Care utilisation in the last years of life in Sweden: the effects of gender and marital status differ by type of care
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The effects of gender and marital status on care utilisation in the last years of life are highly correlated. This study analysed whether gender differences in use of eldercare (home help services or institutional care) or hospital care in the last 5 years of life, and the place of death, could be attributed to differences in marital status and thereby to potential access to informal care. A longitudinal Swedish study provided register data on 567 participants (aged 83 +) who died between 1995 and 2004. A higher proportion of unmarried than married people used home help services; this was true of both men and women. The likelihood of receiving home help was lower for those living with their spouse (OR = 0.38) and for those with children (OR = 0.60). In the 2 years preceding death, the proportion receiving home help services decreased and the proportion in institutional care increased. Women were significantly more likely to die in institutional care (OR = 1.88) than men. Although men were less likely to live in institutional care than women and more likely to be inpatients in the 3 months preceding death, after controlling for residence in institutional care, neither gender nor marital status was statistically significant when included in the same model. In summary, the determining factor for home help utilisation seemed to be access to informal care, whereas gender differences in health status could explain women’s higher probability of dying in institutional care.
KeywordsGender Marital status End-of-life care Place of death Home help services Institutionalisation
This research was supported by Grants from the Swedish Council for Working Life and Social Research, Grant 2004:0850 and 2007:1947. We thank all the members of the Kungsholmen Project Study Group for data collection and management and for giving us access to the database. The first author of this paper, Kristina Larsson, deceased in the autumn 2010. This was a great loss for the scientific community and for all of us working with her—she was both a great person and a great scientist.
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