Abstract
In this paper, we present empirical results for the very old (75+) concerning transitions between independent living in ordinary home without public support, independent living in ordinary home or special accommodations with home help and home health care, and living in around the clock care. We investigate the role of age and gender, dependency in activities of daily living (ADL) and the informal support from a partner. We also study mortality conditional on the above-mentioned variables and on the mode of old age care. The results show that the propensity to move to a more intensive mode of care is less for males, higher with more limitations in personal ADL and increasing with age. There is also a stabilizing effect of the availability of informal care support, as measured by marriage or cohabitation, as it makes it less likely to move from the current care mode. In the case of mortality, the observed relations pointed in the expected directions—mortality increasing with increasing PADL-limitations and age and being higher for men than for women. The age relation, however, does not hold in the same way in around the clock care. The estimated relationships are used as input in a micro-simulation model intended for analysis of the effect of population aging on the needs and resource requirements for old age care in Sweden.
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Notes
1,217 observations and 1,071 observations contain imputed values on IADL in the first and second waves, respectively. The imputation was based on the estimated relation between nonmissing values of IADL and age group, gender, PADL, and a random term.
We tried to use another variable by coding, as a proxy for the distance to a relative, the telephone area code number to the nearest of kin reported in data. In a preliminary analysis this variable turned out significant but was, unfortunately, missing for a substantial part of the sample (around 65.1% in wave 1 was missing).
The standard errors allow for intragroup correlation, that is, the observations are assumed independent across individuals (clusters) but not necessarily within clusters.
Simulation of multinomial logit and ordered logit shows very small differences in outcome, even though it matters some for the sign and the level of significance of the marginal effect whether we treat choices as ordered or unordered.
The Cox model assumes absence of unobserved heterogeneity, which potentially could represent a particular complication in duration models. Using a piece-wise constant hazard (PWCH) model with a gamma-frailty assumption we did find support for unobserved heterogenity (estimates are availible upon request from the authors). However, the change in estimates and inference were, however, not too dramatic compared to the Cox model. We will therefore discuss only the estimates from the latter model.
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Acknowledgments
We are grateful for comments and suggestions from Björn Lindgren, Anders Klevmarken, Lennart Flood, Kristian Bolin, Urban Fransson, Matias Eklöf, and two anonomous referees. Financial support from the Swedish council for working life and social research (FAS) is gratefully acknowledged.
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Hallberg, D., Lagergren, M. Moving in and out of public old age care among the very old in Sweden. Eur J Ageing 6, 137–145 (2009). https://doi.org/10.1007/s10433-009-0111-2
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DOI: https://doi.org/10.1007/s10433-009-0111-2