Psychological distress has been indicated to affect the risk of death from cardiovascular disease, cancer, and external causes. Mortality from these major causes of death is also known to be elevated after widowhood when distress is at a heightened level. Surprisingly little is known about changes in health other than mental and cardiac health shortly before widowhood. We used longitudinal data of widowing (n=19,185) and continuously married individuals (n=105,939) in Finland (1996-2002) to assess the risk of hospitalization for cancer and the external and musculoskeletal causes surrounding widowhood or random dates. The study employed population-averaged logit models for longitudinal data of older adults aged 65 and over. The results show that hospitalization for injuries had already increased prior to widowhood and clearly peaked after it. The increases were largely related to falls. A similar increasing pattern of findings was not found around a random date for a group of continuously married individuals. Hospitalizations for cancer and musculoskeletal disorders appeared to be unrelated to the process of widowhood. Hospitalizations for poisonings increased after widowhood. The results imply that the process of widowhood is multifaceted and that various types of health changes should be studied separately and already before the actual loss.
OBJECTIVES: The effects of socio-demographic and economic factors on institutional long-term care (LTC) among people with dementia remain unclear. Inconsistent findings may relate to time-varying effects of these factors as dementia progresses. To clarify the question, we estimated institutional LTC trajectories by age, marital status and household income in the eight years preceding dementia-related and non-dementia-related deaths.
METHODS: We assessed a population-representative sample of Finnish men and women for institutional LTC over an eight-year period before death. Deaths related to dementia and all other causes at the age of 70+ in 2001-2007 were identified from the Death Register. Dates in institutional LTC were obtained from national care registers. We calculated the average and time-varying marginal effects of age, marital status and household income on the estimated probability of institutional LTC use, employing repeated-measures logistic regression models with generalised estimating equations (GEE).
RESULTS: The effects of age, marital status and household income on institutional LTC varied across the time before death, and the patterns differed between dementia-related and non-dementia-related deaths. Among people who died of dementia, being of older age, non-married and having a lower income predicted a higher probability of institutional LTC only until three to four years before death, after which the differences diminished or disappeared. Among women in particular, the probability of institutional LTC was nearly equal across age, marital status and income groups in the last year before dementia-related death. Among those who died from non-dementia-related causes, in contrast, the differences widened until death.
CONCLUSIONS: We show that individuals with dementia require intensive professional care at the end of life, regardless of their socio-demographic or economic resources. The results imply that the potential for extending community living for people with dementia is likely to be difficult through modification of their socio-demographic and economic environments.
BACKGROUND: Several studies have found that the loss of a child is associated with psychiatric health problems, yet few studies examined whether child loss influences psychotropic medication use. This study examined short- and long-term use of psychotropic medication, both before and after the death of a child, and its potential effect modifiers.
METHODOLOGY/PRINCIPAL FINDINGS: A random sample of 205,456 parents, including 902 bereaved parents, were selected from a Finnish total population registry. The analyses were based on linear regressions using generalised estimation equations (GEE) and adjusted for sociodemographic factors. Annual psychotropic use was defined as having purchased prescribed psychotropic medication between 1996 and2012. Bereaved parents were followed for four years prior to and up to four years after the death of their child. An increase in the use of antidepressants and anxiolytics was found in parents following their loss. The highest percentage of use was found around one year after bereavement, followed by a steady decrease although this remained higher than the level of use among non-bereaved four years after the death. Between 20-25% of bereaved mothers and 10-15% of bereaved fathers used antidepressants or anxiolytics one year after bereavement while the corresponding number in non-bereaved was 5-10%. An increase in psychotropic medication was also found several years before the disease-related loss of a child.
CONCLUSIONS/SIGNIFICANCE: The use of psychotropic medication is markedly higher among parents after losing a child. Patterns of use leading up to and following the death of a child should be further examined in relation to clinical risk factors so as to identify at risk populations.
MEDICAL SUBJECT HEADINGS: Bereavement, child death, psychotropic medication, death, child, register, Finland.
Using nationally-representative register data for older people in Finland in period 1998-2003 we study how the number of days in acute hospital and long term institutional care services varies by age and proximity to death and how these use patterns change as mortality improves. Acute health care use depends more on proximity to death than on age, a finding often interpreted as showing that the need for care services among older people will be substantially less than would be expected based on the likely increase in population numbers. We show that this assumption is too optimistic for three reasons : (1) the increase in population numbers will be concentrated mainly among the "old old" where use of services is substantial ; (2) earlier findings of much lower use of acute care services by older than younger people who are close to death are not observed ; and (3) any savings in acute care are more than offset by greater use of residential long-term care (LTC). The main consequences of improving mortality are : (1) to postpone rather than to reduce overall demand for health care ; (2) to shift the balance of care from acute to long-term care services ; and (3) to increase considerably the average age of time spent in care. We further construct a new indicator "care-free life expectancy" based on number of days in hospital and long-term care to summarise care use patterns for cohorts under a range of plausible mortality assumptions. As mortality improves, lifetime use of acute hospital and long-term care after age 65 and the proportion of life spent in LTC increases for later cohorts, but the proportion spent in acute care decreases slightly.
Origine : BDSP. Notice produite par INIST-CNRS sAR0xoJ7. Diffusion soumise à autorisation
La fourniture des services de soins hospitaliers et à long terme pour le nombre croissant de personnes âgées est une inquiétude potilique majeure. Les auteurs estiment, dans cet article, l'utilisation des soins à l'hôpital et dans les maisons de soins par âge et proximité de la mort pour des causes de décès sélectionnées et selon le sexe, l'éducation et le status marital. Les effets de l'âge sont plus substantiels pour l'utilisation des soins dans les maisons de soins que pour celle à l'hôpital. L'usage de soins sera considérablement augmenté parmi les personnes célibataire. L'accroissement de la longévité couplé à une tendance accrue à la démence est susceptible de signifier une orientation significative vers l'utilisation de soins dans les maisons de soins dans l'avenir.
Origine : BDSP. Notice produite par INIST-CNRS FA7lR0xB. Diffusion soumise à autorisation
Objectifs : Nous avons étudié le risque d'entrer en soins institutionnels à long terme après la mort du conjoint en relation avec la durée de veuvage parmi les hommes et femmes âgés en Finlande. Nous avons également examiné si les niveaux élevés d'éducation ou de revenus du ménage atténuaient les effets du deuil sur l'institutionnalisation.
Méthodes : Nous avons utilisé des données liées au registre sur les adultes finlandais de 65 ans et plus qui vivaient avec un conjoint au début de la période d'étude (n = 140 902) et qui étaient suivis de janvier 1998 à décembre 2002.
Résultats : Le risque excédant d'institutionnalisation était le plus élevé pendant le premier mois suivant le décès du conjoint comparé à celui des personnes vivant toujours avec un conjoint (rapport de risque ajusté = 3,31 pour les hommes, 3,62 pour les femmes). Le risque décroît au cours du temps tant chez les hommes que chez les femmes. L'effet relatif de la durée de veuvage sur l'institutionnalisation ne variait pas significativement selon le niveau d'éducation ou les revenus.
Conclusions : Le risque d'institutionnalisation est particulièrement élevé immédiatement après la mort du conjoint, démontrant l'importance de la perte du soutien social et instrumental.
[Traduction du résumé fourni par le producteur]
Origine : BDSP. Notice produite par INIST-CNRS R0xqHIjH. Diffusion soumise à autorisation