Long-term care is increasingly concentrated in the last years of life
Very old people often need round-the-clock long-term care (LTC) in the last phase of life. As longevity is becoming more common, more people live the last years of life at very old age. The association of this change with use of round-the-clock LTC was studied at the University of Tampere.
LTC in the last two years of life was more common in 2011 than in 2000 among those who died at the age of 70 years or older. Underlying this change was postponement of death: those died in 2011 were significantly older than those who died in 2000. The differences between age groups are remarkable: in 2011 27% of those who died at the age of 70-79, 49% of those who died at the age of 80-89 and 67% of those who died at the age of 90+ were in LTC for some time during the last two years of live.
LTC decreased among those who lived at least two years longer. The difference between those who lived their last years of life and those who lived longer increased, and LTC concentrated increasingly in the last years of life.
However, LTC is common among very old people also before the last years of life: a fourth of people at the age of 90+ were in LTC before their last two years of life. In very old age and in the last years of life people usually have diseases and disabilities and they are not able to live at home anymore, but they need round-the-clock care. As the number of very old people increase, need for round-the-clock care increase. Not everyone is able to live at home until the end of life.
The study was based on register data. LTC was compared between those who lived their last two years of life (cases, decedents) and those who were at the same age, but lived at least two years longer (controls, survivors). There were 315 458 case-control pairs in the data. LTC included residential home, sheltered housing with 24-hour assistance and LTC in the inpatient ward of health center.
The study is part of the project New dynamic of longevity and the changing needs for services (COCTEL). The study was funded by the Academy of Finland and published in the European Journal of Public Health.
Original publication:
Forma L, Aaltonen M, Pulkki J, Raitanen J, Rissanen P, Jylhä M 2017. Long-term care is increasingly concentrated in the last years of life: a change from 2000 to 2011. European Journal of Public Health, online first, text will be published in http:/dx.doi.org/10.1093/eurpub/ckw260
Article in PubMed database:
https://www.ncbi.nlm.nih.gov/pubmed/28339763
More information:
postdoctoral researcher Leena Forma, 040 190 1604, leena.forma@uta.fi
Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere