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Background
The structure of long-term care (LTC) for old people has changed: care has been shifted from institutions to the community, and death is being postponed to increasingly old age. The aim of the study was to analyze how the use and costs of LTC in the last two years of life among old people changed between 2002 and 2013.
Methods
Data were...
Contexts in source publication
Context 1
... they are entitled to apply for reim- bursements of medical and housing expenses from the Social Insurance Institution (SII), responsibility for the funding of LTC is being shifted from local-to national- level welfare systems, and to service users themselves [16]. The unit costs of health centers are highest and those of sheltered housing lowest (Table 1), but these costs do not include all the same cost items, and there- fore the differences in cost are not clear at the societal level. From the viewpoint of municipalities, sheltered housing has been found to be 22% cheaper than institu- tional care, but when SII reimbursement is taken into account, the total costs of sheltered housing are 9% cheaper than those of institutional care [17]. ...
Context 2
... multiplied the number of days in different types of LTC by their daily unit costs, derived from a national re- port [20] (Table 1). The unit costs for residential homes and health centers are gross costs caused by the use of services. ...
Context 3
... unit cost of sheltered housing included staff, meals, and materials, but excluded housing, medicines, and some purchased services [21]. Instead, these were included in the unit costs of health centers and residen- tial homes (cost items are described in Table 1). We esti- mated the cost of housing (an average of €13.60 per day in sheltered housing) using statistics from the SII [22]. ...
Context 4
... many other costs paid by users of sheltered housing were excluded, such as for clothing, TVs, hy- giene products, and phones. In residential homes and health centers these costs are covered (see Table 1). The unit cost for sheltered housing is an underestimation, but it is the best estimation available, and this limitation must be kept in mind when interpreting the results. ...
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Citations
... The patterns of LTC use and specifically the length of stay in residential care has mostly been described in previous cross-sectional studies based on population register data in Sweden [10], in Finland [11] and in Canada [12]. Swedish research addressing older people's use of LTC highlighted a decreasing length of stay in residential care [13]. ...
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.
... While the prevalence of opioid utilisation among all Finnish persons over 65 remained stable throughout the study period, it increased significantly among Finns aged 85 or older. Although this implies a shift in the opioid prescribing culture for the oldest old, part of the increase may come from prioritizing home care and assisted housing over institutional care [54,55], increasing the time people with higher disease burden purchase their medicines through community pharmacies [54]. Similarly to our results, a previous study found that morbidity in Finnish long-term care facilities has increased and opioid use almost tripled from 2003 to 2017 [56]. ...
... While the prevalence of opioid utilisation among all Finnish persons over 65 remained stable throughout the study period, it increased significantly among Finns aged 85 or older. Although this implies a shift in the opioid prescribing culture for the oldest old, part of the increase may come from prioritizing home care and assisted housing over institutional care [54,55], increasing the time people with higher disease burden purchase their medicines through community pharmacies [54]. Similarly to our results, a previous study found that morbidity in Finnish long-term care facilities has increased and opioid use almost tripled from 2003 to 2017 [56]. ...
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.
... Meinow and his associates [55] argued that age, gender, the type of household, and income are intertwined in old age and impact the need for and design of elderly care. Meinow et al. [55] also showed that women likely have greater need for institutionalized long-term care (LTC) than men, while further research has proven that women stay longer in long-term care facilities than men, with differences in age and fragility across genders [60][61][62]. Gender has also been noted to influence a variance in quality of life of the elderly [63]. Socioeconomic inequalities have been noted to exist in the provision, distribution, and utilization of long-term care among the elderly across different regions [64,65]. ...
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.
... This is often also the municipality's preferred choice as institutional care is expensive [15] and in Finland, most of it is paid for by the municipality. Institutionalization is increasingly concentrating to the last years of life [16]. The growing number of very old people with chronic conditions will lead to increased demand of care, especially institutional care [17,18]. ...
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.
... However, the use of institutional care is high among the oldest old and those who are in their last years of life [3,4]. It has also been argued that old people may not be able to live longer at home with the current level of home care [5]. The growing number of very old people with chronic conditions will increase the need for care, especially institutional care [3,4]. ...
... Concurrent decision to reduce the supply of institutional care has created huge challenges for care offered in the community [3]. Although majority of older people prefer living at home for as long as possible [1,2], ageing in place has become more challenging with increasing age and concomitant dementia and functional impairment [24] and current level of home care [5]. It is argued that the period of disability and need for help before death is lengthening [25]. ...
PurposeTo 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.ResultsThe 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.
... At the same time, the elderly over 65 had turned to home care, which reflects the cost-effectiveness of home care to some extent. Leena et al. [57] studied the cost of all-day use on long-term care from 2002 to 2013 in Finland, and it was discovered that the cost in the shelters is much lower than that in nursing institutions. ...
... Thirdly, the long-term care costs under different forms of care (such as institutional care, community care, and home care) have become another important topic of academic discussion regarding the development of elderly care institutions in China [36][37][38][39][40] and other countries [55][56][57]. By comparison, the relevant research in China is still a simple analysis of the comparison of long-term care costs under different forms of care, but the relevant research in other countries has begun to delve into the expectations and comparison of long-term care costs of different forms of care among patient groups with different income or education levels [55]. ...
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).
... As shown previously, the potential availability of a cohabiting partner seemed to influence LTC use similarly for men and women. 24,25 The finding that older age at death was associated with more LTC use is mirrored in other studies that found institutional care to be more prevalent with increasing age, even when adjusting for closeness of death,in Sweden, 11,19 other European countries, 13,16,17,26,27 and the United States. 18 Given that survival is still increasing, the increase of LTC with older age highlights the importance of policies addressing strategies for optimizing the use of limited public resources. ...
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.
... The data that we used originates from year 2006 and there may have been changes in the levels and relatives shares of the two cost drivers. A more recent study (Forma et al. 2017) suggests that the effect of age on the use and costs of long-term care (LTC) did not change much between 2002 and 2013. Use of LTC increased in the last two years of life, but this was associated with longer lifetimes. ...
Ageing populations pose a major challenge for long-term sustainability of public finances. The respond has been a wave of pension reforms that has lowered markedly the projected pension expenditure in EU countries. The increase in the second major expenditure item, health and long-term care costs, has become the most important element of fiscal sustainability gaps. We compare different demography-based approaches generally used to evaluate the costs. The interaction of different projection approaches and demography is illustrated by using realizations of a sto-chastic population projection as inputs in a numerical expenditure model. Our example country is Finland. Our results show that considering the effects of proximity to death on the expenditure generates markedly slower expected expenditure growth for the health and long-term care costs than using age-specific costs or the method developed and used by the European Commission and the Finnish Ministry of Finance. In addition , the sensitivity of the expenditure projections to demographic risks is lower. The differences in the outcomes of the different approaches are largest in long-term care costs, which are in any case growing faster in Finland than the health care expenditure because on population ageing.
... Despite the cutbacks in LTC overall, a previous study showed that the use of round-the-clock LTC in the last 2 years of life has increased among older adults in Finland (Forma et al., 2017). This is partly explained by the postponement of death to an increasingly advanced age, when LTC use is at its highest. ...
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.
... This article explores older people's perceptions of quality of life from the perspective of access and use of health and social care services, using focus group discussions with older people living alone. The number of people in old age is growing rapidly, and the use of health and social care services is increasing ( Forma et al., 2017). This highlights the importance of analysing the influence of social and healthcare services on the quality of life (QoL) in old age and how these services can be developed further. ...
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.
