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

https://arctichealth.org/en/permalink/ahliterature152068
Source
Eur J Public Health. 2009 Jun;19(3):313-8
Publication Type
Article
Date
Jun-2009
Author
Leena Forma
Pekka Rissanen
Mari Aaltonen
Jani Raitanen
Marja Jylhä
Author Affiliation
Tampere School of Public Health, University of Tampere, Finland. leena.forma@uta.fi
Source
Eur J Public Health. 2009 Jun;19(3):313-8
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Case-Control Studies
Female
Finland
Health Services - utilization
Home Care Services - utilization
Hospitalization - statistics & numerical data
Humans
Long-Term Care - utilization
Male
Sex Factors
Social Work - statistics & numerical data
Terminal Care - utilization
Terminally Ill - statistics & numerical data
Time Factors
Abstract
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.
Data were derived from multiple national registers. The sample consisted of 56,001 persons, who died during years 1998-2000 at the age of > or = 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 > or = 90 years) and by gender.
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.
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.
PubMed ID
19286838 View in PubMed
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Burden of illness and use of health care services before and after celiac disease diagnosis in children.

https://arctichealth.org/en/permalink/ahliterature107934
Source
J Pediatr Gastroenterol Nutr. 2013 Jul;57(1):53-6
Publication Type
Article
Date
Jul-2013
Author
Eeva Mattila
Kalle Kurppa
Anniina Ukkola
Pekka Collin
Heini Huhtala
Leena Forma
Marja-Leena Lähdeaho
Leila Kekkonen
Markku Mäki
Katri Kaukinen
Author Affiliation
School of Medicine, University of Tampere, Tampere, Finland.
Source
J Pediatr Gastroenterol Nutr. 2013 Jul;57(1):53-6
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Celiac Disease - diagnosis - diet therapy - physiopathology - therapy
Child
Child, Preschool
Cohort Studies
Cost of Illness
Diet, Gluten-Free
Dietary Supplements
Early Diagnosis
Family
Female
Finland
Follow-Up Studies
Health Care Surveys
Humans
Infant
Male
Patient Acceptance of Health Care
Prospective Studies
Retrospective Studies
Abstract
Prevalence of celiac disease in children is approximately 1%, but most patients remain unrecognized by reason of variable clinical presentation. Undetected patients may have an increased burden of illness and use of health care services because of nonspecific complaints. We investigated these issues prospectively in newly detected patients with celiac disease before and after diagnosis in a large nationwide cohort of children.
A validated questionnaire was sent to consecutive families whose children had been diagnosed as having celiac disease within 1 year. The survey contained questions about the use of medical consultations, on-demand drugs, vitamins and herbal products, children's absenteeism from day care or school and, parents' work absenteeism. A follow-up questionnaire was sent after 1 year of receiving a gluten-free diet.
A total of 132 families responded. A total of 44 children were diagnosed because of gastrointestinal and 88 because of extraintestinal symptoms or by risk-group screening. On treatment, outpatient visits to primary health care decreased from a mean of 3.0 to 1.3 visits per year (P
PubMed ID
23961546 View in PubMed
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Burdensome transitions at the end of life among long-term care residents with dementia.

https://arctichealth.org/en/permalink/ahliterature262778
Source
J Am Med Dir Assoc. 2014 Sep;15(9):643-8
Publication Type
Article
Date
Sep-2014
Author
Mari Aaltonen
Jani Raitanen
Leena Forma
Jutta Pulkki
Pekka Rissanen
Marja Jylhä
Source
J Am Med Dir Assoc. 2014 Sep;15(9):643-8
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Continuity of Patient Care
Dementia - mortality
Female
Finland - epidemiology
Hospitalization - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Long-Term Care
Male
Patient Transfer - statistics & numerical data
Registries
Retrospective Studies
Terminal Care - statistics & numerical data
Abstract
The purpose of the study was to examine the frequency of burdensome care transitions at the end of life, the difference between different types of residential care facilities, and the changes occurring between 2002 and 2008.
A nationwide, register-based retrospective study.
Residential care facilities offering long-term care, including traditional nursing homes, sheltered housing with 24-hour assistance, and long-term care facilities specialized in care for people with dementia.
All people in Finland who died at the age of 70 or older, had dementia, and were in residential care during their last months of life.
Three types of potentially burdensome care transition: (1) any transition to another care facility in the last 3 days of life; (2) a lack of continuity with respect to a residential care facility before and after hospitalization in the last 90 days of life; (3) multiple hospitalizations (more than 2) in the last 90 days of life. The 3 types were studied separately and as a whole.
One-tenth (9.5%) had burdensome care transitions. Multiple hospitalizations in the last 90 days were the most frequent, followed by any transitions in the last 3 days of life. The frequency varied between residents who lived in different baseline care facilities being higher in sheltered housing and long-term specialist care for people with dementia than in traditional nursing homes. During the study years, the number of transitions fluctuated but showed a slight decrease since 2005.
The ongoing change in long-term care from institutional care to housing services causes major challenges to the continuity of end-of-life care. To guarantee good quality during the last days of life for people with dementia, the underlying reasons behind transitions at the end of life should be investigated more thoroughly.
PubMed ID
24913211 View in PubMed
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Changes in older people's care profiles during the last 2 years of life, 1996-1998 and 2011-2013: a retrospective nationwide study in Finland.

https://arctichealth.org/en/permalink/ahliterature293459
Source
BMJ Open. 2017 Dec 01; 7(11):e015130
Publication Type
Journal Article
Date
Dec-01-2017
Author
Mari Aaltonen
Leena Forma
Jutta Pulkki
Jani Raitanen
Pekka Rissanen
Marja Jylha
Author Affiliation
Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, University of Tampere, Tampere, Finland.
Source
BMJ Open. 2017 Dec 01; 7(11):e015130
Date
Dec-01-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Cross-Sectional Studies
Dementia - epidemiology
Female
Finland - epidemiology
Home Care Services - statistics & numerical data
Homes for the Aged
Hospitalization - statistics & numerical data
Humans
Long-Term Care - statistics & numerical data
Male
Nursing Homes - statistics & numerical data
Patient Transfer - statistics & numerical data
Registries
Retrospective Studies
Terminal Care - statistics & numerical data
Time Factors
Abstract
The time of death is increasingly postponed to a very high age. How this change affects the use of care services at the population level is unknown. This study analyses the care profiles of older people during their last 2?years of life, and investigates how these profiles differ for the study years 1996-1998 and 2011-2013.
Retrospective cross-sectional nationwide data drawn from the Care Register for Health Care, the Care Register for Social Care and the Causes of Death Register. The data included the use of hospital and long-term care services during the last 2?years of life for all those who died in 1998 and in 2013 at the age of =70 years in Finland.
We constructed four care profiles using two criteria: (1) number of days in round-the-clock care (vs at home) in the last 2?years of life and (2) care transitions during the last 6?months of life (ie, end-of-life care transitions).
Between the study periods, the average age at death and the number of diagnoses increased. Most older people (1998: 64.3%, 2013: 59.3%) lived at home until their last months of life (profile 2) after which they moved into hospital or long-term care facilities. This profile became less common and the profiles with a high use of care services became more common (profiles 3 and 4 together in 1998: 25.0%, in 2013: 30.9%). People with dementia, women and the oldest old were over-represented in the latter profiles. In both study periods, fewer than one in ten stayed at home for the whole last 6?months (profile 1).
Postponement of death to a very old age may translate into more severe disability in the last months or years of life. Care systems must be prepared for longer periods of long-term care services needed at the end of life.
Notes
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PubMed ID
29196476 View in PubMed
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Dementia as a determinant of social and health service use in the last two years of life 1996-2003.

https://arctichealth.org/en/permalink/ahliterature135510
Source
BMC Geriatr. 2011;11:14
Publication Type
Article
Date
2011
Author
Leena Forma
Pekka Rissanen
Mari Aaltonen
Jani Raitanen
Marja Jylhä
Author Affiliation
School of Health Sciences, FI-33014 University of Tampere, Finland. leena.forma@uta.fi
Source
BMC Geriatr. 2011;11:14
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cause of Death - trends
Dementia - mortality - psychology - therapy
Female
Finland - epidemiology
Home Care Services - trends
Hospitalization - trends
Humans
Long-Term Care - psychology - trends
Male
Patient Acceptance of Health Care - psychology
Registries
Social Work - trends
Abstract
Dementia is one of the most common causes of death among old people in Finland and other countries with high life expectancies. Dementing illnesses are the most important disease group behind the need for long-term care and therefore place a considerable burden on the health and social care system. The aim of this study was to assess the effects of dementia and year of death (1998-2003) on health and social service use in the last two years of life among old people.
The data were derived from multiple national registers in Finland and comprise all those who died in 1998, 2002 or 2003 and 40% of those who died in 1999-2001 at the age of 70 or over (n = 145 944). We studied the use of hospitals, long-term care and home care in the last two years of life. Statistics were performed using binary logistic regression analyses and negative binomial regression analyses, adjusting for age, gender and comorbidity.
The proportion of study participants with a dementia diagnosis was 23.5%. People with dementia diagnosis used long-term care more often (OR 9.30, 95% CI 8.60, 10.06) but hospital (OR 0.33, 95% CI 0.31, 0.35) and home care (OR 0.50, 95% CI 0.46, 0.54) less often than people without dementia. The likelihood of using university hospital and long-term care increased during the eight-year study period, while the number of days spent in university and general hospital among the users decreased. Differences in service use between people with and without dementia decreased during the study period.
Old people with dementia used long-term care to a much greater extent and hospital and home care to a lesser extent than those without dementia. This difference persisted even when controlling for age, gender and comorbidity. It is important that greater attention is paid to ensuring that old people with dementia have equitable access to care.
Notes
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PubMed ID
21470395 View in PubMed
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Effects of municipality factors on care transitions.

https://arctichealth.org/en/permalink/ahliterature114573
Source
Scand J Public Health. 2013 Aug;41(6):604-15
Publication Type
Article
Date
Aug-2013
Author
Mari Aaltonen
Leena Forma
Pekka Rissanen
Jani Raitanen
Marja Jylhä
Author Affiliation
Gerontology Research Center and School of Health Sciences, University of Tampere, Tampere, Finland. mari.s.aaltonen@uta.fi
Source
Scand J Public Health. 2013 Aug;41(6):604-15
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cities
Continuity of Patient Care - statistics & numerical data
Female
Finland
Health Facilities - utilization
Home Care Services - utilization
Humans
Male
Registries
Residence Characteristics - statistics & numerical data
Socioeconomic Factors
Time Factors
Abstract
To analyse whether transitions between care settings differ between municipalities in the last 2 years of life among older people in Finland.
Data were derived from Finnish national registers, and include all those who died in 2002 and 2003 at the age of 70 or older except those living in very small municipalities (n=67,027). Data include admissions and discharges from health and social care facilities (university hospitals, general hospitals, health centres, residential care facilities) and time spent outside care facilities for 730 days prior to death. Three-level negative binomial regression analyses were performed to study the effect of municipal factors on (1) the total number of all care transitions, (2) the number of transitions between home and different care facilities, and (3) transitions between different care facilities.
The municipality of residence had only a minor effect on the total number of care transitions, but greater variation between municipalities was found when different types of care transition were examined separately. Largest differences were found in care transitions involving specialised care. Age structure, urbanity, and economic situation of the municipality had an impact on several different care transitions.
The total number of care transitions in 2 final years of life was approximately similar irrespective of the municipality of residence, but the findings imply differences in transitioning specialised care. Potentially, this may suggest inequality between the municipalities, but more detailed studies are needed to confirm the factors underlying these differences.
PubMed ID
23604036 View in PubMed
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Hospitalisation costs for infant bronchiolitis are up to 20 times higher if intensive care is needed.

https://arctichealth.org/en/permalink/ahliterature267955
Source
Acta Paediatr. 2015 Mar;104(3):269-73
Publication Type
Article
Date
Mar-2015
Author
Paula Heikkilä
Leena Forma
Matti Korppi
Source
Acta Paediatr. 2015 Mar;104(3):269-73
Date
Mar-2015
Language
English
Publication Type
Article
Keywords
Bronchiolitis - economics - therapy
Female
Finland
Hospital Costs - statistics & numerical data
Hospitalization - economics
Humans
Infant
Intensive Care - economics
Intensive Care Units, Pediatric - economics
Length of Stay - economics
Linear Models
Male
Retrospective Studies
Abstract
Up to 3% of infants with bronchiolitis under 12 months of age are hospitalised, and up to 9% require intensive care. We evaluated the costs of bronchiolitis hospitalisation, with a special focus on whether infants needed intensive care.
Baseline and cost data were retrospectively collected, using electronic hospital files, for 80 infants under 12 months old who were treated in the paediatric intensive care unit (PICU) for bronchiolitis during a 13-year period. We calculated the daily costs for patients admitted to the PICU and compared them with 104 admitted to inpatient wards and 56 outpatients treated in the emergency department.
The mean hospitalisation cost for PICU patients was €8061 (95% CI 6193-9929), compared to €1834 (1649-2020) for other inpatients and €359 (331-387) for the outpatients. The hospitalisation cost per patient was associated with length of hospital stay, but not gender, age on admission or gestational age. There was no constant increase or decrease in hospitalisation costs during the study period.
The hospitalisation costs of infants treated in the PICU for bronchiolitis at
PubMed ID
25431309 View in PubMed
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The impact of dementia on care transitions during the last two years of life.

https://arctichealth.org/en/permalink/ahliterature129596
Source
Age Ageing. 2012 Jan;41(1):52-7
Publication Type
Article
Date
Jan-2012
Author
Mari Aaltonen
Pekka Rissanen
Leena Forma
Jani Raitanen
Marja Jylhä
Author Affiliation
School of Health Sciences, University of Tampere, Tampere FIN-33014, Finland. mari.s.aaltonen@uta.fi
Source
Age Ageing. 2012 Jan;41(1):52-7
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Continuity of Patient Care
Dementia - epidemiology - therapy
Female
Finland - epidemiology
Humans
Male
Residential Facilities - statistics & numerical data
Abstract
Dementia is one of the main challenges to our health and social care. This study compares the number and timing of transitions between care settings in the last 2 years of life among older people with and without dementia.
Data were derived from Finnish national registers, and include all those who died in 2002 and 2003 at the age of 70 or older (n = 70,366). Negative binomial regression analyses were used to analyse the impact of dementia on number of transitions among people with and without dementia and to adjust the number for age, gender and other diagnoses.
In the group that lived at home 2 years before death people with a dementia diagnosis had 32% more care transitions than people without dementia, while the group that was in residential care facility 2 years before death people with dementia had 12% fewer moves than those without dementia The average number of transition was highest in last 3 months of life. People with dementia had their last move more often between care facilities and hospitals offering basic health care than people without dementia.
Dementia has a significant impact on the number and type of transitions. As the number of people with dementia increases, the quality and equity of care of these patients in their last years constitute a special challenge.
PubMed ID
22089082 View in PubMed
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Long-term care is increasingly concentrated in the last years of life: a change from 2000 to 2011.

https://arctichealth.org/en/permalink/ahliterature292269
Source
Eur J Public Health. 2017 08 01; 27(4):665-669
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
08-01-2017
Author
Leena Forma
Mari Aaltonen
Jutta Pulkki
Jani Raitanen
Pekka Rissanen
Marja Jylhä
Author Affiliation
School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland.
Source
Eur J Public Health. 2017 08 01; 27(4):665-669
Date
08-01-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Age Factors
Aged
Aged, 80 and over
Case-Control Studies
Female
Finland - epidemiology
Humans
Logistic Models
Long-Term Care - statistics & numerical data
Male
Registries
Terminal Care - statistics & numerical data
Abstract
The use of long-term care (LTC) is common in very old age and in the last years of life. It is not known how the use pattern is changing as death is being postponed to increasingly old age. The aim is to analyze the association between the use of LTC and approaching death among old people and the change in this association from 2000 to 2011.
The data were derived from national registers. The study population consists of 315 458 case-control pairs. Cases (decedents) were those who died between 2000 and 2011 at the age of 70 years or over in Finland. The matched controls (survivors) lived at least 2 years longer. Use of LTC was studied for the last 730 days for decedents and for the same calendar days for survivors. Conditional logistic regression analyses were performed to test the association of LTC use with decedent status and year.
The difference in LTC use between decedents and survivors was smallest among the oldest (OR 9.91 among youngest, 4.96 among oldest). The difference widened from 2000 to 2011 (OR of interaction of LTC use and year increased): use increased or held steady among decedents, but decreased among survivors.
The use of LTC became increasingly concentrated in the last years of life during the study period. The use of LTC is also common among the oldest survivors. As more people live to very old age, the demand for LTC will increase.
PubMed ID
28339763 View in PubMed
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Long-term care use among old people in their last 2 years of life: variations across Finland.

https://arctichealth.org/en/permalink/ahliterature291240
Source
Health Soc Care Community. 2016 07; 24(4):439-49
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
07-2016
Author
Jutta Pulkki
Marja Jylhä
Leena Forma
Mari Aaltonen
Jani Raitanen
Pekka Rissanen
Author Affiliation
Gerontology Research Center, School of Health Sciences, University of Tampere, Tampere, Finland.
Source
Health Soc Care Community. 2016 07; 24(4):439-49
Date
07-2016
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Finland
Health facilities
Home Care Services
Hospitalization
Humans
Long-Term Care
Abstract
Variations across Finland in the use of six different long-term care (LTC) services among old people in their last 2 years of life, and the effects of characteristics of municipalities on the variations were studied. We studied variations in the use of residential home, sheltered housing, regular home care and inpatient care in health centre wards by using national registers. We studied how the use of LTC was associated with characteristics of the individuals and in particular characteristics of the municipalities in which they lived. Analyses were conducted with multilevel binary logistic regression. Data included all individuals (34,753) who died in the year 2008 at the age of 70 or over. Of those, 58.3% used some kind of LTC during their last 2 years of life. We found considerable variations between municipalities in the use of different kinds of LTC. A portion of the variation was explained by municipality characteristics. The size and location of the municipality had the strongest association with the use of different kinds of LTC. The economic status of the municipality and morbidity at the population level were poorly associated with LTC use, whereas old-age dependency showed no association. When individual-level characteristics were added to the models, these associations did not alter. Results indicated that the delivery system characteristics had an important effect on the use of LTC services. The considerable variation in LTC services also poses questions with respect to equity in access and to quality of LTC across the country.
PubMed ID
25809383 View in PubMed
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14 records – page 1 of 2.