Abstract

Background: The number of very old people (90+) is rapidly increasing. It is known that need for and use of long-term care (LTC) is high among the oldest, and in the last year(s) of life. The aim of this study is to analyse 1) to what extent closeness of death is associated with LTC use among the oldest and 2) to what extent individual predisposing, enabling and need factors are associated with LTC use among the oldest.

Methods: Survey data came from the Vitality 90+ Study from years 2001, 2003, 2007 and 2010. All individuals aged 90 or older in the city of Tampere, Finland, were included each year, irrespective of dwelling place. Register data on round-the-clock LTC were linked with the survey data based on personal identity codes. Two groups were analysed: decedents, who died in a year after the survey, and survivors, who lived at least one year after the survey. Generalized estimating equations (GEE) logistic regression analyses were performed to model the probability to use LTC in the preceding year. Independent variables were decedent status (decedent or survivor); survey year; age and gender (predisposing factors); socioeconomic status, availability of informal care and living arrangements (enabling factors) as well as diagnoses, self-rated health and functional ability (need factors).

Results: There were 4074 individuals in the data. 755 (19%) of them died in a year after the survey and were thus coded as decedents. Mean age was 93.2 among decedents and 92.3 among survivors. 78% of decedents and 81% of survivors were women. 53% of decedents and 34% of survivors were in LTC at least for one day in the preceding year. Closeness of death was positively associated with LTC use. Adding predisposing, enabling and need factors diminished the effect of closeness of death, but the effect remained statistically significant. In the final model, age was not significantly associated with LTC use, but the number of diagnoses and the number of functional limitations were. Probability to use LTC was lower in 2010 than in 2001.

Conclusion: Closeness of death is an important determinant of LTC use even among the oldest olds. In previous studies, also age has been found to be a determinant of LTC. In this study, we were able to control for the enabling and need factors, and then the predisposing factors were not anymore associated with LTC use. Use of LTC among the oldest decreased in the study period, which is alarming, as this is the group, which probably needs the care most.