Socio-demographic variations in moves to institutional care 1991-2001: a record linkage study from England and Wales.
BACKGROUND
Only a minority of older people in England and Wales live in institutional care, but among the older of the old, this minority is large. Disability is the major driver of admissions, but socio-demographic factors are also relevant. Understanding more about the influence of these is important for planning by long-term care.


OBJECTIVE
To investigate effects of socio-demographic factors, including housing tenure, household type, marital status, and number of children, on the proportions of elderly people who made a transition from living in the community in 1991 to living in institutional care in 2001.


METHODS
Nationally representative record linkage study including 36,650 people aged 65 years and over, living in the community in England and Wales in 1991, who were still alive in 2001. Nineteen thousand women aged 75-89 years in 2001 were included in additional analyses of effects of parity (number of children borne).


METHODS
Bi-variate and multivariate analyses of variations in sample proportions, who by 2001 were resident in institutional care.


RESULTS
4.3% of men and 9.3% of women in the surviving sample then aged 75 years and over, were in institutional care in 2001. Older age, living in rented accommodation, living alone in 1991 and being unmarried in 2001, as well as long-term illness, were associated with higher proportions making this transition. Women had higher risks than men. Childless women aged 64-79 years in 1991 had a 25% higher risk than women with children of being in institutional care in 2001.


CONCLUSIONS
Socio-demographic factors continue to influence risks of entry to institutional care in England and Wales.
Grundy
Emily
E
Centre for Population Studies, London School of Hygiene & Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP, UK. Emily.grundy@lshtm.ac.uk
Jitlal
Mark
M
D032721:Adult Children; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D004739:England; D005260:Female; D016852:Housing for the Elderly / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization / Q000191:economics / Q000639:trends*; D008134:Long-Term Care / Q000191:economics / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D017533:Marital Status; D008498:Medical Record Linkage; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014852:Wales