Trends in the use and costs of round-the-clock long-term care in the last two years of life among old people between 2002 and 2013 in Finland

Trends in formal care by age and time to death: the use of healthcare and care-home facilities in Finland between 2005 and 2018

Population ageing may further increase formal care use. Strong predictors in addition to age include time to death and the cause of death. The aim of this study is to analyse trends in the use of formal care in Finland by these factors. We analysed patterns of care use among all Finnish residents who died at the age of 65 and older between 2005 and 2018 (263 660 men and 315 439 women), linking different administrative registers. We used multinomial logistic models to examine the time spent in healthcare and care-home facilities, stratifying our analyses by gender and time to death. Between 2005 and 2018, formal care use became increasingly concentrated in the last years of life for all causes of death, and the effect of age slightly diminished. However, in 2017-18, decedents aged 65 in their last year of life spent up to seven months less in care than their counterparts aged 105. Over time, unadjusted per-capita care usage in the last seven years of life increased from 9.3 to 10.5 months for men, and from 16.8 to 19.3 months for women. Concurrently, the total time spent in care on the population level increased by 44%. Age and time to death are major determinants of formal care use. An increasing age at death drove the increase in per-capita and total care usage over time. Population ageing will continue to increase future care needs; governments must prepare for this scenario.

The effect of multidomain lifestyle intervention on health care service use and costs - secondary analyses from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): a randomised controlled trial

BACKGROUND

The Finnish multidomain lifestyle intervention study to prevent cognitive impairment and disability (FINGER, N = 1259), a randomised controlled trial had beneficial effects on morbidity in older people, but to what extent such a lifestyle intervention may affect the use of health care services and their costs especially in long term are unknown.

OBJECTIVE

This study investigated the effect of a two-year FINGER multidomain intervention on health care service use during the 8-year follow-up. The costs of service use were also evaluated.

METHODS

Health care service use obtained from national health care registers (days of inpatient hospital stay and long-term care, number of visits to emergency services, hospital as outpatient, home care, primary care physician and primary care nurse) was analysed among participants of the FINGER. Trial targeted community-dwelling people aged 60-77 years at risk for cognitive impairment, who were randomly allocated to the multidomain intervention or control group. Costs were evaluated as the mean costs of services used.

RESULTS

There were no significant differences in total health care costs between the intervention and control groups. The participants in the intervention group, however, had a lower use of the hospital inpatient care (RR 0.73, 95% CI 0.54-1.00) and emergency services (RR 0.83, 95% CI 0.70-0.97) than those in the control group. Hospital inpatient care was lower especially among men. The use of other types of health care services did not differ between the groups. The costs of health care service use without including long-term care were lower in the intervention group (RR 0.81, 95% CI 0.68-0.99).

CONCLUSIONS

The FINGER intervention has a potential to reduce the need for the inpatient hospital care and emergency visits and associated costs, especially among men.

Patterns of long-term care utilization during the last five years of life among Swedish older adults with and without dementia

AIMS

The aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecare, residential care) among people with and without dementia aged 70+ in Sweden during their last five years of life and its association with sociodemographic factors (age, gender, education, cohabitation status) and time with a dementia diagnosis.

METHODS

This retrospective cohort study included all people who died in November 2019 aged 70 years and older (n = 6294) derived from several national registers. A multinomial logistic regression was conducted to identify which sociodemographic factors predicted the patterns of LTC use.

RESULTS

Results showed that the time with a dementia diagnosis and cohabitation status were important predictors that influence the patterns of LTC use during the last five years of life. Nearly three-quarters of people living with dementia (PlwD) used residential care during the last five years of life. PlwD were more likely to reside in residential care close to death. Women who lived alone, with or without dementia, used residential care to a higher degree compared to married or cohabiting women.

CONCLUSIONS

Among people without a dementia diagnosis, as well as those who were newly diagnosed, it was common to have no LTC at all, or use LTC only for a brief period close to death. During the last five years of life, PlwD and those living alone more often entered LTC early and used residential care for a longer time compared to people without dementia and people living alone, respectively.

Prescription opioids among older adults: ten years of data across five countries

BACKGROUND

Opioid use has increased globally in the recent decade. Although pain remains a significant problem among older adults, susceptibility to opioid-related harms highlights the importance of careful opioid therapy monitoring on individual and societal levels. We aimed to describe the trends of prescription opioid utilisation among residents aged ≥65 in all Nordic countries during 2009-2018.

METHODS

We conducted cross-sectional measurements of opioid utilisation in 2009-2018 from nationwide registers of dispensed drugs in Denmark, Finland, Iceland, Norway, and Sweden. The measures included annual opioid prevalence, defined daily doses (DDDs) per 1000 inhabitants per day (DIDs), and morphine milligram equivalents (MMEs) per user per day.

RESULTS

From 2009 to 2018, an average of 808,584 of adults aged ≥65 used opioids yearly in all five countries; an average annual prevalence of 17.0%. During this time period, the prevalence decreased in Denmark, Norway, and Sweden due to declining codeine and/or tramadol use. Iceland had the highest opioid prevalence in 2009 (30.2%), increasing to 31.7% in 2018. In the same period, DIDs decreased in all five countries, and ranged from 28.3 in Finland to 58.5 in Denmark in 2009, and from 23.0 in Finland to 54.6 in Iceland in 2018. MMEs/user/day ranged from 4.4 in Iceland to 19.6 in Denmark in 2009, and from 4.6 in Iceland to 18.8 in Denmark in 2018. In Finland, Norway, and Sweden, MMEs/user/day increased from 2009 to 2018, mainly due to increasing oxycodone utilisation.

CONCLUSIONS

The stable or decreasing opioid utilisation prevalence among a majority of older adults across the Nordic countries coincides with an increase in treatment intensity in 2009-2018. We found large cross-national differences despite similarities across the countries' cultures and healthcare systems. For the aged population, national efforts should be placed on improving pain management and monitoring future trends of especially oxycodone utilisation.

The Sustainable Care Model for an Ageing Population in Vietnam: Evidence from a Systematic Review

Social demographic studies in Vietnam have shown a growing trend of an ageing population. Demographic trends project that one third of the Vietnamese population will be aged 65 years and older by 2050. Vietnam is a country where the majority of the elderly live with their children, with little savings and pension. The purpose of this review was to explore existing literature on models of care for an ageing population and provide evidence to develop a care model that is suitable for the ageing community in Vietnam. A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was carried out. An extensive literature search was performed, with a focus on articles and other materials with relevance to elderly care in Vietnam in terms of socio-economic, demographic, and associated factors based on comprehensive data sources. The review found that there is a lack of evidence of professional practice for caring for the aged in Vietnam. There also is a lack of evidence of government support for the limited community initiatives to support the ageing. There exist no community models of care for the ageing population in Vietnam. From a global perspective, there exist alternative models of care options to support the elderly through various care models, such as living in assisted-care facilities, home care, and other assistance. Inter-professional practice care models and health services were found to be essential for an ageing population. There is limited literature specifically for the care of an ageing population in Vietnam. Most of the available literature on care models for the aged is drawn from developed countries. The review offers insights into the development of care models for the elderly in Vietnam, with the need for inter-professional efforts in practice settings to support the ageing Vietnamese population. The reviewed literature agrees on the developing global challenges due to ageing. Despite the existing literature on care models for the ageing, there is a lack evidence-based care models concerning the current and future needs of elderly care in middle- and lower-income economies like Vietnam. More evidence is required to establish evidence for best care models for the elderly in developing economies.

Chronic conditions and multimorbidity associated with institutionalization among Finnish community-dwelling older people: an 18-year population-based follow-up study

Aim

The aim of the study is to assess the association of chronic conditions and multimorbidity with institutionalization in older people.

Findings

Having dementia, mood or neurological disorder and/or five or more chronic conditions were associated with a higher risk of institutionalization.

Message

These risk factors should be recognized in primary care when providing and targeting care and support for home-dwelling older people.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41999-021-00535-y.

Purpose

The ageing population is increasingly multimorbid. This challenges health care and elderly services as multimorbidity is associated with institutionalization. Especially dementia increases with age and is the main risk factor for institutionalization. The aim of this study was to assess the association of chronic conditions and multimorbidity with institutionalization in home-dwelling older people, with and without dementia.

Methods

In this prospective study with 18-year follow-up, the data on participants’ chronic conditions were gathered at the baseline examination, and of conditions acquired during the follow-up period from the municipality’s electronic patient record system and national registers. Only participants institutionalized or deceased by the end of the follow-up period were included in this study. Different cut-off-points for multimorbidity were analyzed. Cox regression model was used in the analyses. Death was used as a competing factor.

Results

The mean age of the participants (n = 820) was 74.7 years (64.0‒97.0). During the follow-up, 328 (40%) were institutionalized. Dementia, mood disorders, neurological disorders, and multimorbidity defined as five or more chronic conditions were associated with a higher risk of institutionalization in all the participants. In people without dementia, mood disorders and neurological disorders increased the risk of institutionalization.

Conclusion

Having dementia, mood or neurological disorder and/or five or more chronic conditions were associated with a higher risk of institutionalization. These risk factors should be recognized when providing and targeting care and support for older people still living at home.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41999-021-00535-y.

Factors associated with institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic: a 3-year follow-up study

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.

Comparison of the Measurement of Long-Term Care Costs between China and Other Countries: A Systematic Review of the Last Decade

BACKGROUND

The rapid aging of populations in some countries has led to a growing number of the disabled elderly, creating a huge need for Long-Term Care (LTC) and meeting its costs, which is a heavy economic burden on the families of the disabled elderly and governments. Therefore, the measurement of Long-Term Care (LTC) costs has become an important basis for the government to formulate Long-Term Care (LTC) policies, and academic research on Long-Term Care (LTC) costs is also in the process of continuous development and deepening.

METHODS

This is a systematic review that aims to examine the evidence published in the last decade (2010-2019) regarding the comparison of the measurement of Long-Term Care (LTC) costs between China and other countries.

RESULTS

Eighteen Chinese studies and 17 other countries' studies were included in this review. Most Chinese scholars estimated long-term care costs based on the degree of disability among the disabled elderly. However, the studies of European and American countries are more and more in-depth and comprehensive, and more detailed regarding the post-care cost of specific diseases, such as Parkinson's disease, Alzheimer's disease, and epilepsy.

CONCLUSION

In future academic research, we should fully consider the human value of long-term care providers and further study the differences in the long-term care costs of different chronic diseases. In China's future policymaking, according to the experience of Germany, Sweden, and other countries, it may be an effective way to develop private long-term care insurance and realize the effective complementarity between private long-term care insurance and public long-term care insurance (LTCI).

Long-Term Care Use During the Last 2 Years of Life in Sweden: Implications for Policy to Address Increased Population Aging

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.

"They're always in a hurry" - Older people´s perceptions of access and recognition in health and social care services

The article examines older people's perceptions of quality of life from the perspective of access and use of health and social care services. The data include focus group discussions with older people living alone. The data were analysed using thematic analysis focusing on the older people's collective views on health and social care services as supportive or restrictive factors for their quality of life. Two central themes were present in all the focus group discussions: the importance of accessing services and information regarding the services, and need for recognition within the services/by the professionals. Both themes were connected to the older people's desire to maintain autonomy in their everyday life despite increasing functional disabilities, which was seen as an important factor of quality of life. The older people felt that accessing and finding information about the services was difficult, and dependent on the professional's good will and the older person's own financial resources. Within the services, older people experienced a lack of recognition of their own personhood and individual needs. The participants felt that they were easily bypassed and left out of negotiations regarding their own care. The article highlights the importance of developing health and social care services and practices towards a more holistic approach recognising older people's individual needs.

The Joint Impact of Age at Death and Dementia on Long-Term Care Use in the Last Years of Life: Changes From 1996 to 2013 in Finland

Welfare states increasingly rely on aging in place policies and have cut back on institutional long-term care (LTC) provision. Simultaneously, the major determinants of LTC use, that is, dementia and living to very old age, are increasing. We investigated how increasing longevity and concomitant dementia were associated with changes in round-the-clock LTC use in the last 5 years of life between 1996 and 2013. Retrospective data drawn from national registers included all those who died aged 70+ in 2007 and 2013, plus a 40% random sample from 2001 (N = 86,554). A generalized estimating equations (GEE) were used to estimate the association of dementia and age with LTC use during three study periods 1996-2001, 2002-2007, and 2008-2013. Between the study periods, the total number of days spent in LTC increased by around 2 months. Higher ages at death and the increased number of persons with dementia contributed to this increase. The group of the most frequent LTC users, that is, people aged 90+ with or without dementia, grew the most in size, yet their LTC use decreased. The implications of very old age and concomitant dementia for care needs must be acknowledged to guarantee an adequate quantity and quality of care.

Changes in place of death among people with dementia in Finland between 1998 and 2013: A register study

INTRODUCTION

The place of death is suggested as a quality indicator for end-of-life care. We investigated how the place of death changed between 1998 and 2013 among people with dementia.

METHODS

Data from the Finnish national health and social care registers were extracted for all people with dementia, who had died at 70 years old during these years (N = 140,034). Descriptive analysis and logistic regression analysis were conducted.

RESULTS

In 2013, the most common place of death was the primary care hospital (39.8%), followed by nursing home and sheltered housing with 24-hour assistance (20.5%). Dying at home was rare (8.1%). During the study years, dying in the hospital decreased while dying in sheltered housing with 24-hour assistance increased.

DISCUSSION

The place of death for people with dementia has changed from institutions to noninstitutional care facilities. Further research on noninstitutional care facilities' ability to provide high-quality care at the end of life is needed.