Trends in Life Expectancy in Residential Long-Term Care by Sociodemographic Position in 1999–2018: A Multistate Life Table Study of Finnish Older Adults

Abstract

Objectives Residential long-term care (LTC) use has declined in many countries over the past years. This study quantifies how changing rates of entry, exit, and mortality have contributed to trends in life expectancy in LTC (i.e., average time spent in LTC after age 65) across sociodemographic groups. Methods We analyzed population-register data of all Finns aged ≥65 during 1999–2018 (n=2,016,987) with dates of LTC and death, and sociodemographic characteristics. We estimated transition rates between home, LTC and death using Poisson generalized additive models, and calculated multistate life tables across 1999–2003, 2004–2008, 2009–2013 and 2014–2018. Results Between 1999–2003 and 2004–2008, life expectancy in LTC increased from 0.75 (95% CI 0.74–0.76) to 0.89 (0.88–0.90) years among men and from 1.61 (1.59–1.62) to 1.83 (1.81–1.85) years among women, mainly due to declining exit rates from LTC. Thereafter, life expectancy in LTC decreased, reaching 0.80 (0.79–0.81) and 1.51 (1.50–1.53) years among men and women, respectively, in 2014–2018. Especially among women and non-married men, the decline was largely due to increasing death rates in LTC. Admission rates declined throughout the study period, which offset the increase in life expectancy in LTC attributable to declining mortality in the community. Marital status differences in life expectancy in LTC narrowed over time. Discussion Recent declines in LTC use were driven by postponed LTC admission closer to death. The results suggest that across sociodemographic strata older adults enter LTC in ever worse health and spent a shorter time in care than before.