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Scandinavian Journal of Public Health, Vol. 36, No. 1,
35-43 (2008)
DOI: 10.1177/1403494807086421
Why older people living with a spouse are less likely to be institutionalized: The role of socioeconomic factors and health characteristics
Elina Nihtilä
Population Research Unit, Department of Sociology, University of Helsinki, Finland, Elina.k.nihtila{at}helsinki.fi
Pekka Martikainen
Helsinki Collegium for Advanced Studies, University of Helsinki, Finland
Aims: To examine whether the lower risk of institutionalization among older adults living with a spouse as compared with those living alone or with other persons could be explained by socioeconomic factors, housing, and chronic medical conditions. Methods: We used population-based follow-up data on Finnish adults aged 65 years and over (N=280,722), covering the period from January 1998 to September 2003, to analyse the risk of entering into long-term institutional care by living arrangements. Kaplan-Meier estimates and Cox regression models were applied. Results: Among men, those living alone had a 70% higher risk and those living with other persons a 56% higher risk of being institutionalized than those living with a spouse, independently of age, region, and urbanicity. The corresponding figures for women were 29% and 21%. Among men, the lower risk of institutionalization among those living with a spouse than among those living alone was partly explained by higher educational level, occupation-based social class, household income, home ownership, house type, better housing conditions, and lower likelihood of having depressive symptoms. Almost the same factors helped to explain the lower risk among women, except that those living with a spouse were not advantaged in terms of education or having fewer chronic diseases. Conclusions: As controlling for socioeconomic factors, housing and health characteristics explained only 35-43% of the lower risk of institutionalization among those living with a spouse as compared to those living alone, having a spouse seems to have a major independent role in preventing and delaying institutionalization among older men and women.
Key Words: Aged • Finland • institutionalization • living arrangements • population register • prospective studies
References
- Economic Policy Committee, Budgetary challenges posed by ageing populations: the impact on public spending, health and long-term care for the elderly and possible indicators of long-term sustainability on public spending. Brussels: Directorate General for Economic and Financial Affairs of the European Commission; 2001.
- Hujanen T. Terveydenhuollon yksikkokustannukset Suomessa vuonna 2001. Aiheita 1/2003. Helsinki: Stakes; 2003.
- Daatland SO What are families for? On family solidarity and preferences for help. Ageing Society 1990;10:1-15.
- Branch LG, Jette AM A prospective study of long-term care institutionalization among the aged. Am J Public Health 1982;72:1373-9.[Abstract/Free Full Text]
- Shapiro E., Tate R. Who is really at risk of institutionalization? Gerontologist 1988;28:237-45.[ISI][Medline]
[Order article via Infotrieve]
- Steinbach U. Social networks, institutionalization, and mortality among elderly people in the United States. J Gerontol 1992;47:S183-90.[ISI][Medline]
[Order article via Infotrieve]
- Wolinsky FD, Callahan CM, Fitzgerald JF, Johnson RJ The risk of nursing home placement and subsequent death among older adults. J Gerontol 1992;47:S173-82.[ISI][Medline]
[Order article via Infotrieve]
- Aguero-Torres H., von Strauss E., Viitanen M., Winblad B., Fratiglioni L. Institutionalization in the elderly: the role of chronic diseases and dementia. Cross-sectional and longitudinal data from a population-based study. J Clin Epidemiol 2001;54:795-801.[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- Tomiak M., Berthelot JM, Guimond E., Mustard CA Factors associated with nursing-home entry for elders in Manitoba, Canada. J Gerontol A Biol Sci Med Sci 2000;55:M279-87.[Abstract/Free Full Text]
- Foley DJ, Ostfeld AM, Branch LG, Wallace RB, McGloin J., Cornoni-Huntley JC The risk of nursing home admission in three communities. J Aging Health 1992;4:155-73.[Abstract/Free Full Text]
- Breeze E., Sloggett A., Fletcher A. Socioeconomic and demographic predictors of mortality and institutional residence among middle aged and older people: results from the Longitudinal Study. J Epidemiol Community Health 1999;53:765-74.[Abstract]
- Grundy EMD. Socio-demographic variations in rates of movement into institutions among elderly people in England and Wales: an analysis of linked census and mortality data 1971-1985. Population Studies 1992;46:65-84.[CrossRef]
- Grundy E., Glaser K. Trends in, and transitions to, institutional residence among older people in England and Wales, 1971-91. J Epidemiol Community Health 1997;51: 531-40.[Abstract]
- Grundy E., Jitlal M. Socio-demographic variations in moves to institutional care 1991-2001: a record linkage study from England and Wales. Age Ageing 2007;36:424-30.[Abstract/Free Full Text]
- Greene VL, Ondrich JI Risk factors for nursing home admissions and exits: a discrete-time hazard function approach. J Gerontol 1990;45:S250-8.[ISI][Medline]
[Order article via Infotrieve]
- Yaffe K., Fox P., Newcomer R., Sands L., Lindquist K., Dane K., et al. Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA 2002;287:2090-7.[Abstract/Free Full Text]
- Liu K., Coughlin T., McBride T. Predicting nursing-home admission and length of stay. A duration analysis. Med Care 1991;29:125-41.[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- Official Statistics of Finland. Care and Services for Older People 2002. SVT: Social Security 2003:1. Helsinki: National Research and Development Centre for Welfare and Health (STAKES); 2003.
- Sund R., Kauppinen S. Kuinka laskea ikaantyneiden pitkaaikaisasiakkaiden maaria rekisteritietojen perusteella? [How to determine the number of older people in long-term care using register-based data?]. Sosiaalilaaketieteellinen aikakauslehti 2005;42:137-44.
- Statistics Finland, Perheasema [Family status]. Available at: http://tilastokeskus.fi/tk/tt/luokitukset/lk/perheasema_index.html (accessed 20 July 2007).
- Wikipedia vt. Suomen maakunnat [Finnish regions]. 1997. Available at: http://fi.wikipedia.org/wiki/Luokka:Suomen_maakunnat (accessed 11 November 2006).
- OECDThe OECD list of social indicators. Paris: OECD; 1982.
- STAKES [National Research and Development Centre for Welfare and Health]. Second edition of Finnish version of the International Statistical Classification of Diseases and Related Health Problems, tenth revision, Vol. 1. Helsinki: STAKES; 1999.
- Social Insurance Institution, Statistical Yearbook of the Social Insurance Institution, Finland, 1997, Tl:33. Helsinki: Social Insurance Institution; 1998.
- Laakelaitos [National Agency for medicines]. Laakkeiden luokitus (ATC) ja maaritellyt vuorokausiannokset (DDD) [Classification of medicines (ATC) and defined daily doses (DDD)]. Helsinki: Laakelaitos; 1997.
- Laakelaitos [National Agency for medicines]. Laakkeiden luokitus (ATC) ja maaritellyt vuorokausiannokset (DDD) [Classification of medicines (ATC) and defined daily doses (DDD)]. Helsinki: Laakelaitos; 1998.
- Nihtila EK, Martikainen PT, Koskinen SVP, Reunanen AR, Noro AM, Hakkinen UT Chronic conditions and the risk of long-term institutionalization among older people. Eur J Public Health 2008 (in press).
- Stata Corporation. Stata statistical software. Special Edition. Release 9.2. College Station, TX: Stata Corporation; 2006.
- Freedman VA Family structure and the risk of nursing home admission. J Gerontol B Psychol Sci Soc Sci 1996;51:S61-9.[Abstract]
- Ross CE Reconceptualizing marital status as a continuum of social attachment. J Marriage Fam 1995;57: 129-40.[CrossRef][ISI]
- Joung IM, Stronks K., van de Mheen H., Mackenbach JP Health behaviours explain part of the differences in self reported health associated with partner/marital status in The Netherlands. J Epidemiol Community Health 1995;49: 482-8.[Abstract]
- Glaser K., Murphy M., Grundy E. Limiting long-term illness and household structure among people aged 45 and over, Great Britain 1991. Ageing Society 1997;17:3-19.[CrossRef][ISI]
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