Background Provision of hospital and long-term care services for the growing number of older people is a major policy concern. The authors estimate hospital and nursing home care use by age and proximity to death for selected causes and by gender, education and marital status.
Methods A 40% random sample of the Finnish population aged 65+ years alive at the end of 1997 was followed to death in 1998–2002. Use of hospital and nursing home care was assessed up to 7 years prior to death for those who died and prior to the end of 2002 for survivors.
Results In the 7-year period, before death total average care days were 294 (95% CI 286 to 301) for men and 430 (95% CI 423 to 438) for women. For surviving men and women, the corresponding figures were 89 (95% CI 86 to 92) and 136 (95% CI 130 to 141) days. Use of hospital and particularly nursing home care increased rapidly with age, while proximity to death was more important for hospital care. The married used less care than the non-married. Care use of those dying from dementia was approximately twice that for all causes combined and was substantial for an extended period before death.
Conclusions The effects of age are more substantial for nursing home than for hospital care use, and both are larger the older the age at death. Care use will be considerably higher among the non-married. Increasing longevity coupled with a rising trend of dementia is likely to mean a major shift towards higher nursing home care use in the future.
- nursing home
- end of life
- cause of death
- social factors
- social epidemiology
- marital status
- health expectancy
- longitudinal studies
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Funding This study was supported by the Academy of Finland (210752 and 205631) and the ESRC (RES-339-25-0002). The study sponsors had no role in the design or conduct of the study; the collection, management, analysis and interpretation of the data or the preparation, review or approval of the manuscript.
Competing interests None.
Ethics approval We are grateful to the National Research and Development Centre for Welfare and Health (STAKES) and the Social Insurance Institution and Statistics Finland (permission TK 53-576-04 and TK 53-499-05) for making the data available to us.
Provenance and peer review Not commissioned; externally peer reviewed.