Bettina Meinow1, Jonas W Wastesson2, Ingemar Kåreholt3, Susanne Kelfve4. 1. Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden. Electronic address: bettina.meinow@ki.se. 2. 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. 3. 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. 4. 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.
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.
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.
Authors: Bettina Meinow; Peng Li; Domantas Jasilionis; Anna Oksuzyan; Louise Sundberg; Susanne Kelfve; Jonas W Wastesson Journal: BMC Public Health Date: 2022-04-14 Impact factor: 4.135
Authors: Joana Vicente; Kevin J McKee; Lennart Magnusson; Pauline Johansson; Björn Ekman; Elizabeth Hanson Journal: PLoS One Date: 2022-03-07 Impact factor: 3.240