How does availability of county-level healthcare services shape terminal decline in well-being?

  • Nina Vogel
  • Nilam Ram
  • Jan Goebel
  • Gert G. Wagner
  • Denis Gerstorf
Original Investigation

Abstract

Both lifespan psychology and life course sociology highlight that contextual factors influence individual functioning and development. In the current study, we operationalize context as county-level care services in inpatient and outpatient facilities (e.g., number of care facilities, privacy in facilities) and investigate how the care context shapes well-being in the last years of life. To do so, we combine 29 waves of individual-level longitudinal data on life satisfaction from now deceased participants in the nationwide German Socio-Economic Panel Study (N = 4557; age at death: M = 73.35, SD = 14.20; 47% women) with county-level data from the Federal Statistical Office. Results from three-level growth models revealed that having more inpatient care facilities, more employees per resident, and more staff in administration are each uniquely associated with higher late-life well-being, independent of key individual (age at death, gender, education, disability) and county (affluence, demographic composition) characteristics. Number of employees in physical care, residential comfort, and flexibility and care indicators in outpatient institutions were not found to be associated with levels or change in well-being. We take our results to provide empirical evidence that some contextual factors shape well-being in the last years of life and discuss possible routes how local care services might alleviate terminal decline.

Keywords

County Socio-Economic Panel Life satisfaction Care Regional differences 

References

  1. Andersen RM (1995) Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 36:1–10. doi:10.2307/2137284 CrossRefGoogle Scholar
  2. Aneshensel CS, Wight RG, Miller-Martinez D, Botticello AL, Karlamangla AS, Seeman TE (2007) Urban neighborhoods and depressive symptoms among older adults. J Gerontol B Psychol Sci Soc Sci 62:52–59. doi:10.1093/geronb/62.1.S52 CrossRefGoogle Scholar
  3. Backman L, MacDonald SWS (2006) Death and cognition—viewing a 1962 concept through 2006 spectacles—introduction to the special section. Eur Psychol 11:161–163. doi:10.1027/1016-9040.11.3.161 CrossRefGoogle Scholar
  4. Bainbridge D, Brazil K, Ploeg J, Krueger P, Taniguchi A (2016) Measuring healthcare integration: operationalization of a framework for a systems evaluation of palliative care structures, processes, and outcomes. Palliat Med 30:567–579. doi:10.1177/0269216315619862 CrossRefGoogle Scholar
  5. Baltes PB (1997) On the incomplete architecture of human ontogeny: selection, optimization, and compensation as foundation of developmental theory. Am Psychol 52:366–380. doi:10.1037/0003-066X.52.4.366 CrossRefGoogle Scholar
  6. Brockmann H, Klein T (2004) Love and death in Germany: the marital biography and its effect on mortality. J Marriage Fam 66:567–581. doi:10.1111/j.0022-2445.2004.00038.x CrossRefGoogle Scholar
  7. Bronfenbrenner U (1979) The ecology of human development: experiments by nature and design. Harvard University Press, CambridgeGoogle Scholar
  8. Choi S (2014) How does satisfaction with medical care differ by citizenship and nativity status? A county-level multilevel analysis. Gerontologist 55:gnt201. doi:10.1093/geront/gnt201 Google Scholar
  9. Clarke P, Morenoff J, Debbink M, Golberstein E, Elliott MR, Lantz PM (2013) Cumulative exposure to neighborhood context: consequences for health transitions over the adult life course. Res Aging 36:115–142. doi:10.1177/0164027512470702 CrossRefGoogle Scholar
  10. Degenholtz HB, Kane RA, Kane RL, Bershadsky B, Kling KC (2006) Predicting nursing facility residents’ quality of life using external indicators. Health Serv Res 41:335–356. doi:10.1111/j.1475-6773.2005.00494.x CrossRefGoogle Scholar
  11. Federal Statistical Office (2012) Care statistics. Care in the framework of care insurance. County comparison 2009 [Pflegestatistik. Pflege im Rahmen der Pflegeversicherung. Kreisvergleich 2009]. WiesbadenGoogle Scholar
  12. Federal Statistical Office (2014) Care statistics 2013. Care in the framework of care insurance. Results in Germany [Pflegestatistik 2013. Pflege im Rahmen der Pflegeversicherung. Deutschlandergebnisse]. WiesbadenGoogle Scholar
  13. Fujita F, Diener E (2005) Life satisfaction set point: stability and change. J Pers Soc Psychol 88:158–164. doi:10.1037/0022-3514.88.1.158 CrossRefGoogle Scholar
  14. Gerstorf D, Ram N (2012) Late-life: a venue for studying the mechanisms by which contextual factors influence individual development. In: Whitbourne SK, Sliwinski MJ (eds) Handbook of adulthood and aging. Wiley, New York, pp 49–71Google Scholar
  15. Gerstorf D, Ram N (2013) Inquiry into terminal decline: five objectives for future study. Gerontologist 53:727–737. doi:10.1093/geront/gnt046 CrossRefGoogle Scholar
  16. Gerstorf D, Ram N, Goebel J, Schupp J, Lindenberger U, Wagner GG (2010) Where people live and die makes a difference: individual and geographic disparities in well-being progression at the end of life. Psychol Aging 25:661–676. doi:10.1037/a0019574 CrossRefGoogle Scholar
  17. Glass TA, McAtee MJ (2006) Behavioral science at the crossroads in public health: extending horizons, envisioning the future. Soc Sci Med 62:1650–1671. doi:10.1016/j.socscimed.2005.08.044 CrossRefGoogle Scholar
  18. Guse LW, Masesar MA (1999) Quality of life and successful aging in long-term care: perceptions of residents. Issues Ment Health Nurs 20:527–539. doi:10.1080/016128499248349 CrossRefGoogle Scholar
  19. Harrington C, Zimmerman D, Karon SL, Robinson J, Beutel P (2000) Nursing home staffing and its relationship to deficiencies. J Gerontol B Psychol Sci Soc Sci 55:278–287. doi:10.1093/geronb/55.5.S278 CrossRefGoogle Scholar
  20. Headey B, Muffels R, Wagner GG (2010) Long-running German panel survey shows that personal and economic choices, not just genes, matter for happiness. Proc Natl Acad Sci USA 107:17922–17926. doi:10.1073/pnas.1008612107 CrossRefGoogle Scholar
  21. Kane RL, Bershadsky B, Kane RA, Degenholtz HH, Liu JJ, Giles K, Kling KC (2004) Using resident reports of quality of life to distinguish among nursing homes. Gerontologist 44:624–632. doi:10.1093/geront/44.5.624 CrossRefGoogle Scholar
  22. King KE, Morenoff JD, House JS (2011) Neighborhood context and social disparities in cumulative biological risk factors. Psychosom Med 73:572–579. doi:10.1097/PSY.0b013e318227b062 CrossRefGoogle Scholar
  23. Kotakorpi K, Laamanen J-P (2010) Welfare state and life satisfaction: evidence from public health care. Economica 77:565–583. doi:10.1111/j.1468-0335.2008.00769.x Google Scholar
  24. Kottwitz A (2014) Mode of birth and social inequalities in health: the effect of maternal education and access to hospital care on cesarean delivery. Health Place 27:9–21. doi:10.1016/j.healthplace.2014.01.005 CrossRefGoogle Scholar
  25. Lawton MP (1982) Competence, environmental press, and the adaptation of older people. In: Lawton MP, Windley PG, Byerts TO (eds) Aging and the environment. Springer, New York, pp 33–59Google Scholar
  26. Lawton MP, Moss M, Glicksman A (1990) The quality of the last year of life of older persons. Milbank Q 68:1–28. doi:10.2307/3350075 CrossRefGoogle Scholar
  27. Little RJA, Rubin DB (1987) Statistical analysis with missing data. Wiley, New YorkGoogle Scholar
  28. Litwin H (2010) Social networks and well-being: a comparison of older people in mediterranean and non-mediterranean countries. J Gerontol B Psychol Sci Soc Sci 65:599–608. doi:10.1093/geronb/gbp104 CrossRefGoogle Scholar
  29. Lucas RE (2007) Long-term disability is associated with lasting changes in subjective well-being: evidence from two nationally representative longitudinal studies. J Pers Soc Psychol 92:717–730. doi:10.1037/0022-3514.92.4.717 CrossRefGoogle Scholar
  30. McFarland MJ, Smith CA, Toussaint L, Thomas PA (2012) Forgiveness of others and health: do race and neighborhood matter? J Gerontol B Psychol Sci Soc Sci 67:66–75. doi:10.1093/geronb/gbr121 CrossRefGoogle Scholar
  31. OECD (2011) Premature mortality. In: Health at a glance 2011: OECD indicators. OECD Publishing, Paris. doi:10.1787/health_glance-2011-5-en
  32. Payne G, Laporte A, Deber R, Coyte PC (2007) Counting backward to health care’s future: using time-to-death modeling to identify changes in end-of-life morbidity and the impact of aging on health care expenditures. Milbank Q 85:213–257. doi:10.1111/j.1468-0009.2007.00485.x CrossRefGoogle Scholar
  33. Pekkarinen L, Sinervo T, Perälä M-L, Elovainio M (2004) Work stressors and the quality of life in long-term care units. Gerontologist 44:633–643. doi:10.1093/geront/44.5.633 CrossRefGoogle Scholar
  34. Pruchno RA, Wilson-Genderson M, Cartwright FP (2012) The texture of neighborhoods and disability among older adults. J Gerontol B Psychol Sci Soc Sci 67:89–98. doi:10.1093/geronb/gbr131 CrossRefGoogle Scholar
  35. Ram N, Grimm K (2015) Growth curve modeling and longitudinal factor analysis. In: Overton W, Molenaar PCM (eds) Handbook of child psychology: vol 1. Theoretical models of human development, 7th edn. Wiley, HobokenGoogle Scholar
  36. Robichaud L, Durand PJ, Bédard R, Ouellet J-P (2006) Quality of life indicators in long-term care: opinions of elderly residents and their families. Can J Occup Ther 73:245–251. doi:10.2182/cjot.06.003 CrossRefGoogle Scholar
  37. Sampson RJ, Morenoff JD, Gannon-Rowley T (2002) Assessing “neigborhood effects”: social processes and new directions in research. Ann Rev Sociol 28:443–478. doi:10.1146/annurev.soc.28.110601.141114 CrossRefGoogle Scholar
  38. SAS Institute Inc (2009) SAS/STAT user’s guide 9.2. SAS Institute Inc, CaryGoogle Scholar
  39. Schimmack U, Oishi S (2005) The influence of chronically and temporarily accessible information on life satisfaction judgments. J Pers Soc Psychol 89:395–406. doi:10.1037/0022-3514.89.3.395 CrossRefGoogle Scholar
  40. Shippee TP, Henning-Smith C, Kane RL, Lewis T (2015) Resident- and facility-level predictors of quality of life in long-term care. Gerontologist. doi:10.1093/geront/gnt148 Google Scholar
  41. Vogel N, Schilling OK, Wahl H-W, Beekman ATF, Penninx BWJH (2013) Time-to-death-related change in positive and negative affect among older adults approaching the end of life. Psychol Aging 28:128–141. doi:10.1037/a0030471 CrossRefGoogle Scholar
  42. Voigtländer S, Berger U, Razum O (2010) The impact of regional and neighbourhood deprivation on physical health in Germany: a multilevel study. BMC Public Health 10:403. doi:10.1186/1471-2458-10-403 CrossRefGoogle Scholar
  43. Wahl H-W, Schilling O, Oswald F, Iwarsson S (2009) The home environment and quality of life-related outcomes in advanced old age: findings of the ENABLE-AGE project. Eur J Ageing 6:101–111. doi:10.1007/s10433-009-0114-z CrossRefGoogle Scholar
  44. Wahl H-W, Iwarsson S, Oswald F (2012) Aging well and the environment: toward an integrative model and research agenda for the future. Gerontologist 52:306–316. doi:10.1093/geront/gnr154 CrossRefGoogle Scholar
  45. Walshe K, Harrington C (2002) Regulation of nursing facilities in the United States: an analysis of resources and performance of state survey agencies. Gerontologist 42:475–486. doi:10.1093/geront/42.4.475 CrossRefGoogle Scholar
  46. Wight RG, Ko MJ, Aneshensel CS (2011) Urban neighborhoods and depressive symptoms in late middle age. Res Aging 33:28–50. doi:10.1177/0164027510383048 CrossRefGoogle Scholar
  47. Windsor TD, Fiori KL, Crisp DA (2012) Personal and neighborhood resources, future time perspective, and social relations in middle and older adulthood. J Gerontol B Psychol Sci Soc Sci 67:423–431. doi:10.1093/geronb/gbr117 CrossRefGoogle Scholar
  48. World Health Organization (2002) Towards a common language for functioning, disability and health: ICF—the International classification of functioning, disability and health. World Health Organization, GenevaGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.German Institute for Economic Research (DIW Berlin)BerlinGermany
  2. 2.Department of PsychologyHumboldt University BerlinBerlinGermany
  3. 3.Pennsylvania State University, HDFSUniversity ParkUSA
  4. 4.Max Planck Institute for Human DevelopmentBerlinGermany
  5. 5.The German Environment AgencyBerlinGermany

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