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Increasing life expectancy has postponed the last years of life to older ages. Previous studies have demonstrated that disability is determined by age, age at death and closeness to death but only few have focused on oldest old population. We examined disability during the last years of life among people aged 90 years and older between 2001 and 2014 and assessed whether it varied by age at death, sex and study year. We used population-based survey data from the Vitality 90+ Study years 2001, 2003, 2007, 2010 and 2014 (N=5711, response rate 77-86%) linked with dates of death from Statistics Finland. Disability was defined as dependency in daily activities (dressing, getting in and out of bed) and mobility (moving indoors, walking 400m, using stairs). We analyzed disability stratified by closeness to death and age at death for men and women in each study year with logistic regression method. Disability in daily activities and mobility increased systematically with closeness to death (>4, 3-3.99, 2-2.99, 1-1.99 and 1> years to death) for both sexes in each study year. Also higher age at death (90-91 vs. 94+ years) was associated with disability. These associations remained consistent throughout the study period. This study shows that in the oldest old population both closeness to death and age at death determine the level of disability. We suggest that the complex and resource-draining care needs at the end of life will increase with growing number of people living their last years of life in very old age.

In recent decades, care policy in the Netherlands reduced budgets for residential care and formal home care, which increased the demand for informal care. Women use formal care more often than men, but we lack information on the extent to which the gender gap in care use is explained by differences in individual chracteristics and changes in care policy. Data from the Longitudinal Aging Study Amsterdam (LASA) were employed to explore the gender gap in the use of informal, formal and private home care, community services, and residential care in the years 1996-2016, analyzed using Generalized Estimating Equations (GEE). The data consisted of 9,497 observations, gathered from 3,369 respondents aged 65-85. Women used all types of formal care more than men. The gender differences persisted even when individual characteristics were taken into account; however, only in residential care the differences diminished after care preferences were included in the analysis. During the study years, the gender gap increased in formal home care and in non-use of care, as women increasingly used formal home care and the proportion of men without care expanded. The gender gap in informal care use reversed, with men using more informal care during the earlier years and women using more in the later years. The persistent and even increasing gender differences in care use deserve further exploration of the role of gender in current care culture. The growing gender gab in non-use of care raises concern for older men and their possible increase in unmet care needs.

Advanced age and dementia are important contributors to care use, especially long-term care (LTC). We studied the impact of age on use of LTC and hospital care (HC) in last five years of life in those who died from dementia in three time periods.

Background 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. Methods 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. Results 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. Conclusion 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.