Life Expectancy in Long-Term Institutional Care by Marital Status: Multistate Life Table Estimates for Older Finnish Men and Women

Martikainen, Pekka; Moustgaard, Heta; Einiö, Elina; Murphy, Michael J.

doi:10.1093/geronb/gbt131

Cited by 24 publications

(29 citation statements)

References 19 publications

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“…Lifetable studies estimated likelihoods for Australia, 14,15 USA 23 and UK 24 . Six simulation models were from the US 25–30 and one from Finland 31 …”

Section: Resultsmentioning

confidence: 99%

“…24 Six simulation models were from the US [25][26][27][28][29][30] and one from Finland. 31 Median overall estimates of lifetime use of RAC for people aged 65+ varied substantially: 39% (range 22%-47%) for decedent cohorts, 34% (26%-53%) for lifetables and 53% for simulations (35%-60%). Of the 12 studies from the US, decedent cohort studies in general yielded lower estimates than other studies, but there was wide variation, from 35% 26 to 60%.…”

Section: International Comparisonsmentioning

confidence: 98%

See 1 more Smart Citation

Likelihood of residential aged care use in later life: a simple approach to estimation with international comparison

Broad

Ashton

Gott

et al. 2015

Australian and New Zealand Journal of Public Health

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L ong-term residential aged care (RAC) is used at any one time by about 4-6% of those aged 65 years or over in many developed countries, including NZ. [1][2][3] This figure -usually derived from research adopting cross-sectional methods such as censuses and surveys -sometimes leads to the erroneous assumption that only few people use RAC during their lifetimes. 4 Inappropriate use of cross-sectional figures for estimating the likelihood of use of RACwhich Kastenbaum and Candy referred to as "the four per cent fallacy" 5,6 -may suggest that the sector is small and affects few people. To avoid such misunderstandings, and for policy and planning purposes, estimates are needed of the likelihood people aged 65 and over will use residential care at any time before they die, hereafter termed 'lifetime use' .Studies of place of death have been used to answer this question. 5,[7][8][9] Deaths in RAC are widely available, based on death certificate information. For example, a large international comparison of 21 populations aged 65+ years showed RAC was the place of death for a median of 18% (inter-quartile range 14-29 %) of decedents 10 . In the US the proportion was 29% and in Australia and Canada 32%, but in Iceland and NZ the proportion was higher at 38%. However, deaths in RAC underestimate total RAC use wherever a proportion of RAC residents die in an acute hospital.Other than place of death, three methodologies have previously been used to assess lifetime use. These include 1) assembling a population-representative cohort and following it either prospectively until death or from death retrospectively; 2) using the lifetable method as used in demographic projections; and 3) modelling transition probabilities between residence at home, residence in RAC and death, and then simulating lifetime risk. All these methods require the assembly of large or long cohorts. In countries where there are no such cohorts, including NZ, another method of estimation is required. The need for simple methods to estimate lifetime use has previously been recognised. 9 This paper describes a simple method of estimation of lifetime use of RAC for people who reach the age of 65 years. Administrative data for place of death obtained from death certificates are obtained first for the NZ population, derived from all death certificates over a five-year period. To that figure is added an estimate of the number of RAC residents who die, not in RAC, but in acute hospital. It then compares NZ estimates to published reports for other countries. Methods: Deaths of RAC residents in acute hospitals were estimated for NZ from four separate studies and added to deaths occurring in RAC, to derive the likelihood of using RAC after age 65 years. Academic and other sources were searched for comparative reports. Likelihood of residential agedResults: An estimated 18% of RAC residents died in acute hospital in NZ. When added to those who died in RAC, the proportion using RAC for late-life care was estimated at over 47% (66% if aged 85+ years). Of 12 US reports,...

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“…Lifetable studies estimated likelihoods for Australia, 14,15 USA 23 and UK 24 . Six simulation models were from the US 25–30 and one from Finland 31 …”

Section: Resultsmentioning

confidence: 99%

Section: International Comparisonsmentioning

confidence: 98%

Likelihood of residential aged care use in later life: a simple approach to estimation with international comparison

Broad

Ashton

Gott

et al. 2015

Australian and New Zealand Journal of Public Health

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show abstract

“…Broad's study found that the proportion using RAC for late‐life care increased from 47% (aged 65 years) to 66% for persons aged 85 years or more in New Zealand 1 . Other analyses have demonstrated that women are more likely to use residential care than men 2,21 due to increased life expectancy, and the likelihood that they will not have a spouse still living who is able to care for them 7,9 . Different risk factors between genders may also apply.…”

Section: Discussionmentioning

confidence: 99%

Cumulative incidence of admission to permanent residential aged care for Australian women – A competing risk analysis

Forder

Byles

et al. 2018

Australian and New Zealand Journal of Public Health

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Objective: To provide a direct estimate of the risk of admission to permanent residential aged care among older women while accounting for death, according to housing type and other variables. Methods:A competing risk analysis from 8,867 Australian women born 1921-26, using linked data from the Australian Longitudinal Study on Women's Health (ALSWH), Residential Aged Care (RAC), and the Australian National Death Index. Results:After accounting for deaths, around 35% of women will be admitted to RAC between ages 73 and 90. The conditional cumulative incidence of admission to RAC was 26.9% if living in a house, compared to 36.0% from an apartment, 43.6% within a retirement village, and 37.1% if living in a mobile home. Each one-year increase in age was associated with a relative 17% increased risk of RAC. Conclusions:Around one-third of women will enter RAC between age 73 and 90. Living in a house had the lowest risk of entering residential aged care over time.Implications for public health: These findings have important implications for planning for aged care services, including the role of housing in delaying admission to residential aged care, and the need for residential care by a high proportion of women towards the end of life.

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“…The difference between the expected move and the actual relocation to a nursing home indicates that the development of home‐care arrangements is almost unpredictable. A Finnish study with a population aged 65 and over shows that women aged 65 and over are more likely to go into institutional LTC than men and are also more likely to stay there longer . Unexpected hospital admissions may be a reason for delays in arranging institutional care.…”

Section: Discussionmentioning

confidence: 99%

Gender disparities in German home‐care arrangements

Dorin

Krupa²,

Metzing

et al. 2015

Scandinavian Caring Sciences

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An ageing population correlates with rising needs for long-term care (LTC). Support programmes should consider the specific needs of the various subgroups of care dependents and family caregivers. The objective of this study was to analyse the gender-specific disparities in home-care arrangements in Germany, and for this purpose, survey and insurance claims data were used. A survey of 2545 insured care recipients with high-level care needs was conducted in 2012 with the Barmer GEK, a major German statutory healthcare insurance. Insurance claims data were provided for a follow-up, focussing on the group aged 60 years and older. For statistical comparison, chi-squared test and t-tests were used, and a p-value < 0.05 was considered statistically significant. Most care recipients are female, and they are on average 2 years older than males. Men receive family care mostly from their wives, whereas widows frequently live alone and receive care from daughters, sons, other relatives, neighbours and friends, as well as from professional nursing services. Furthermore, women more often anticipate the need for (further) professional assistance and move in with a relative or to an assisted living facility or a nursing home in good time. The desired rate for relocation to a nursing home was higher than the anticipated, and during the 6-month follow-up, the actual rate of relocations was in between both. In summary, the caring situation of men and women is different. Care-receiving men are most often cared for by their wives. Widowed women need a social network and their children in order to remain in their own home. To provide better home-care arrangements for women in this situation, the family and social networks need a stronger focus in politics and research. To stabilise the home-care situation of men with high-level care needs, their wives need more support.

show abstract

Life Expectancy in Long-Term Institutional Care by Marital Status: Multistate Life Table Estimates for Older Finnish Men and Women

Abstract: The resources that are needed to provide long-term care services will increase as age of death increases. We demonstrate significantly longer care expectancy among women and among the unmarried.

Cited by 24 publications

References 19 publications

Likelihood of residential aged care use in later life: a simple approach to estimation with international comparison

Likelihood of residential aged care use in later life: a simple approach to estimation with international comparison

Cumulative incidence of admission to permanent residential aged care for Australian women – A competing risk analysis

Gender disparities in German home‐care arrangements

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