The European Journal of Public Health Advance Access published online on June 11, 2007
The European Journal of Public Health, doi:10.1093/eurpub/ckm025
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Chronic conditions and the risk of long-term institutionalization among older people
Elina K. Nihtilä1, Pekka T. Martikainen2, Seppo V.P. Koskinen3, Antti R. Reunanen3, Anja M. Noro4 and Unto T. Häkkinen4
1 Population Research Unit, Department of Sociology, University of Helsinki, Finland
2 Helsinki Collegium for Advanced Studies, University of Helsinki, Finland
3 Department of Health and Functional Capacity, National Public Health Institute (KTL), Finland
4 Centre for Health Economics (CHESS), National Research and Development Centre for Welfare and Health (STAKES), Finland
Correspondence: Elina K. Nihtilä, Population Research Unit, Department of Sociology, PO Box 18, FIN-00014, University of Helsinki, tel: +358 919123882, fax: +358 919123967, e-mail: elina.k.nihtila{at}helsinki.fi
Received October 11, 2006 , accepted February 26, 2007
Background: As the public expenditure on long-term care is likely to increase with the ageing of the population, identifying chronic medical conditions associated with the risk of long-term institutionalization is of particular interest. However, there is little systematic evidence showing how chronic medical conditions, other than dementia, affect the risk of entering into institutional care in the general older population. Methods: We used population-based follow-up data on Finnish older people aged 65 and over (n = 280 722), to estimate the impact of different chronic conditions on the risk of long-term institutionalization. Furthermore, we analysed which chronic conditions were more strongly associated with the risk of institutionalization than with the risk of death without institutionalization. Cox proportional hazard regression models were used. Results: Our results showed that dementia, Parkinson's disease, stroke, depressive symptoms, other mental health problems, hip fracture and diabetes were strongly associated with increased risk of long-term institutionalization, independent of socio-demographic confounders and the presence of other chronic conditions. All these conditions raised the risk of institutionalization by 50% or more. Dementia, Parkinson's disease, stroke and mental health problems were more strongly associated with the risk of institutionalization than with the risk of death without institutionalization. Conclusions: Overall, these results show that the future demand for institutional care depends not only on the ageing of the population but also on the development of the prevalence and severity of chronic conditions associated with institutionalization.
Keywords: chronic disease, follow-up study, institutionalization, older adults, population based
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