Use of long-term care is increasingly concentrated in the last years of life – a comparison of old decedents and survivors from 2000 to 2011
Leena Forma | University of Tampere
Objective: Use of long-term care (LTC) is concentrated in the very old age and in the last years of life. As the deaths are postponed to increasingly old age, more people will probably use LTC in their last years of life. Aims of the study are to analyse the association of use of round-the-clock LTC with approaching death among old people and the change of this association from 2000 to 2011.
Data and methods: The data were derived from national registers. The study population consists of 315 458 case-control pairs. Cases (decedents) were those who died between 2000 and 2011 at the age of 70 years or over in Finland. Controls (survivors) lived at least two years longer. The pairs were individually matched for age, gender and municipality of residence. Use of LTC was studied for the last 730 days for decedents and for the same calendar days for survivors. Conditional logistic regression analyses were performed to test the association of LTC use with decedent status and calendar year.
Results: The difference in LTC use between decedents and survivors was smallest among the oldest, for use of LTC is high among old survivors, too. In the total study population the use of LTC increased from 2000 to 2011 both among decedents and survivors, for the proportion of the oldest, whose use is highest, increased remarkably. The difference between decedents and survivors widened from 2000 to 2011 in all age groups: use increased among decedents in younger age groups, held steady among the oldest but decreased among survivors in all age groups.
Policy implications: The association of approaching death with use on LTC became stronger from 2000 to 2011. That is, use of LTC was increasingly concentrated in the last years of life during the twelve-year study period. Use of LTC is common among the oldest, despite the closeness of death. As more people live to a very old age, the demand for LTC will increase.