Larsson Kristina, Kåreholt Ingemar, Thorslund Mats
Department of Social Work, Aging Research Center, Karolinska Institutet/Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden.
Aging Research Center, Karolinska Institutet/Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden.
Eur J Ageing. 2008 Oct 31;5(4):349-357. doi: 10.1007/s10433-008-0099-z. eCollection 2008 Dec.
The majority of older people experience progressive disability at the end of their lives and require long-term care as a result. This study analysed patterns of care utilisation during the 5 years prior to death, particularly the effects of age and time to death in relation to the use of public elder care (i.e. home help services and institutional care) and hospital care. A longitudinal study provided data on care utilisation among participants (aged 83+) who died between 1995 and 2004 ( = 567). Almost everyone received some kind of care in the last 5 years, 91% in the last year and 88% in the last 3 months preceding death. The number of days of elder care outnumbered the number of days in hospital by ten to one. Increasing chronological age was important for receipt of home help, whereas time to death was important for admission to hospital; there was a sharp increase in the proportion treated in hospital in the last 9 months before death. The proportion residing in institutional care facilities with around-the-clock care increased steadily with a sharper gradient 6 months before death. Both age and time to death had an effect on use of institutional care, but time to death had twice the effect of increasing age. In conclusion, age and time to death have different effects depending on the type of care studied, and individual-based longitudinal data gives a very different picture of care utilisation among the oldest old compared to cross-sectional data.
大多数老年人在生命末期会出现渐进性残疾，因此需要长期护理。本研究分析了死亡前5年的护理使用模式，特别是年龄和死亡时间对公共老年护理（即居家帮助服务和机构护理）及医院护理使用的影响。一项纵向研究提供了1995年至2004年间死亡的参与者（83岁以上）的护理使用数据（n = 567）。几乎每个人在过去5年中都接受了某种护理，在去年有91%的人接受了护理，在死亡前的最后3个月有88%的人接受了护理。老年护理的天数与住院天数之比为十比一。实际年龄的增加对获得居家帮助很重要，而死亡时间对住院至关重要；在死亡前的最后9个月，住院治疗的比例急剧上升。住在提供全天候护理的机构护理设施中的比例在死亡前6个月稳步上升，且上升幅度更大。年龄和死亡时间都对机构护理的使用有影响，但死亡时间的影响是年龄增长影响的两倍。总之，年龄和死亡时间根据所研究的护理类型有不同的影响，与横断面数据相比，基于个体的纵向数据呈现出老年人群护理使用的截然不同的情况。
