- Mariagnese Barbera
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Jenni Kulmala
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, Stockholm, Sweden
| | - Inna Lisko
- Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, Stockholm, Sweden
| | - Eija Pietilä
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Anna Rosenberg
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Ilona Hallikainen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Merja Hallikainen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Tiina Laatikainen
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
| | - Jenni Lehtisalo
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Elisa Neuvonen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Minna Rusanen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,Neurocenter Finland, Department of Neurology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Neurocenter Finland, Department of Neurology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,Department of Public Health, University of Helsinki, PO BOX 20, 00014, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Tiia Ngandu
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, Stockholm, Sweden
| | - Alina Solomon
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, Stockholm, Sweden
| | - Miia Kivipelto
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, London, W6 8RP, UK
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Salminen M, Laine J, Vahlberg T, Viikari P, Wuorela M, Viitanen M, Viikari L. Factors associated with institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic: a 3-year follow-up study. Eur Geriatr Med 2020; 11:745-751. [PMID: 32500517 PMCID: PMC7550301 DOI: 10.1007/s41999-020-00338-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/17/2020] [Indexed: 11/28/2022]
Abstract
Aim To examine the effect of predictive factors on institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic during a 3-year follow-up. Findings The rates of institutionalization and mortality were 29.9% and 46.1%, respectively. The use of home care, dementia, higher age and falls during the previous 12 months significantly predicted institutionalization during the follow-up. Message Cognitive and/or functional impairment mainly predicted institutionalization among older patients of UrGeriC having health problems and acute difficulties in managing at home. Purpose To examine the effect of predictive factors on institutionalization among older patients. Methods The participants were older (aged 75 years or older) home-dwelling citizens evaluated at Urgent Geriatric Outpatient Clinic (UrGeriC) for the first time between the 1st of September 2013 and the 1st of September 2014 (n = 1300). They were followed up for institutionalization for 3 years. Death was used as a competing risk in Cox regression analyses. Results The mean age of the participants was 85.1 years (standard deviation [SD] 5.5, range 75–103 years), and 74% were female. The rates of institutionalization and mortality were 29.9% and 46.1%, respectively. The mean age for institutionalization was 86.1 (SD 5.6) years. According to multivariate Cox regression analyses, the use of home care (hazard ratio 2.43, 95% confidence interval 1.80–3.27, p < 0.001), dementia (2.38, 1.90–2.99, p < 0.001), higher age (≥ 95 vs. 75–84; 1.65, 1.03–2.62, p = 0.036), and falls during the previous 12 months (≥ 2 vs. no falls; 1.54, 1.10–2.16, p = 0.012) significantly predicted institutionalization during the 3-year follow-up. Conclusion Cognitive and/or functional impairment mainly predicted institutionalization among older patients of UrGeriC having health problems and acute difficulties in managing at home.
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Affiliation(s)
- Marika Salminen
- City of Turku, Welfare Division/Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland.
- Faculty of Medicine, Unit of Family Medicine, University of Turku, Joukahaisenkatu 3-5 A, 20014, Turku, Finland.
| | - Jonna Laine
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Tero Vahlberg
- Institute of Clinical Medicine, Biostatistics, University of Turku, Kiinamyllynkatu 10, 20014, Turku, Finland
| | - Paula Viikari
- City of Turku, Welfare Division/Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Maarit Wuorela
- City of Turku, Welfare Division/Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Matti Viitanen
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Laura Viikari
- City of Turku, Welfare Division/Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
- Faculty of Medicine, Department of Geriatrics, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
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Lisko I, Törmäkangas T, Jylhä M. Structure of self-rated health among the oldest old: Analyses in the total population and those living with dementia. SSM Popul Health 2020; 11:100567. [PMID: 32258355 PMCID: PMC7110410 DOI: 10.1016/j.ssmph.2020.100567] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/08/2020] [Accepted: 03/12/2020] [Indexed: 01/04/2023] Open
Abstract
No previous study has explored the structure of self-rated health (SRH), a measure holding strong predictive value for future health events, in the oldest old or in individuals with dementia. The aim was to construct a structural equation model of SRH for oldest old in general and for oldest old with dementia, and to explore direct and indirect associations between health-related factors and SRH. Cross-sectional data from the Vitality 90+, a population-based study in the city of Tampere, Finland, was used. Data were gathered by a mailed questionnaire in 2014. Altogether 1299 nonagenarians, of which 408 had self-reported dementia or cognitive decline, were included. Structural equation models were constructed for all participants and separately for participants with dementia. Diseases (heart disease, stroke, diabetes, arthritis, hip fracture, cancer and dementia for the model for all), dizziness, hearing, vision, mobility, activities of daily living, fatigue, depression and SRH were included in the models. Among all participants, fatigue, depression, problems in mobility, dizziness, deficits in vision and heart disease were directly associated with poor SRH. Among participants with dementia, only fatigue, dizziness and deficits in vision were directly associated with poor SRH. Among all participants, dementia and arthritis were indirectly associated with poor SRH through problems in mobility, depression and fatigue. Among the oldest old, the effects of diseases on SRH were mainly manifested through the consequences of diseases, namely fatigue, dizziness, deficits in vision and problems in mobility. Depression has an important direct and indirect role, and dementia and arthritis an important indirect role in the structure of SRH. Dementia weakens many of the direct and indirect associations for SRH. First study to explore structure of self-rated health in oldest old and persons with dementia. Fatigue, depression, mobility, dizziness, vision and heart disease directly affect health-rating in oldest old. Dementia, depression and arthritis affect health rating indirectly through various routes in oldest old. Dementia weakens many of the associations between objective indicators of health with self-rated health.
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Affiliation(s)
- Inna Lisko
- Tampere University, Faculty of Social Sciences (Health Sciences), P.O. Box 100, FI-33014, Finland.,Gerontology Research Center, Tampere University and University of Jyväskylä, Finland.,University of Jyväskylä, Faculty of Sport and Health Sciences, P.O. Box 35, FI-40014, Finland.,Karolinska Institutet, Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Stockholm, Karolinska Vägen 37 A, QA32, SE-171 64, Solna, Sweden
| | - Timo Törmäkangas
- Gerontology Research Center, Tampere University and University of Jyväskylä, Finland.,University of Jyväskylä, Faculty of Sport and Health Sciences, P.O. Box 35, FI-40014, Finland
| | - Marja Jylhä
- Tampere University, Faculty of Social Sciences (Health Sciences), P.O. Box 100, FI-33014, Finland.,Gerontology Research Center, Tampere University and University of Jyväskylä, Finland.,Science Center, Tampere University Hospital, Finland
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8
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Meinow B, Wastesson JW, Kåreholt I, Kelfve S. Long-Term Care Use During the Last 2 Years of Life in Sweden: Implications for Policy to Address Increased Population Aging. J Am Med Dir Assoc 2020; 21:799-805. [PMID: 32081681 DOI: 10.1016/j.jamda.2020.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/14/2019] [Accepted: 01/02/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To map out the total use of long-term care (LTC; ie, home care or institutional care) during the last 2 years of life and to investigate to what extent gender differences in LTC use were explained by cohabitation status and age at death. DESIGN The National Cause of Death Register was used to identify decedents. Use of LTC was based on the Social Services Register (SSR) and sociodemographic factors were provided by Statistics Sweden. SETTING AND PARTICIPANTS All persons living in Sweden who died in November 2015 aged ≥67 years (n = 5948). METHODS Zero inflated negative binomial regression was used to estimate the relative impact of age, gender, and cohabitation status on the use of LTC. RESULTS Women used LTC to a larger extent [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.92-2.50] and for a longer period [risk ratio (RR) 1.14, 95% CI 1.11-1.18] than men. When controlling for age at death and cohabitation status, gender differences in LTC attenuated (OR 1.47, 95% CI 1.28-1.72) and vanished in regard to the duration. In the controlled model, women used LTC for 15.6 months (95% CI 15.2-16.0) and men for 14.1 months (95% CI 13.7-14.5) out of 24 months. The length of stay in institutional care was 7.2 (95% CI 6.8-7.5) and 6.2 months (95% CI 5.8-6.6), respectively. CONCLUSIONS AND IMPLICATIONS A substantial part of women's greater use of LTC was due to their higher age at death and because they more often lived alone. Given that survival continues to increase, the association between older age at death and LTC use suggests that policy makers will have to deal with an increased pressure on the LTC sector. Yet, increased survival among men could imply that more women will have access to spousal caregivers, although very old couples may have limited capacity for extensive caregiving at the end of life.
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Affiliation(s)
- Bettina Meinow
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Jonas W Wastesson
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ingemar Kåreholt
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden; Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Susanne Kelfve
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden; Division Ageing and Social Change, Department of Social and Welfare studies, Linköping University, Linköping, Sweden
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9
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Mori H, Ishizaki T, Takahashi R. Association of long-term care needs, approaching death and age with medical and long-term care expenditures in the last year of life: An analysis of insurance claims data. Geriatr Gerontol Int 2020; 20:277-284. [PMID: 31977156 DOI: 10.1111/ggi.13865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/03/2019] [Accepted: 12/21/2019] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to examine whether long-term care needs, approaching death and age were associated with the use of medical and long-term care resources (care/service use and expenditures) in the last year of life among older Japanese individuals. METHODS Using data on insurance claims and death certificates, we described the use of medical and long-term care resources in the last year of life by residents of Soma City in Japan aged ≥65 years who died between September 2006 and October 2009. Using a generalized estimating equation, we examined whether long-term care needs, approaching death and age were associated with resource use during each 3-month period in the last year of life. RESULTS Resource use in medical and long-term care among 882 non-survivors and 8504 survivors were analyzed. Analyses for the non-survivors showed statistically significant associations between: (i) severe long-term care needs and greater service use in outpatient care, higher expenditures for outpatient care and higher expenditures for in-home/facility services; (ii) approaching death and greater use in both inpatient care and facility services; and (iii) being aged 65-74 years and greater service use in outpatient/in-hospital care and in-home/facility services, higher expenditures in outpatient/inpatient care, and lower expenditures for in-home/facility services. CONCLUSIONS The present study showed that severe long-term care needs and approaching death, rather than advancing age, were significantly and independently associated with greater use of resources in both medical and long-term care services. Geriatr Gerontol Int 2020; 20: 277-284.
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Affiliation(s)
- Hiroko Mori
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ryutaro Takahashi
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Tamadaira-no-mori Hospital, Tokyo, Japan
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10
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Alwin J, Karlson BW, Husberg M, Carlsson P, Ekerstad N. Societal costs of informal care of community-dwelling frail elderly people. Scand J Public Health 2019; 49:433-440. [PMID: 31826709 DOI: 10.1177/1403494819844354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aims: The aims of this study are to describe informal care activities and to estimate the societal cost of informal care of community-dwelling frail elderly people in Sweden. Methods: This study was performed within the frame of the TREEE project that included 408 frail elderly patients. At index hospitalisation (baseline), primary informal caregivers of the patients were provided with a questionnaire on informal care during a period of three months. Questions concerning other (secondary) informal caregivers were also included. A rough estimate of the total cost of informal care of frail elderly people in Sweden was obtained by combining data from this study with published data and official statistics. Results: In total, 176 informal caregivers responded, and 89% had provided informal care. The informal caregivers (primary and secondary) provided care for an average of 245 hours over three months. Taking care of the home was the dominating activity. In total, the mean cost of informal care was estimated to approximately 18,000 SEK (€1878) over three months, corresponding to an annual cost of approximately 72,000 SEK (€7477) per frail elderly person. The total annual societal costs of informal care of community dwelling frail elderly people aged 75 years and older in Sweden was estimated to be approximately 11,000 million SEK (€1150 million). Conclusions: The care of frail elderly people provided by informal caregivers is extensive and represents a great economic value. Although our calculations are associated with uncertainty, the size indicates that supporting informal caregivers should be a priority for society.
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Affiliation(s)
- Jenny Alwin
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Sweden
| | - Björn W Karlson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Acute and Internal Medicine, NU (NÄL-Uddevalla) Hospital Group, Sweden
| | - Magnus Husberg
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Sweden
| | - Per Carlsson
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Sweden
| | - Niklas Ekerstad
- Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Sweden
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11
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Canova C, Anello P, Barbiellini Amidei C, Parolin V, Zanier L, Simonato L. Use of healthcare services at the end of life in decedents compared to their surviving counterparts: A case-control study among adults born before 1946 in Friuli Venezia Giulia. PLoS One 2019; 14:e0212086. [PMID: 30730965 PMCID: PMC6366789 DOI: 10.1371/journal.pone.0212086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/28/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is a heterogeneous literature on healthcare utilization patterns at the end of life. The objective of this study is to examine the impact of closeness to death on the utilization of acute hospital-based healthcare services and some primary healthcare services and compare differences in gender, age groups and major causes of death disease specific mortality. METHODS A matched case-control study, nested in a cohort of 411,812 subjects, linked to administrative databases was conducted. All subjects were residents in the Friuli Venezia Giulia Region (Italy), born before 1946, alive in January 2000 and were followed up to December 2014. Overall, 158,571 decedents/cases were matched by gender and year of birth to one control, alive at least one year after their matched case's death (index-date). Hospital admissions, emergency department visits, drug prescriptions, specialist visits and laboratory tests that occurred 365 days before death/index-date, have been evaluated. Odds Ratios (ORs) for healthcare utilization were estimated through conditional regression models, further adjusted for Charlson Comorbidity Index and stratified by gender, age groups and major causes of death. RESULTS Decedents were significantly more likely of having at least one hospital admission (OR 7.0, 6.9-7.1), emergency department visit (OR 5.2, 5.1-5.3), drug prescription (OR 2.8, 2.7-2.9), specialist visit (OR 1.4, 1.4-1.4) and laboratory test (OR 2.7, 2.6-2.7) than their matched surviving counterparts. The ORs were generally lower in the oldest age group (95+) than in the youngest (55-74). Healthcare utilization did not vary by sex, but was higher in subjects who died of cancer. CONCLUSION Closeness to death appeared to be strongly associated with healthcare utilization in adult/elderly subjects. The risk seems to be greater among younger age groups than older ones, especially for acute based services. Reducing acute healthcare at the EOL represents an important issue to improve the quality of life in proximity to death.
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Affiliation(s)
- Cristina Canova
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
- * E-mail:
| | - Paola Anello
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Vito Parolin
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Loris Zanier
- Epidemiological Service, Health Directorate, Friuli Venezia Giulia Region, Udine, Italy
| | - Lorenzo Simonato
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
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12
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Kauppi M, Raitanen J, Stenholm S, Aaltonen M, Enroth L, Jylhä M. Predictors of long-term care among nonagenarians: the Vitality 90 + Study with linked data of the care registers. Aging Clin Exp Res 2018; 30:913-919. [PMID: 29222731 DOI: 10.1007/s40520-017-0869-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/27/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The need for long-term care services increases with age. However, little is known about the predictors of long-term care (LTC) entry among the oldest old. AIMS Aim of this study was to assess predictors of LTC entry in a sample of men and women aged 90 years and older. METHODS This study was based on the Vitality 90 + Study, a population-based study of nonagenarians in the city of Tampere, Finland. Baseline information about health, functioning and living conditions were collected by mailed questionnaires. Information about LTC was drawn from care registers during the follow-up period extending up to 11 years. Cox regression models were used for the analyses, taking into account the competing risk of mortality. RESULTS During the mean follow-up period of 2.3 years, 844 (43%) subjects entered first time into LTC. Female gender (HR 1.39, 95% CI 1.14-1.69), having at least two chronic conditions (HR 1.24, 95% CI 1.07-1.44), living alone (HR 1.37, 95% CI 1.15-1.63) and help received sometimes (HR 1.23, 95% CI 1.02-1.49) or daily (HR 1.68, 95% CI 1.38-2.04) were independent predictors of LTC entry. CONCLUSION Risk of entering into LTC was increased among women, subjects with at least two chronic conditions, those living alone and with higher level of received help. Since number of nonagenarians will increase and the need of care thereby, it is essential to understand predictors of LTC entry to offer appropriate care for the oldest old in future.
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Affiliation(s)
- Maarit Kauppi
- Finnish Institute of Occupational Health, Turku, Finland.
- Gerontology Research Center, University of Tampere, Tampere, Finland.
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland.
| | - Jani Raitanen
- Gerontology Research Center, University of Tampere, Tampere, Finland
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Sari Stenholm
- Gerontology Research Center, University of Tampere, Tampere, Finland
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
- Department of Public Health, University of Turku, Turku, Finland
| | - Mari Aaltonen
- Gerontology Research Center, University of Tampere, Tampere, Finland
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
| | - Linda Enroth
- Gerontology Research Center, University of Tampere, Tampere, Finland
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
| | - Marja Jylhä
- Gerontology Research Center, University of Tampere, Tampere, Finland
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
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13
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Lehto V, Jolanki O, Valvanne J, Seinelä L, Jylhä M. Understanding functional ability: Perspectives of nurses and older people living in long-term care. J Aging Stud 2017; 43:15-22. [PMID: 29173510 DOI: 10.1016/j.jaging.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/22/2017] [Accepted: 09/01/2017] [Indexed: 11/25/2022]
Abstract
The functional ability of older people has come to play a significant role in their care. Policies and public debate promote active aging and the need to maintain functioning in old age, including among older people living in long-term care. This study explores the meanings given to functional ability in the interview talk of long-term care nurses (n=24) and older people living in long-term care (n=16). The study is based on discourse analysis and positioning theory. In this study, accounts of functioning differed between nurses and older residents. For the nurses, functional ability was about the basic functions of everyday life, and they often used formal and theoretical language, whereas for older long-term care residents, functional ability was a more versatile concept. Being active was promoted, particularly in the nurses' talk but also sometimes in residents' talk, thereby reflecting the public discourse about functioning. In their talk, the nurses positioned themselves in relation to functional ability as competent professionals and active caregivers. In residents' talk, we found three positions: an active individual taking care of him or herself, a recipient of help, and a burden to nurses. To move in a direction that promotes activity and rehabilitative care, a better understanding of older people's individual needs and their own views of functional ability is needed.
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Affiliation(s)
- Vilhelmiina Lehto
- Faculty of Social Sciences, University of Tampere, Finland; Gerontology Research Center, University of Tampere, University of Jyväskylä, Finland.
| | - Outi Jolanki
- Department of Social Sciences and Philosophy, University of Jyväskylä, Finland; Faculty of Social Sciences, University of Tampere, Finland; Gerontology Research Center, University of Tampere, University of Jyväskylä, Finland
| | - Jaakko Valvanne
- Faculty of Medicine and Life Sciences, University of Tampere, Finland; Gerontology Research Center, University of Tampere, University of Jyväskylä, Finland; Geriatric Unit, Tampere University Hospital, Finland; Social Services and Outpatient Care, Welfare Services, Tampere, Finland
| | - Lauri Seinelä
- Faculty of Medicine and Life Sciences, University of Tampere, Finland; Gerontology Research Center, University of Tampere, University of Jyväskylä, Finland; Purchaser for the Promotion for senior citizens welfare, Tampere, Finland; Pirkanmaan erikoislääkäripalvelu Oy, Tampere, Finland
| | - Marja Jylhä
- Faculty of Social Sciences, University of Tampere, Finland; Gerontology Research Center, University of Tampere, University of Jyväskylä, Finland
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14
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Does use of long-term care differ between occupational classes among the oldest old? Vitality 90 + Study. Eur J Ageing 2017; 15:143-153. [PMID: 29867299 DOI: 10.1007/s10433-017-0445-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Long-term care (LTC) use increases with ageing due to an age-related increase in disability. Both the levels of disability and social resources vary among socioeconomic groups. The association of socioeconomic status with LTC use is largely unexplored for the oldest old. This study examined how occupational class is associated with LTC use among nonagenarians in the context of universal care coverage. A population-based prospective cohort study with 2862 participants who answered the Vitality 90 + Study surveys in 2001, 2003, 2007, or 2010 in Tampere, Finland, was combined with national register data on LTC use. LTC use in total and separately for publicly and privately provided LTC facilities was assessed in a cross-sectional setting and during the 34-month follow-up by using logistic regression and competing-risks regression methods. Functional status, multimorbidity, family relations, and help at home were controlled. In total or public LTC use, only a few differences between occupational classes were found at baseline. However, upper non-manuals used more private LTC than lower non-manuals (OR 0.54, 95% CI 0.35-0.85), skilled manuals (OR 0.40, 95% CI 0.26-0.62), or housewives (OR 0.40, 95% CI 0.22-0.74). There were no statistically significant differences in entering any kind of LTC after adjustments for all independent variables. During the study period, the share of privately provided care out of all LTC increased and the upper non-manuals no more used private care more than other groups. This study underlines the importance of following the structural changes in LTC provision to guarantee that the need for LTC is met equally for all socioeconomic groups.
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