Mari Aaltonen

Finnish Institute for Health and Welfare | THL

Objectives The time of death is increasingly postponed to a very high age. How this change affects the use of care services at the population level is unknown. This study analyses the care profiles of older people during their last 2 years of life, and investigates how these profiles differ for the study years 1996–1998 and 2011–2013. Design Retro...

Background: Time at home at end-of-life is perceived as valuable to individuals. Increasing home care is therefore often a political goal. Yet, little is known about where individuals live towards their end-of-life. Our aim was to describe where individuals reside their last 6 months of life in Finland and Norway, and how this differed by cause of...

Aim To describe long-term care (LTC) use in Finland and Sweden in 2020, by reporting residential entry and exit patterns including hospital admissions and mortality, compared with the 2018–2019 period and community-living individuals. Methods From national registers in Finland and Sweden, all individuals 70+ were included. Using the Finnish and Sw...

This study investigates the association between insufficient home care and the use of health and social care services among older adults. Data was collected from the Resident Assessment Instrument (RAI) home care register linked to registers for health care and primary health care (N = 33,493). The results show that one in six respondents felt that...

The COVID-19 pandemic had a high impact on society and healthcare systems. Since healthcare data during COVID-19 accumulated, several studies have reported reductions in hospitalizations and emergency room visits during the period of restrictions. Analyses of individual healthcare utilization could help explain the phenomenon. In this study, we dev...

Tässä laadullisessa tutkimuksessa selvitimme, miten muistisairautta sairastava ikääntyvä puoliso ja hänen puoliso-omaishoitajansa kuvaavat muistisairaan puolison toimijuutta parisuhteessa. Analysoimme aineiston sisällönanalyysin keinoin. Muodostimme aineistosta neljä pääteemaa. Puoliso-omaishoitajat kuvasivat muistisairaan toimijuutta eri tavalla k...

Introduction In ageing societies, the number of older adults with complex chronic conditions (CCCs) is rapidly increasing. Care for older persons with CCCs is challenging, due to interactions between multiple conditions and their treatments. In home care and nursing homes, where most older persons with CCCs receive care, professionals often lack ap...

Objective The aim of this study was to describe the benefits of digital health and social services perceived by older adults and to examine factors associated with perceiving these benefits. Several factors related to (a) sociodemographic characteristics, (b) area of residence, (c) physical, cognitive, psychological, and social functioning, and (d)...

Background The burden of dementia, multimorbidity, and disability is high in the oldest old. However, the contribution of dementia and comorbidities to functional ability in this age group remains unclear. We examined the combined effects of dementia and comorbidities on ADL and mobility disability and differences between dementia-related disabilit...

Objective: The study analysed how its participants positioned themselves and other people as actors in daily life, and what matters they portrayed as meaningful in seeking and receiving support in daily life.Background: Family care has traditionally played an important role in elder care in Finland. Current policy goals will further increase the im...

As the population ages, the number of people with dementia increases. An emerging body of research is focusing on living with dementia and understanding the experience of caring and the care burden. There is much less research on the meaning of dementia from the perspective of an older couple’s spousal relationship and related intimacy. This qualit...

Muistisairauksiin usein liittyvät kognitiiviset ja persoonallisuuden muutokset sekä itseilmaisun vaikeudet saattavat ilmetä käyttäytymisen muutoksina. Puoliso ja muut läheiset kohtaavat nämä muutokset ensimmäisinä. Laadullisessa tutkimuksessamme selvitimme, millaisissa tilanteissa muistisairauden aiheuttamia ongelmallisina ja kielteisinä koettuja k...

This study examines whether the gender gap in long-term care use in the Netherlands has changed between 1995 and 2016. Previous research has shown that women use more formal care services than men, while men use more informal care. In the past decades, there have been changes in the individual determinants of care use, such as health and social res...

Background Unmet care needs are usually defined in terms of receiving sufficient help in instrumental activities and activities of daily living. Research on unmet needs is mostly based on quantitative data. Older persons’ and informal carers’ views and experiences have received less attention. Methods In this paper, we rely on a definition of unme...

Care policies for older adults emphasize aging-in-place and home care over residential long-term care (LTC). We explore how the use of residential LTC in the last five years of life among people with and without dementia changed between those who died in 2001, 2007, 2013, and 2017 in Finland. Retrospective data drawn from the national health and so...

Background Comorbidities have major implications for the care of people with dementia. Aim To investigate the patterns of comorbidities in dementia in the last five years of life and how these patterns differed between three cohorts. Methods The study included people who died at age 70 and above in 2001 (n = 13,717), 2007 (n = 34,750) and 2013 (n...

Koronaviruspandemian rajoittamiseen liittyvät ensimmäiset toimenpiteet ja seuraukset kohdistuivat erityisesti ikääntyneisiin. Sosiaali- ja terveyspalvelujen resursseja kohdennettiin uudelleen ja osa palveluista suljettiin. Samanaikaisesti lähikontaktien välttäminen vaikeutti omaisten tarjoamaa apua. Selvitimme puolistrukturoitujen haastattelujen (N...

Muistisairautta sairastavien ikääntyneiden kotona asuminen onnistuu usein omaishoitajien avulla, mutta tukea tarvitaan myös sosiaali- ja terveyspalveluista. Aina kaikki eivät kuitenkaan saa riittävää apua ja tukea. Niin muistisairautta sairastavat ihmiset kuin omaishoitajatkin voivat kärsiä avun riittämättömyydestä. Tässä artikkelissa tutkimme, mil...

Background: People with memory disorders often need care and help from family carers and health and social care providers. Due to the deterioration of cognitive capacity and language skills, they may be unable to convey their thoughts and care preferences to other people. As a result, their agency may become restricted. We investigated the descrip...

Increasing life expectancy has postponed the last years of life to older ages. Previous studies have demonstrated that disability is determined by age, age at death and closeness to death but only few have focused on oldest old population. We examined disability during the last years of life among people aged 90 years and older between 2001 and 201...

Delayed hospital discharge, also known as alternate level of care (ALC) in Canada, refers to a stay in hospital when acute services are no longer needed but the patient occupies a hospital bed while waiting to be discharged to an appropriate care setting. ALC has negative consequences for both the service system (high costs, inappropriate use of ho...

Objectives Delayed discharge, remaining in acute care longer than medically necessary, reflects less than optimal use of hospital care resources and can have negative implications for patients. We studied (1) the change over time in delayed discharge in people with and without dementia, and (2) the association of delayed discharge with discharge de...

While it is known that those who are living their last years are frequent users of social and health services, research about medicines at the end of life is scarce. We examined whether the proportions of purchasers and the types of prescription medicines purchased during a 2-year period differed between community-dwelling old people who died (dece...

Aims: This study aimed to find out how place of death varied between countries with different health and social service systems. This was done by investigating typical groups (concerning age, sex and end-of-life trajectory) of older people dying in different places in Finland and Norway. Methods: The data were derived from national registers. All t...

Article available: https://ltccovid.org/2020/06/14/new-report-covid-19-and-clients-of-long-term-care-in-finland-impact-and-measures-to-control-the-virus/ Key Findings: Finland has succeeded in protecting people aged 70 years and over from coronavirus in general, but almost half of the 318 deaths in the country have occurred in care homes for older...

Aims: Ageing in place has become a policy priority. Consequently, residential care has been reduced, and more older people with multiple care needs reside at home with the help of informal care and home care services. An increasing share of these people has memory disorders. We examined the extent to which memory problems, in addition to other indi...

In recent decades, care policy in the Netherlands reduced budgets for residential care and formal home care, which increased the demand for informal care. Women use formal care more often than men, but we lack information on the extent to which the gender gap in care use is explained by differences in individual chracteristics and changes in care p...

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-cl...

Background: The need for long-term care services increases with age. However, little is known about the predictors of long-term care (LTC) entry among the oldest old. Aims: Aim of this study was to assess predictors of LTC entry in a sample of men and women aged 90 years and older. Methods: This study was based on the Vitality 90 + Study, a po...

Observation of long-term trends within countries is needed to increase insight into how policy initiatives are reflected in the use of care over time in addition to individual determinants of care use. In the past decades, Dutch care policies have favoured homecare and reduced the availability of institutional care which extended the care responsib...

Aims: Cross-country comparisons of mortality and longevity patterns of Nordic populations could contribute with novel insights into the compositional changes of these populations. We investigated three metrics of population ageing: the proportion of the population aged 75+ and 90+ years, the proportion of birth cohorts reaching 75 and 90 years, an...

Long-term care (LTC) use increases with ageing due to an age-related increase in disability. Both the levels of disability and social resources vary among socioeconomic groups. The association of socioeconomic status with LTC use is largely unexplored for the oldest old. This study examined how occupational class is associated with LTC use among no...

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 yea...

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...

Death is increasingly postponed to a very old age. Both high age and closeness of death are major contributors to use of care.We used nationwide register based data to identify care profiles during the last two years of life among those who died at the age of 70 or older in Finland in 1998 (N= 34,116) and 2013 (N=38,087). From 1998 to 2013, the num...

Advanced age and dementia are important contributors to care use, especially long-term care (LTC). We studied the impact of age on use of LTC and hospital care (HC) in last five years of life in those who died from dementia in three time periods. Data were drawn from Finnish National Registers. The outcome variables, (1) use of LTC and (2) use of H...

The aim of the study is (1) to describe and analyse health and social service use and medicine purchases in the last 2 years of life among older adults who died by suicide and (2) to compare use and purchases between three groups: those who died by suicide, died a natural death or who lived longer. Nation-wide Finnish register data were used. The d...

Background: The use of long-term care (LTC) is common in very old age and in the last years of life. It is not known how the use pattern is changing as death is being postponed to increasingly old age. The aim is to analyze the association between the use of LTC and approaching death among old people and the change in this association from 2000 to...

Variations across Finland in the use of six different long-term care (LTC) services among old people in their last 2 years of life, and the effects of characteristics of municipalities on the variations were studied. We studied variations in the use of residential home, sheltered housing, regular home care and inpatient care in health centre wards...

Tehostettu palveluasuminen on Suomessa yleistyvä ikääntyneiden pitkäaikaishoidon muoto. Tehostetusta palveluasumisesta tehdään enemmän siirtoja toisiin hoitolaitoksiin kuin vanhainkotihoidosta, mutta siirtojen syitä ei ole Suomessa tutkittu.Tämän tutkimuksen tarkoituksena olitarkastella tehostetusta palveluasumisesta muihin hoitolaitoksiin tehtyjä...

Objectives: The purpose of the study was to examine the frequency of burdensome care transitions at the end of life, the difference between different types of residential care facilities, and the changes occurring between 2002 and 2008. Design: A nationwide, register-based retrospective study. Setting: Residential care facilities offering long...

Aims: To analyse whether transitions between care settings differ between municipalities in the last 2 years of life among older people in Finland. Methods: Data were derived from Finnish national registers, and include all those who died in 2002 and 2003 at the age of 70 or older except those living in very small municipalities (n=67,027). Data...

Dementia is one of the main challenges to our health and social care. This study compares the number and timing of transitions between care settings in the last 2 years of life among older people with and without dementia. Data were derived from Finnish national registers, and include all those who died in 2002 and 2003 at the age of 70 or older (n...

To describe and analyse municipal differences in health and social service use among old people in the last 2 years of life. The data were derived from national registers. All those who died in 2002 or 2003 at the age of ≥ 70 years were included except those who lived in very small municipalities. The services included were different types of hospi...

Dementia is one of the most common causes of death among old people in Finland and other countries with high life expectancies. Dementing illnesses are the most important disease group behind the need for long-term care and therefore place a considerable burden on the health and social care system. The aim of this study was to assess the effects of...

This study focuses on the amount and types of transitions in health and social service system during the last 2years of life and the places of death and among Finnish people aged 70–79, 80–89 and 90 or older. The data set, derived from multiple national registers, consists of 75,578 people who died between 1998 and 2001. The services included unive...

We used case-control design to compare utilization of health and social services between older decedents and survivors, and to identify the respective impact of age and closeness of death on the utilization of services. Data were derived from multiple national registers. The sample consisted of 56,001 persons, who died during years 1998-2000 at the...