Gender, living arrangements, and social circumstances as determinants of entry into and exit from long-term institutional care at older ages: a 6-year follow-up study of older Finns.
OBJECTIVE
Due to population aging, the need for long-term institutional care is increasing. We study the potentially modifiable sociodemographic factors that affect the rate of entry into and exit from long-term care.


METHODS
A 40% sample from the population registration data of Finns aged 65 and older living in private households at the end of 1997 (n = 280,722) was followed for first entry into (n = 35,926) and subsequent exit -- due to death or return to the community -- from long-term institutional care until the end of 2003.


RESULTS
Being female, old, living alone, and of low socioeconomic status increased the risk for entering long-term care. Exit was affected by the same factors, but the associations were weaker and, with the exception of age, in the opposite direction. Women's higher risk for entry was due to older age and greater likelihood of living alone. The effects of living arrangements and socioeconomic factors on entry were stronger among men and were attenuated after adjustment for each other and for health status. The mean duration of care was 1,064 days among women and 686 among men.


CONCLUSIONS
Gender, age, living arrangements, and socioeconomic status are major determinants of institutional residence. Women and certain other population groups, e.g., those living alone, are likely to spend a longer time in institutional care because of higher rates of entry and lower rates of exit. These results have implications for the financing of long-term care and for targeting of interventions aimed at delaying it.
Martikainen
Pekka
P
Population Research Unit, Department of Sociology, University of Helsinki, Helsinki, Finland. pekka.martikainen@helsinki.fi
Moustgaard
Heta
H
Murphy
Michael
M
Einiö
Elina K
EK
Koskinen
Seppo
S
Martelin
Tuija
T
Noro
Anja
A
D000368:Aged; D000369:Aged, 80 and over; D019992:Databases as Topic; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007902:Length of Stay; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D018570:Risk Assessment; D012923:Social Class