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Care Trajectories in the Oldest Old
Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis demonstrates relations among health, social network, ADL and patterns of care in the oldest old guided by a resource theoretical model.

The analyzed data are based on two studies: the Nona study, a longitudinal study of 157 individuals aged 86 to 94 years, and the H70 study, a longitudinal study of 964 individuals aged 70 at baseline. Data were collected by interviews and to some extent in the H70 study, medical exams and medical records.

The results demonstrate that perceived resources seem to affect patterns of care to a higher extent than the more objective resources in the sample of the oldest old. On the other hand, sociodemographic variables such as gender, marital status and SES, in addition to the more objective resources of having children nearby and the number of symptoms of illness predicted institutionalization during a subsequent 30-year period from the age of 70. The proportion of elderly persons’ institutionalization was further significantly higher than that generally found in cross-sectional studies. ADL was one of the strongest predictors for both use of formal care and institutionalization in both samples, indicating an effective targeting of the formal care system in Sweden. The care at end of life in the oldest old is challenged by the problems with progressive declines in ADL and health, which makes it hard to fit in the dying oldest old in the palliative care system. There is a need to increase the knowledge and the possibility for care staff to support and encourage social network factors and for decision-making staff to consider factors beyond ADL.

Place, publisher, year, edition, pages
Jönköping: Hälsohögskolan , 2007. , p. 97
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 3
Keywords [en]
Oldest-old, Health, Social network, ADL, Care, Institutionalization, End-of-life
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:hj:diva-1027ISBN: 978-91-85835-02-7 (print)OAI: oai:DiVA.org:hj-1027DiVA, id: diva2:3463
Public defence
2007-11-29, Kurt Johanssonaulan, Hälsohögskolan i Jönköping, 10:00 (English)
Opponent
Supervisors
Available from: 2007-11-09 Created: 2007-11-09 Last updated: 2011-10-24Bibliographically approved
List of papers
1. Factors related to care pattern in Swedish oldest old
Open this publication in new window or tab >>Factors related to care pattern in Swedish oldest old
(English)Manuscript (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-1433 (URN)
Available from: 2007-11-09 Created: 2014-08-04 Last updated: 2010-01-13Bibliographically approved
2.
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3. Sooner or later?: A study of institutionalization in late life
Open this publication in new window or tab >>Sooner or later?: A study of institutionalization in late life
2009 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 21, no 4/5, p. 329-337Article in journal (Refereed) Published
Abstract [en]

Background and aims: Existing information about institutionalization of elderly individuals is mainly based on cross-sectional data and does not address the cumulative risk of institutionalization. The purpose of the present study was to analyze longitudinal data prospectively and estimate the risk of placement in an elder care institution for individuals aged 70 years or older. Methods: The study was based on a longitudinal investigation (the H70 study) of a random sample of 70-year-olds living in Gothenburg, Sweden, in 1971. Individuals were followed from age 70-100 years. Three different analyses were performed: a descriptive prospective analysis, cross-sectional analyses at ages 70, 79 and 85 years, and a longitudinal analysis of predictors for institutionalization. Results: The prospective analysis indicated that 50% of the individuals eventually moved to an elder care institution. Significantly more women than men were institutionalized, although for women the move occurred later in life. Cross-sectional analyses demonstrated that various factors were important to institutionalization at different ages. The Cox regression model with time-varying covariates indicated that gender, socio-economic situation, marital status, number of symptoms, having children living nearby, and activities in daily life were related to institutionalization. Conclusions: The proportion of elderly persons relocating to institutions was significantly higher than that generally found in cross-sectional studies. It was possible to identify variables that predict institutionalization during a subsequent 30-year period, but different analyses revealed different effects from the factors evaluated.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-11255 (URN)
Available from: 2010-01-07 Created: 2010-01-07 Last updated: 2017-12-12Bibliographically approved
4. End of life care in the oldest old
Open this publication in new window or tab >>End of life care in the oldest old
2010 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 8, p. 335-344Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to describe the last year of life of a sample of the oldest old, focusing on care trajectories, health, social networks, and function in daily life activities.

METHOD: Data originated from the NONA study, a longitudinal study of 193 individuals among the oldest old living in a Swedish municipality. During this longitudinal study, 109 participants died. Approximately one month after their death, a relative was asked to participate in a telephone interview concerning their relative's last year of life. One hundred two relatives agreed to participate.

RESULTS: Most of the elderly in this sample of the oldest old (74.5%) died at an institution and the relatives were mostly satisfied with the end-of-life care. The oldest old relatives estimated that the health steadily declined during the last year of life, and that there was a decline in performing of daily life activities. They also estimated that those dying in institutions had fewer social contacts than those dying in a hospital or at home.

SIGNIFICANCE OF RESULTS: Care at end of life for the oldest old is challenged by problems with progressive declines in ability to perform activities of daily living and health. The findings also highlight the need to support social networks at eldercare institutions.

Keywords
Location at time of death, Care quality, Problems with activities of daily living, Social support, Health
National Category
Geriatrics
Identifiers
urn:nbn:se:hj:diva-1436 (URN)10.1017/S1478951510000131 (DOI)20875177 (PubMedID)
Available from: 2007-11-09 Created: 2007-11-09 Last updated: 2017-12-12Bibliographically approved

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