Dataset Information

Patterns of long-term care utilization during the last five years of life among Swedish older adults with and without dementia.

ABSTRACT:

Aims

The aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecare, residential care) among people with and without dementia aged 70+ in Sweden during their last five years of life and its association with sociodemographic factors (age, gender, education, cohabitation status) and time with a dementia diagnosis.

Methods

This retrospective cohort study included all people who died in November 2019 aged 70 years and older (n = 6294) derived from several national registers. A multinomial logistic regression was conducted to identify which sociodemographic factors predicted the patterns of LTC use.

Results

Results showed that the time with a dementia diagnosis and cohabitation status were important predictors that influence the patterns of LTC use during the last five years of life. Nearly three-quarters of people living with dementia (PlwD) used residential care during the last five years of life. PlwD were more likely to reside in residential care close to death. Women who lived alone, with or without dementia, used residential care to a higher degree compared to married or cohabiting women.

Conclusions

Among people without a dementia diagnosis, as well as those who were newly diagnosed, it was common to have no LTC at all, or use LTC only for a brief period close to death. During the last five years of life, PlwD and those living alone more often entered LTC early and used residential care for a longer time compared to people without dementia and people living alone, respectively.

SUBMITTER: Sm-Rahman A

PROVIDER: S-EPMC10597483 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Publications

Patterns of long-term care utilization during the last five years of life among Swedish older adults with and without dementia.

Sm-Rahman Atiqur A Meinow Bettina B Hydén Lars-Christer LC Kelfve Susanne S

PloS one 20231024 10

<h4>Aims</h4>The aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecare, residential care) among people with and without dementia aged 70+ in Sweden during their last five years of life and its association with sociodemographic factors (age, gender, education, cohabitation status) and time with a dementia diagnosis.<h4>Methods</h4>This retrospective cohort study included all people who died in November 2019 aged 70 years and older (n = 6294) derived from s ...[more]

PMID: 37874798

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Project description:Common diseases, particularly dementia, have large social costs for the U.S. population. However, less is known about the end-of-life costs of specific diseases and the associated financial risk for individual households.To examine social costs and financial risks faced by Medicare beneficiaries 5 years before death.Retrospective cohort.The HRS (Health and Retirement Study).Medicare fee-for-service beneficiaries, aged 70 years or older, who died between 2005 and 2010 (n = 1702), stratified into 4 groups: persons with a high probability of dementia or those who died because of heart disease, cancer, or other causes.Total social costs and their components, including Medicare, Medicaid, private insurance, out-of-pocket spending, and informal care, measured over the last 5 years of life; and out-of-pocket spending as a proportion of household wealth.Average total cost per decedent with dementia ($287 038) was significantly greater than that of those who died of heart disease ($175 136), cancer ($173 383), or other causes ($197 286) (P < 0.001). Although Medicare expenditures were similar across groups, average out-of-pocket spending for patients with dementia ($61 522) was 81% higher than that for patients without dementia ($34 068); a similar pattern held for informal care. Out-of-pocket spending for the dementia group (median, $36 919) represented 32% of wealth measured 5 years before death compared with 11% for the nondementia group (P < 0.001). This proportion was greater for black persons (84%), persons with less than a high school education (48%), and unmarried or widowed women (58%).Imputed Medicaid, private insurance, and informal care costs.Health care expenditures among persons with dementia were substantially larger than those for other diseases, and many of the expenses were uncovered (uninsured). This places a large financial burden on families, and these burdens are particularly pronounced among the demographic groups that are least prepared for financial risk.National Institute on Aging.

Project description:BackgroundSocial isolation and loneliness are critical to the health of older adults, but they have not been well-described at the end of life.ObjectivesTo determine the prevalence and correlates of social isolation and loneliness among older adults in the last years of life.DesignNationally representative, cross-sectional survey.SettingHealth and Retirement Study, 2006-2016 data.ParticipantsAdults age > 50 interviewed once in the last 4 years of life (n = 3613).MeasurementsWe defined social isolation using a 15-item scale measuring household contacts, social network interaction, and community engagement, and frequent loneliness using the 3-item UCLA Loneliness Scale. We used multivariable logistic regression to determine their adjusted prevalence by time prior-to-death and by subgroups of interest.ResultsApproximately 19% experienced social isolation, 18% loneliness, and 5% both in the last 4 years of life (correlation = 0.11). The adjusted prevalence of social isolation was higher for individuals nearer to death (4 years: 18% vs 0-3 months: 27%, p = 0.05) and there was no significant change in loneliness (4 years: 19% vs 0-3 months: 23%, p = 0.13). Risk factors for both isolation and loneliness included (p < 0.01): low net-worth (Isolation: 34% vs 14%; Loneliness: 29% vs 13%), hearing impairment (Isolation: 26% vs 20%; Loneliness: 26% vs 17%), and difficulty preparing meals (Isolation: 27% vs 19%; Loneliness: 29% vs 15%). Factors associated with loneliness, but not social isolation, included being female, pain, incontinence, and cognitive impairment.ConclusionsSocial isolation and loneliness are common at the end of life, affecting 1 in 4 older adults, but few experience both. Rates were higher for older adults who were poor and experienced functional or sensory impairments. Results can inform clinical efforts to identify and address end-of-life psychosocial suffering and health policies which prioritize social needs at the end of life.

Dataset Information

Patterns of long-term care utilization during the last five years of life among Swedish older adults with and without dementia.

Aims

Methods

Results

Conclusions

Publications

Patterns of long-term care utilization during the last five years of life among Swedish older adults with and without dementia.

Similar Datasets

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