Weaver France, Stearns Sally C, Norton Edward C, Spector William
Swiss Health Observatory, Neuchâtel, Switzerland.
Health Econ. 2009 Aug;18(8):867-83. doi: 10.1002/hec.1409.
The extent to which increasing longevity increases per capita demand for long-term care depends on the degree to which utilization is concentrated at the end of life. We estimate the marginal effect of proximity to death, measured by being within 2 years of death, on the probabilities of nursing home and formal home care use, and we determine whether this effect differs by availability of informal care--i.e. marital status and co-residence with an adult child. The analysis uses a sample of elderly aged 70+ from the 1993-2002 Health and Retirement Study. Simultaneous probit models address the joint decisions to use long-term care and co-reside with an adult child. Overall, proximity to death significantly increases the probability of nursing home use by 50.0% and of formal home care use by 12.4%. Availability of informal support significantly reduces the effect of proximity to death. Among married elderly, proximity to death has no effect on institutionalization. In conclusion, proximity to death is one of the main drivers of long-term care use, but changes in sources of informal support, such as an increase in the proportion of married elderly, may lessen its importance in shaping the demand for long-term care.
长寿的增加在多大程度上提高人均长期护理需求，取决于护理利用集中在生命末期的程度。我们估计临近死亡（以距死亡不到2年衡量）对使用养老院和正规家庭护理概率的边际效应，并确定这种效应是否因非正式护理的可获得性（即婚姻状况和与成年子女同住）而异。该分析使用了1993 - 2002年健康与退休研究中70岁及以上老年人的样本。联立概率模型处理使用长期护理和与成年子女同住的联合决策。总体而言，临近死亡显著提高了使用养老院的概率50.0%，以及使用正规家庭护理的概率12.4%。非正式支持的可获得性显著降低了临近死亡的影响。在已婚老年人中，临近死亡对机构化没有影响。总之，临近死亡是长期护理使用的主要驱动因素之一，但非正式支持来源的变化，如已婚老年人比例的增加，可能会降低其在塑造长期护理需求方面的重要性。
