Abstract
ObjectivesThe effects of socio-demographic and economic factors on institutional long-term care (LTC) among people with dementia remain unclear. Inconsistent findings may relate to time-varying effects of these factors as dementia progresses. To clarify the question, we estimated institutional LTC trajectories by age, marital status and household income in the eight years preceding dementia-related and non-dementia-related deaths.MethodsWe assessed a population-representative sample of Finnish men and women for institutional LTC over an eight-year period before death. Deaths related to dementia and all other causes at the age of 70+ in 2001–2007 were identified from the Death Register. Dates in institutional LTC were obtained from national care registers. We calculated the average and time-varying marginal effects of age, marital status and household income on the estimated probability of institutional LTC use, employing repeated-measures logistic regression models with generalised estimating equations (GEE).ResultsThe effects of age, marital status and household income on institutional LTC varied across the time before death, and the patterns differed between dementia-related and non-dementia-related deaths. Among people who died of dementia, being of older age, non-married and having a lower income predicted a higher probability of institutional LTC only until three to four years before death, after which the differences diminished or disappeared. Among women in particular, the probability of institutional LTC was nearly equal across age, marital status and income groups in the last year before dementia-related death. Among those who died from non-dementia-related causes, in contrast, the differences widened until death.ConclusionsWe show that individuals with dementia require intensive professional care at the end of life, regardless of their socio-demographic or economic resources. The results imply that the potential for extending community living for people with dementia is likely to be difficult through modification of their socio-demographic and economic environments.
Highlights
Among the many concerns relating to population ageing is the increasing demand for institutional long-term care (LTC) [1]
Among people who died of dementia, being of older age, non-married and having a lower income predicted a higher probability of institutional LTC only until three to four years before death, after which the differences diminished or disappeared
We show that individuals with dementia require intensive professional care at the end of life, regardless of their socio-demographic or economic resources
Summary
Among the many concerns relating to population ageing is the increasing demand for institutional long-term care (LTC) [1]. One of the strongest determinants of admission to institutional LTC [4,5]. Periods in institutional care at the end of life are longer for people who die of dementia compared to people who die of any other cause [6]. Because institutional dementia care imposes a heavy economic burden on social and health care sectors, national long-term targets have been to promote community living as an alternative to institutionalisation [7]. To support independent living and, at the same time, ensure timely access to institutional LTC for those in need, a more comprehensive understanding of the factors contributing to the use of LTC with dementia is needed
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