Municipal variation in health and social service use in the last 2 years of life among old people
To describe and analyse municipal differences in health and social service use among old people in the last 2 years of life.
The data were derived from national registers. All those who died in 2002 or 2003 at the age of ≥ 70 years were included except those who lived in very small municipalities. The services included were different types of hospitals, long-term care, and home care. The variation in service use was described by coefficients of variation (CV). To analyse local differences, three-level (individual, municipal, and regional) binary logistic and Poisson regression analyses were performed.
A total of 67,027 decedents from 315 municipalities in 20 hospital districts were included. There was considerable variation in service use between residents of different municipalities, especially in the types of hospital used. Of the individual-level variables age and use of other services were associated (p < 0.05) with use of all services. Of the municipal-level variables, indicators describing the service pattern in the municipality were associated with use of all services and average age of decedents with most of the services. The presence of a university hospital in the hospital district increased the probability of using university and general hospitals, but among the users increased days in university hospital and decreased days in general hospital.
Considerable differences between municipalities exist, but these cannot be exhaustively explained. Behind the differences are probably factors which are difficult to describe and quantify, such as historical developments and political realities.
Available from: Mika Immonen
- "Our research question is 'How do neighbourhoods in rural areas influence on perceived health and social care service availability and usage?' To answer this question, we use an analytical research approach. This article contributes to the debate on access barriers in rural health care where more arguments on user behaviour are needed (Forma et al., 2011; Lewando Hundt et al., 2012; Koike and Furui, 2013). "
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This article focuses on the availability and demanded locations of health care services in a rural context. We analyse subjective experiences because mobility and other individual factors influence the availability of public services.
Results from a mail survey in southeastern Finland are presented. Data collection was conducted using a random sample of 3,000 people from age 60 to 90 years. A total of 1,121 valid responses were received.
The acceptable distance to service sites depends on learned behaviour where differences exist between suburban and rural residents. We found that service networks can be sparser in rural areas if the service sites are located in the daily activity space of the residents and travel burdens caused by distance and time are adequately solved. However, continuous downscaling of the provision may lead to the loss of health benefits which is harmful for individuals and expensive for society.
Further research should assess a broader variety of residential areas from the perspective of service availability. The results presented do not enable a direct comparison of the service availability between cities and sparsely populated rural areas.
The article contributes to the debate on access barriers to public service in rural regions. The question of availability of public services is topical because increasing overall demand requires urgent productivity improvements in public services. Currently this is solved by centralisation to search economies of scale.
International Journal of Public Sector Management 01/2015; 28(1):-. · 0.32 Impact Factor
- "In addition, similar services have been available for all clients without acknowledging potential individual variations (Forma et al. 2011). However, high-quality home care is not solely dependent on the ability of professionals to assess and support clients' resources and needs, but is also related to policies of and home care services provided in municipalities (Forma et al. 2011, Janl€ ov et al. 2011). In many countries, health and social services are under economic pressure due to the global demographic change caused by the increasing number of older adults. "
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ABSTRACT: Aims and objectivesTo identify descriptions of older (75+) home care clients and practical nurses regarding the current structure of home care available for older clients and the elements promoting the ability of clients to continue living at home. Background
The ageing population is a major global challenge in social and health care. In many countries, the focus of care for older clients has shifted from institutional care towards a model of home care. Increasing attention has been paid to maximising the resources of older clients and aiming to support their living at home for as long as possible. DesignA descriptive qualitative study Methods
Data were collected from individual interviews by using videotaped home care visits as a tool for stimulated recall interviews. Two groups of participants were interviewed: 14 practical nurses and 23 older clients. Data were analysed by using the inductive content analysis. ResultsBoth participant groups, practical nurses and older home care clients, described home care as organisationally driven, but highlighted the importance of individual encounters. In addition, both groups noted that clients' living at home can be supported by offering individually designed care. Individually designed care refers to showing respect to clients' opinions and promoting their individual resources. Conclusion
In order to be able to promote older home clients' living at home, the provided home care needs to be individually designed and must take into account clients' resources and their perspectives of meaningful and inspirational activities. Relevance to clinical practiceThe information produced by this study can be used to promote older clients' living at home for as long as possible. Therefore, practical nurses are required the ability to recognise older clients' individual resources and design individual care plans accordingly.
Journal of Clinical Nursing 02/2014; 23(21-22). DOI:10.1111/jocn.12569 · 1.26 Impact Factor
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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.
Age and Ageing 11/2011; 41(1):52-7. DOI:10.1093/ageing/afr133 · 3.64 Impact Factor
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