Pär Schön

Impact of living alone on institutionalization and mortality: a population-based longitudinal study

BACKGROUND Living alone is common among elderly people in Western countries, and studies on its relationship with institutionalization and all-cause mortality have shown inconsistent results. We investigated that the impact of living alone on institutionalization and mortality in a population-based cohort of elderly people. METHODS Data originate from the Swedish National study on Aging and Care-Kungsholmen. Participants aged ≥66 years and living at home (n = 2404) at baseline underwent interviews and clinical examination. Data on living arrangements were collected in interviews. All participants were followed for 6 years; survival status and admission into institutions were tracked continuously through administrative registers from 2001 to 2007. Data were analysed using Cox proportional hazard models, competing risk regressions and Laplace regressions with adjustment for potential confounders. RESULTS Of the 2404 participants, 1464 (60.9%) lived alone at baseline. During the follow-up, 711 (29.6%) participants died, and 185 (15.0%) were institutionalized. In the multi-adjusted Cox model, the hazard ratio (HR) of mortality in those living alone was 1.35 (95% confidence interval [CI] 1.18 to 1.54), especially among men (HR = 1.44, 95% CI 1.18 to 1.76). Living alone shortened survival by 0.6 years and was associated with the risk of institutionalization (HR = 1.74, 95% CI 1.10 to 2.77) after taking death into account as a competing risk. CONCLUSIONS Living alone is associated with elevated mortality, especially among men and an increased risk of institutionalization. Over a 6-year period, living alone was related to a half year reduction in survival among elderly people in Sweden.

Gender differences in associations between ADL and other health indicators in 1992 and 2002.

Background and aims: Research has shown increased prevalence rates over time in several health indicators in the older population. These increases have not been accompanied by corresponding increases in ADL and IADL disability. As disability and other health indicators follow different trends, the associations between them may change. And, as both health and disability also appear to follow different trends for men and women, we can expect gender differences in the associations. We examined gender differences in how objective tests of function, as well as self-reported health and function indicators, were associated with ADL/IADL in 1992 and 2002. Methods: Data came from the Swedish Panel Study of Living Conditions among the Oldest Old (SWEOLD), a nationally representative interview survey of persons aged 77+. Results: Compared with men, women had significantly higher prevalence rates for most health indicators in both survey years, but there were no significant gender differences in ADL/IADL limitations. Prevalence rates increased significantly between 1992 and 2002 for all health indicators, but not for ADL/IADL. Most of the associations between ADL/IADL and other health indicators were stronger for men than for women. The overall pattern found was that associations have become weaker for women over time; for men, the picture was mixed. Conclusions: The changing associations between ADL/IADL and other health indicators may reflect complex interplay between changes in several social and environmental factors, some of which may be modifiable. ADL/IADL appear to reflect different dimensions of health and different kinds of needs for men and women.

Healthy life years in old age: Swedish development 1980-2010 according to different health indicators.

Aims: To investigate the development of healthy life expectancy from 65 years (HLE65) in Sweden in the period 1980 and 2010 by using two different health indicators: self-rated health and the global activity limitation indicator (GALI). Methods: Sources of data for the HLE computations were Swedish national mortality statistics and the nationwide Swedish Survey of Living Conditions (SSLC), which have been conducted biennially by Statistics Sweden since 1974. We used the Sullivan method for calculations of HLE. A decomposition into mortality and disability effect has been made in accordance with the method devised by Nusselder. Results: Life expectancy at age 65 (LE65) increased by 3.1 years for women and 4.0 years for men from 1980/85 to 2006/11. Regardless of which health measure investigated – self-rated health or GALI – HLE65 increased between the periods 1980/85 to 2006/2011 more rapidly than LE65 and as a consequence the years with bad self-rated health and years with activity limitations decreased. These increases as well as the decreases were significant (p<0.05). Conclusions: The Swedish LE65 and HLE65 development, as judged by the SSLC study, are compatible with the postponement hypothesis and there is even a clear tendency for compression. Thus, the years with bad self-rated health and years with activity limitations are postponed to a higher age and the number of those years have decreased. From this respect, the Swedish development looks positive. The need of old age care in 2010 would have been much higher if it had been expansion – not postponement – of bad self-rated health and years with activity limitations during the time period.

Planned and Unplanned Hospital Admissions and Their Relationship with Social Factors: Findings from a National, Prospective Study of People Aged 76 Years or Older

Objective To examine the relationship between social factors and planned and unplanned hospital admissions among older people. Data Sources/Study Setting 2011 data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and data from the Swedish National Patient Register until December 31, 2012. Study Design The study had a prospective design. Data were analyzed via Cox proportional hazard regressions with variables entered as blocks (social factors, sociodemographic and ability factors, health factors). Data Collection Data were collected via interviews with people aged 76+ (n = 931). Principal Findings Living in institutions was negatively associated with planned admissions (hazard ratio (HR): 0.29; confidence interval (CI): 0.09–0.88), while being in receipt of home help was positively associated with unplanned admissions (HR: 1.57; CI: 1.15–2.14). Low levels of social contacts and social activity predicted unplanned admissions in bivariate analyses only. Higher ability to deal with public authorities was positively associated with planned admissions (HR: 1.77; CI: 1.13–2.78) and negatively associated with unplanned admissions, although the latter association was only significant in the bivariate analysis. Conclusions Hospital admissions are not only due to health problems but are also influenced by the social care situation and by the ability to deal with public authorities.

Towards a postponement of activities of daily living dependence and mobility limitations: Trends in healthy life years in old age in Sweden

Aims: To investigate the development of healthy life expectancy from 65 years (HLE65) in Sweden in the period 1980–2011 using the health indicators activities of daily living (ADL) and mobility limitations within the framework of the postponement, compression and expansion theories. Methods: Sources of data for the HLE computations were Swedish national mortality statistics and the nationwide Swedish Surveys of Living Conditions, conducted biennially by Statistics Sweden since 1974. We used the Sullivan method for calculations of HLE and a decomposition into mortality and disability effects was made. Results: Life expectancy at age 65 (LE65) increased by 3.1 years for women and 4.0 years for men from 1980–1985 to 2006–2011. HLE65 calculated according to ADL and mobility limitations increased more rapidly than LE65 for both men and women (p<0.05). Conclusions: Our results for trends in the Swedish LE65 and HLE65, computed on the basis of ADL and mobility limitations and using the Swedish Surveys of Living Conditions study, are in line with the postponement hypothesis and there is also a tendency for compression. Thus the years with ADL dependence and mobility limitations are postponed to a higher age and the numbers of these years have decreased.