Individual and country-level determinants of nursing home admission in the last year of life in Europe

• Published in: PloS one Vol. 14; no. 3; p. e0213787
• Main Authors: Stolz, Erwin, Mayerl, Hannes, Rásky, Éva, Freidl, Wolfgang
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.03.2019; Public Library of Science (PLoS)
• Subjects: Age; Aged; Aged, 80 and over; Aging; Analysis; Bayes Theorem; Bayesian analysis; Biology and Life Sciences; Cognitive ability; Data processing; Determinants; Epidemiology; Europe; Expenditures; Female; Government spending; Home health care; Hospitalization - statistics & numerical data; Humans; Infrastructure (Economics); Long term care; Long term health care; Male; Management; Medicine; Medicine and Health Sciences; Nursing; Nursing home care; Nursing homes; Nursing Homes - statistics & numerical data; Older people; Patient Admission - statistics & numerical data; People and Places; Physical Sciences; Proxy; Public expenditures; Public finance; Regression analysis; Research and Analysis Methods; Retirement; Terminal care; Terminal Care - economics; Terminal Care - trends; Europe; Greece; Austria; Sweden; Netherlands; Switzerland; Estonia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0213787

Previous research has focussed on individual-level determinants of nursing home admission (NHA), although substantial variation in the prevalence of NHA between European countries suggests a substantial impact of country of residence. The aim of this analysis was to assess individual-level determinants and the role of country of residence and specifically a country`s public institutional long-term care infrastructure on proxy-reported NHA in the last year of life. We analysed data from 7,018 deceased respondents (65+) of the Survey of Health, Ageing and Retirement in Europe (2004-2015, 16 countries) using Bayesian hierarchical logistic regression analysis in order to model proxy-reported NHA. In total, 14% of the general older population utilised nursing home care in the last year of life but there was substantial variation across countries (range = 2-30%). On the individual-level, need factors such as functional and cognitive impairment were the strongest predictors of NHA. In total, 18% of the variance of NHA was located at the country-level; public expenditure on institutional care strongly affected the chance of NHA in the last year of life. On the individual-level, the strong impact of need factors indicated equitable access to NHA, whereas differences in public spending for institutional care indicated inequitable access across European countries.