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The European Journal of Public Health Advance Access originally published online on March 13, 2009
The European Journal of Public Health 2009 19(3):313-318; doi:10.1093/eurpub/ckp028
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© The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Health Services Research

Age and closeness of death as determinants of health and social care utilization: a case-control study

Leena Forma1, Pekka Rissanen1, Mari Aaltonen1, Jani Raitanen1 and Marja Jylhä1,2

1 Tampere School of Public Health, University of Tampere, Finland
2 Institute for Social Research, University of Tampere, Finland

Correspondence: Leena Forma, Tampere School of Public Health, FI-33014 University of Tampere, Finland, tel: +358 3 3551 8389, fax: +358 3 3551 6057, e-mail: leena.forma{at}uta.fi

Received September 12, 2008 , accepted February 1, 2009

Background: We used case-control design to compare utilization of health and social services between older decedents and survivors, and to identify the respective impact of age and closeness of death on the utilization of services. Methods: Data were derived from multiple national registers. The sample consisted of 56 001 persons, who died during years 1998–2000 at the age of ≥70, and their pairs matched on age, gender and municipality of residence, who were alive at least 2 years after their counterpart's death. Data include use of hospitals, long-term care and home care. Decedents’ utilization within 2 years before death and survivors’ utilization in the same period of time was assessed in three age groups (70–79, 80–89 and ≥90 years) and by gender. Results: Decedents used hospital and long-term care more than their surviving counterparts, but the time patterns were different. In hospital care the differences between decedents and survivors rose in the last months of the study period, whereas in long-term care there were clear differences during the whole 2-year period. The differences were smaller in the oldest age group than in younger age groups. Conclusion: Closeness of death is an important predictor of health and social service use in old age, but its influence varies between age groups. Not only the changing age structure, but also the higher average age at death affects the future need for services.

Keywords: aged, case-control studies, health services, long-term care, utilization


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