title: Long-term care use among old people in their last 2 years of life: variations across Finland.
abstract: Variations across Finland in the use of six different long-term care (LTC) services among old people in their last 2 years of life, and the effects of characteristics of municipalities on the variations were studied. We studied variations in the use of residential home, sheltered housing, regular home care and inpatient care in health centre wards by using national registers. We studied how the use of LTC was associated with characteristics of the individuals and in particular characteristics of the municipalities in which they lived. Analyses were conducted with multilevel binary logistic regression. Data included all individuals (34,753) who died in the year 2008 at the age of 70 or over. Of those, 58.3% used some kind of LTC during their last 2 years of life. We found considerable variations between municipalities in the use of different kinds of LTC. A portion of the variation was explained by municipality characteristics. The size and location of the municipality had the strongest association with the use of different kinds of LTC. The economic status of the municipality and morbidity at the population level were poorly associated with LTC use, whereas old-age dependency showed no association. When individual-level characteristics were added to the models, these associations did not alter. Results indicated that the delivery system characteristics had an important effect on the use of LTC services. The considerable variation in LTC services also poses questions with respect to equity in access and to quality of LTC across the country.
authors: Gerontology Research Center, School of Health Sciences, University of Tampere, Tampere, Finland.
authors: Jutta
authors: J
authors: Pulkki
authors: Gerontology Research Center, School of Health Sciences, University of Tampere, Tampere, Finland.
authors: Marja
authors: M
authors: Jylhä
authors: Gerontology Research Center, School of Health Sciences, University of Tampere, Tampere, Finland.
authors: Leena
authors: L
authors: Forma
authors: Gerontology Research Center, School of Health Sciences, University of Tampere, Tampere, Finland.
authors: Mari
authors: M
authors: Aaltonen
authors: Gerontology Research Center, School of Health Sciences, University of Tampere, Tampere, Finland.
authors: Jani
authors: J
authors: Raitanen
authors: Gerontology Research Center, School of Health Sciences, University of Tampere, Tampere, Finland.
authors: Pekka
authors: P
authors: Rissanen
mesh_terms: D005387:Finland; D006268:Health Facilities; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008134:Long-Term Care
keywords: Finland; end of life; long-term care; old people; variation in care