title: Who Lives Where and Does It Matter? Changes in the Health Profiles of Older People Living in Long Term Care and the Community over Two Decades in a High Income Country.
abstract: BACKGROUND
  There have been fundamental shifts in the attitude towards, access to and nature of long term care in high income countries. The proportion and profile of the older population living in such settings varies according to social, cultural, and economic characteristics as well as governmental policies. Changes in the profiles of people in different settings are important for policy makers and care providers. Although details will differ, how change occurs across time is important to all, including lower and middle income countries developing policies themselves. Here change is examined across two decades in England.
  
  
  RESULTS
  Using the two Cognitive Function and Ageing Studies (CFAS I: 77% response, CFAS II: 56% response), two population based studies of older people carried out in the same areas conducted two decades apart, the study diagnosis of dementia using the Automated Geriatric Examination for Computer Assisted Taxonomy, health and wellbeing were examined, focusing on long term care. The proportion of individuals with three or more health conditions increased for everyone living in long term care between CFAS I (47.6%, 95% CI: 42.3-53.1) and CFAS II (62.7%, 95% CI: 54.8-70.0) and was consistently higher in those without dementia compared to those with dementia in both studies. Functional impairment measured by activities of daily living increased in assisted living facilities from 48% (95% CI: 44%-52%) to 67% (95% CI: 62%-71%).
  
  
  CONCLUSIONS
  Health profiles of residents in long term care have changed dramatically over time. Dementia prevalence and reporting multiple health conditions have increased. Receiving care in the community puts pressure on unpaid carers and formal services; these results have implications for policies about supporting people at home as well as for service provision within long term care including quality of care, health management, cost, and the development of a skilled, caring, and informed workforce.
authors: MRC Biostatistics Unit, Cambridge Biomedical Campus, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, England.|Newcastle University Institute of Health & Society, Newcastle University, Edwardson Building, Campus for Ageing and Vitality, Newcastle upon Tyne, England.
authors: Fiona E
authors: FE
authors: Matthews
authors: Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, England.
authors: Holly
authors: H
authors: Bennett
authors: Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England.
authors: Raphael
authors: R
authors: Wittenberg
authors: Newcastle University Institute of Health & Society, Newcastle University, Edwardson Building, Campus for Ageing and Vitality, Newcastle upon Tyne, England.
authors: Carol
authors: C
authors: Jagger
authors: Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, England.
authors: Tom
authors: T
authors: Dening
authors: Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, England.
authors: Carol
authors: C
authors: Brayne
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D040561:Assisted Living Facilities; D003704:Dementia / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D015995:Prevalence; D011788:Quality of Life; D012111:Residence Characteristics; D012959:Socioeconomic Factors