Hospital and long-term care use according to age and proximity to death in Finland: variations by cause of death and socio-demographic position

Michael Murphy, London School of Economics and Political Science (LSE)
Pekka Martikainen, University of Helsinki
Heta Moustgaard, University of Helsinki
Niina Metsä-Simola, University of Helsinki

Provision of hospital and long-term institutional care services for the growing number of older people is a major policy concern. Earlier studies usually drawn from administrative records have argued that acute health care costs are largely determined by use of services in the period close to death rather than by age per se, so the demand for resources will be less than the increase in numbers might suggest. We estimate use of hospital and long-term care by age and proximity to death for selected causes and by gender, education and marital status using a 40 % random sample of the Finnish population aged 65 and older at the end of 1997 drawn from population registers with information on socio-demographic factors at baseline who were followed to death in 1998–2002 or to the end of 2002. The use of hospital and long-term institutional care was assessed in 1995–2002 up to seven years prior to death or end of follow-up. Use of both hospital and long-term care increases rapidly with age, although proximity to death is more important for hospital care. Differentials in average care days in the previous seven years according to education are modest, but non-married people use more resources than married ones. Those dying from dementia use approximately twice as many care days as average and for an extended period before death. Future need for long-term care is likely to increase substantially and offset any reduction in hospital care needs arising from incorporation of proximity to death in care projections. Changes in marital status are likely to alleviate long-term care needs among women, while the rapid increase in numbers with dementia is likely to increase the demand for both long-term and hospital care. Simplified models based only on proximity to death may seriously under-estimate future care needs.