Institutionalization of older adults after the death of a spouse.
OBJECTIVE
We investigated the risk of entering long-term institutional care after the death of a spouse in relation to the duration of widowhood among older Finnish men and women. We also examined whether high levels of education or household income buffered the effects of bereavement on institutionalization.


METHODS
We used linked register-based data on Finnish adults 65 years or older who were living with a spouse at the beginning of the study period (n=140902) and were followed from January 1998 to December 2002.


RESULTS
The excess risk of institutionalization was highest during the first month following a spouse's death compared with still living with a spouse (adjusted hazard ratio=3.31 for men, 3.62 for women). This risk decreased over time among both men and women. The relative effect of the duration of widowhood on institutionalization did not significantly vary according to the level of education or income.


CONCLUSIONS
Risk of institutionalization is particularly high immediately after the death of a spouse, demonstrating the importance of loss of social and instrumental support.
Nihtilä
Elina
E
Research Unit, Department of Sociology, University of Helsinki, Helsinki, Finland. elina.k.nihtila@helsinki.fi
Martikainen
Pekka
P
D000368:Aged; D000369:Aged, 80 and over; D001601:Bereavement; D005260:Female; D005387:Finland / Q000453:epidemiology; D006304:Health Status; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012847:Single Person / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D018454:Spouses / Q000706:statistics & numerical data*; D017805:Widowhood / Q000706:statistics & numerical data*