Long-term Care Status in Centenarians and Younger Cohorts of Oldest Old in the Last 6 Years of Life: Trajectories and Potential Mechanisms

Gellert, Paul; Eggert, Simon; Zwillich, Christine; Hörter, Stefan; Kuhlmey, Adelheid; Dräger, Dagmar

doi:10.1016/j.jamda.2018.02.010

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…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.…”

Section: Discussionmentioning

confidence: 74%

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

Meinow

Wastesson

Kåreholt

et al. 2020

Journal of the American Medical Directors Association

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Keywords:Home care use use of institutional care last years of life gender differences household type a b s t r a c t 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 ¼ 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.

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Section: Discussionmentioning

confidence: 74%

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

Meinow

Wastesson

Kåreholt

et al. 2020

Journal of the American Medical Directors Association

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“…Compared with centenarians in other countries, 6,21 those in Taiwan experienced a higher prevalence of dying at their own homes. This result meets the expectation of most Taiwanese that traditionally elders wished to die at their own home.…”

Section: Discussionmentioning

confidence: 85%

“…Moreover, most nursing homes in Taiwan do not accept dying residents in their facility. In Western countries, more than 50% of the centenarians are sent to nursing or residential homes 3,21 due to lack of caregiver support. Children of these centenarians are burdened by providing caregiving support because they are mostly in their retirement phase.…”

Section: Discussionmentioning

confidence: 99%

Where and How Centenarians Die? The Role of Hospice Care

Chen

Fan

et al. 2019

Am J Hosp Palliat Care

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The effect of hospice care on place of death among centenarians remained unexplored. Using data obtained from National Health Insurance Research Database (2002-2010), we compared the differences in place and cause of death between centenarians and noncentenarians. These data were stratified into centenarian (n = 2495) and noncentenarian (n = 820 563) death. Data in place and cause of death and hospice care interventions were retrieved. Poisson regression models were used to evaluate factors associated with the centenarians’ place of death. Time series models were used to predict the number of centenarian deaths until 2025. Most (63.8%) of the centenarians died at their own homes, followed by 30.5% who died in hospital. Hospice home care was involved in only 0.3% of the centenarian deaths but in 1.8% of the noncentenarian deaths. The leading causes of death among centenarians were respiratory diseases (16.6%), circulatory diseases (15.2%), and pneumonia (14.8%). Among the centenarians, those who died of circulatory disease, old age, and respiratory diseases were more likely to die at their own homes. We forecasted the number of annual centenarian deaths to reach 800 in 2025. Therefore, an increase in the provision of advanced care planning and earlier home hospice care intervention may enable centenarians to die at their own residence.

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“…Smoking and drinking are well‐known health risk behaviors. Living alone, 17 psychological distress 18 and comorbidity 19 were risk factors for the onset of functional disability. In addition, their living areas were associated with their social participation 20 .…”

Section: Methodsmentioning

confidence: 98%

Community intervention programs prolong the onset of functional disability among older Japanese

Yamamoto

Hikichi

Kondo

et al. 2022

Geriatrics Gerontology Int

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Aim This study examined the effects of a “community‐based center” intervention to prevent the onset of functional disability among residents in disaster‐affected areas. Methods We used data from a prospective cohort study conducted from 2010 to 2016 in Iwanuma City, Japan. Participants were community‐dwelling independent adults aged ≥65 years. The exposure variable was the experience of using a community‐based center. The outcome variable was functional disability onset. The average treatment effect on the treated (ATET) was estimated by adjusting for possible confounders. Additional analysis stratified by sex was conducted considering the sex differences in social participation rates. Results Among 3794 participants (mean ± SD age = 72.9 ±5.3 years, 46.0% men), 196 (5.2%) used the community‐based center, and 849 (22.4%) exhibited disability onset. Of those with functional disabilities, 40 (20.4%) used the community‐based center, while 809 (22.5%) did not. The ATET for functional disability onset with community‐based center activities across all participants were not significant (ATET: 0.51 years [95% confidence interval [CI] = −0.23; 1.27]). However, the direction of the effect of community‐based center activities differed by sex (ATET: −0.14, 95% CI = −2.59; 2.31 for men [n = 18], and 0.66, 95% CI = 0.18; 1.16 for women [n = 178]). Women exhibited a 15.63% (95% CI = 3.58; 27.68) increase in the time until functional disability onset. Conclusions The use of community‐based centers was associated with a longer period without functional disability in women. Geriatr Gerontol Int 2022; 22: 465–470.

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Long-term Care Status in Centenarians and Younger Cohorts of Oldest Old in the Last 6 Years of Life: Trajectories and Potential Mechanisms

Cited by 7 publications

References 22 publications

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

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

Where and How Centenarians Die? The Role of Hospice Care

Community intervention programs prolong the onset of functional disability among older Japanese

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