Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Institute of Health and Society, University of Oslo, Oslo, Norway; Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
Ann Palliat Med. 2024 May;13(3):496-512. doi: 10.21037/apm-23-269. Epub 2024 Apr 29.
Time at home at end-of-life is perceived as valuable to individuals. Increasing home care is therefore often a political goal. Yet, little is known about where individuals live towards their end-of-life. Our aim was to describe where individuals reside their last 6 months of life in Finland and Norway, and how this differed by cause of death, sex, age, marital status, and income.
We used individual-leveled national registry data on all decedents aged >70 years in 2009-2013 to describe the number of days individuals spent at home, in hospital, in long-term care (LTC) and short-term care (STC) facilities. We described the place of residence for all and by causes of death: cancer, diseases of the circulatory system, disease in the respiratory system, and mental and behavioral disorders (primarily dementia). We analyzed how age, marital status (indicating informal care), and income associated with place of residence. Analyses were stratified by sex and country.
During the last 6 months of life, decedents in Finland (n=186,017) and Norway (n=159,756) spent similar amounts of days in hospital (8 and 11 days) and in STC facilities (15 and 13 days). Finnish decedents spent more days at home (96 vs. 84 days) and fewer days in LTC facilities (64 vs. 80 days). Living arrangement differed similarly by cause of death in the two countries, e.g., decedents from cancer and mental and behavioral disorders spent 123 [113] vs. 29 [21] days at home in Finland (Norway). In both countries, for all causes of death, lower age and marital status were associated with more days at home, for both males and females. While those with higher income spent more days at home in Norway, the opposite was found in Finland.
Older individual's living arrangements in the last 6 months of life were similar in Finland and Norway but differed by cause of death. Younger individuals and those with access to informal care spent more days at home, compared to their counterparts. With aging populations, more individuals will likely need LTC at their end of life. Policies should align with these needs when developing future health care services.
在家度过生命末期被认为是有价值的。因此，增加家庭护理通常是一个政治目标。然而，人们对个人在生命末期的居住地知之甚少。我们的目的是描述 2009-2013 年间芬兰和挪威的个人在生命的最后 6 个月中居住在哪里，以及死因、性别、年龄、婚姻状况和收入如何影响他们的居住地。
我们使用个体层面的全国登记数据，对所有 2009-2013 年年龄大于 70 岁的死者进行描述，内容包括个人在家中、医院、长期护理（LTC）和短期护理（STC）设施中度过的天数。我们描述了所有死者的居住地，并按死因进行了分类：癌症、循环系统疾病、呼吸系统疾病以及精神和行为障碍（主要是痴呆症）。我们分析了年龄、婚姻状况（表明非正式护理）和收入与居住地的关系。分析按性别和国家进行分层。
在生命的最后 6 个月中，芬兰（n=186017）和挪威（n=159756）的死者在医院（8 天和 11 天）和 STC 设施（15 天和 13 天）中度过的天数相似。芬兰死者在家中度过的天数更多（96 天比 84 天），在 LTC 设施中度过的天数更少（64 天比 80 天）。两国的死因也导致了类似的生活安排，例如，癌症和精神行为障碍导致的死者在芬兰家中度过了 123[113]天，而在挪威仅度过了 29[21]天。在这两个国家，所有死因的死者中，年龄较小和婚姻状况较差的人在家中的天数更多，男性和女性都是如此。而收入较高的人在挪威在家中的天数更多，而在芬兰则相反。
芬兰和挪威在生命的最后 6 个月中，老年人的生活安排相似，但死因不同。与同龄人相比，年轻的个体和有机会获得非正式护理的人在家中的天数更多。随着人口老龄化，更多的人在生命末期可能需要长期护理。在制定未来医疗保健服务时，政策应根据这些需求进行调整。
