Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-27T20:29:03.837Z Has data issue: false hasContentIssue false
  • English
  • Français

The last year of life in Europe: regional variations in functional status and sources of support

Published online by Cambridge University Press:  07 May 2010

KARSTEN HANK  and
HENDRIK JÜRGES
KARSTEN HANK*
Affiliation:
Institute of Sociology, University of Cologne, Cologne, Germany.
HENDRIK JÜRGES
Affiliation:
Mannheim Research Institute for the Economics of Aging, University of Mannheim, Mannheim, Germany.
*
Address for correspondence: Karsten Hank, University of Cologne, Institute of Sociology, Greinstr. 2, 50939Cologne, Germany E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

This article aims to provide an initial account of the life circumstances of older people in 11 continental European countries during the year prior to their deaths. It focuses on regional variations in functional limitations and sources of support. Using logistic regression we analyse data from 523 end-of-life interviews in 2006–07, collected for the Survey of Health, Ageing and Retirement in Europe (Wave 2) about the respondents who had died since the baseline data collection in 2004–05. The prevalence of functional limitations was found to be fairly consistent across Northern, Central and Southern Europe. Significant regional differences existed, however, with regard to the deceased respondents' main sources of support and the locations of their deaths. Northern Europeans were the least likely to receive help from their family only and the most likely to be supported by non-kin. They also exhibited the highest risk of dying in a nursing home. In Mediterranean countries, a pattern of exclusive family support and dying at home prevailed. The findings support the notion of a ‘mixed responsibility’ of families and welfare states as providers of support for older people in the last year of life.

Keywords

end-of-life researchADL limitationssocial supportSHARE survey
Type
Research Article
Information
Ageing & Society , Volume 30 , Issue 6 , August 2010 , pp. 1041 - 1054
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahmad, S. and O'Mahony, M. S. 2005. Where older people die: a retrospective population-based study. Quarterly Journal of Medicine, 98, 12, 865–70.CrossRefGoogle Scholar
Andersen-Ranberg, K., Petersen, I., Frederiksen, H., Mackenbach, J. P. and Christensen, K. 2009. Cross-national differences in grip strength among 50+ year-old Europeans: results from the SHARE study. European Journal of Ageing, 6, 3, 227–36.CrossRefGoogle ScholarPubMed
Andersen-Ranberg, K., Robine, J.-M., Thinggaard, M. and Christensen, K. 2008. What has happened to the oldest old in SHARE participants after two years? In Börsch-Supan, A., Brugiavini, A., Jürges, H., Kaypteyn, A., Mackenbach, J., Siegrist, J. and Weber, G. (eds), Health, Ageing and Retirement in Europe (2004–2007): Starting the Longitudinal Dimension. Mannheim Research Institute for the Economics of Aging, Mannheim, Germany, 66–73.Google Scholar
Beccaro, M., Costantini, M., Rossi, P. G., Miccinesi, G., Grimaldi, M. and Bruzzi, M. 2006. Actual and preferred place of death of cancer patients: results from the Italian survey of the dying of cancer. Journal of Epidemiology and Community Health, 60, 5, 412–16.CrossRefGoogle ScholarPubMed
Bickel, H. 1998. Das letzte Lebensjahr: Eine Repräsentativstudie an Verstorbenen. Wohnsituation, Sterbeort und Nutzung von Versorgungsangeboten. [The last year of life: a population-based study on decedents. Living arrangements, place of death and utilisation of care]. Zeitschrift für Gerontologie und Geriatrie, 31, 3, 193–204.CrossRefGoogle Scholar
Börsch-Supan, A., Brugiavini, A., Jürges, H., Mackenbach, J., Siegrist, J. and Weber, G. (eds) 2005. Health, Ageing and Retirement in Europe: First Results from the Survey of Health, Ageing and Retirement in Europe. Mannheim Research Institute for the Economics of Aging, Mannheim, Germany.Google Scholar
Börsch-Supan, A., Brugiavini, A., Jürges, H., Kapteyn, A., Mackenbach, J., Siegrist, J. and Weber, G. (eds) 2008. Health, Ageing and Retirement in Europe (2004–2007): Starting the Longitudinal Dimension. Mannheim Research Institute for the Economics of Aging, Mannheim, Germany.Google Scholar
Börsch-Supan, A., Hank, K., Jürges, H. and Schröder, M. 2010. Longitudinal data collection in continental Europe: experiences from the Survey of Health, Ageing and Retirement in Europe. In Harkness, J., Pennell, B. E., Mohler, P. P., Johnson, T., Lyberg, L., Edwards, B., Smith, T. W. and Braun, M. (eds), Survey Methods in Multinational, Multiregional, and Multicultural Contexts. Wiley, Hoboken, New Jersey.Google Scholar
Bortz, W. M. 1990. The trajectory of dying: functional status in the last year of life. Journal of the American Geriatrics Society, 38, 2, 146–50.CrossRefGoogle ScholarPubMed
Brandt, M., Haberkern, K. and Szydlik, M. 2009. Intergenerational help and care in Europe. European Sociological Review, 25, 5, 585–601.CrossRefGoogle Scholar
Broese van Groenou, M., Glaser, K., Tomassini, C. and Jacobs, T. 2006. Socio-economic status differences in older people's use of informal and formal help: a comparison of four European countries. Ageing & Society, 26, 5, 745–66.CrossRefGoogle Scholar
Cartwright, A. 1992. Social class differences in health and care in the year before death. Journal of Epidemiology and Community Health, 46, 1, 54–7.CrossRefGoogle ScholarPubMed
Costantini, M., Beccaro, M., Merlo, F. and ISDOC Study Group 2005. The last three months of life of Italian cancer patients: methods, sample characteristics and response rate of the Italian Survey of the Dying of Cancer (ISDOC). Palliative Medicine, 19, 8, 628–38.CrossRefGoogle ScholarPubMed
Covinsky, K. E., Eng, C., Lui, L.-Y., Sands, L. P. and Yaffe, K. 2003. The last 2 years of life: functional trajectories of frail older people. Journal of the American Geriatrics Society, 51, 4, 492–98.CrossRefGoogle ScholarPubMed
de Luca, G. and Peracchi, F. 2005. Survey participation in the first wave of SHARE. In Börsch-Supan, A. and Jürges, H. (eds), The Survey of Health, Ageing and Retirement in Europe: Methodology. Mannheim Research Institute for the Economics of Aging, Mannheim, Germany, 88–104.Google Scholar
Gaymu, J., Delbès, C., Springer, S., Binet, A., Désesquelles, A., Kalogirou, S. and Ziegler, U. 2006. Determinants of the living arrangements of older people. European Journal of Population, 22, 3, 241–61.CrossRefGoogle Scholar
Glaser, K., Tomassini, C. and Grundy, E. 2004. Revisiting convergence and divergence: support for older people in Europe. European Journal of Ageing, 1, 1, 64–72.CrossRefGoogle ScholarPubMed
Goldman, N., Korenman, S. and Weinstein, R. 1995. Marital status and health among the elderly. Social Science & Medicine, 40, 12, 1717–30.CrossRefGoogle ScholarPubMed
Grabbe, L., Demi, A. S., Whittington, F., Jones, J. M., Branch, L. G. and Lambert, R. 1995. Functional status and the use of formal home care in the year before death. Journal of Aging and Health, 7, 3, 339–64.CrossRefGoogle ScholarPubMed
Guralnik, J. M., LaCroix, A. Z., Branch, L. G., Kasl, S. V. and Wallace, R. B. 1991. Morbidity and disability in older persons in the years prior to death. American Journal of Public Health, 81, 4, 443–47.CrossRefGoogle ScholarPubMed
Heyland, D. K., Dodek, P., Rocker, G., Groll, D., Gafni, A., Pichora, D., Shortt, S., Tranmer, J., Lazar, N., Kutsogiannis, J. and Lam, L. 2006. What matters most in end-of-life care: perceptions of seriously ill patients and their family members. Canadian Medical Association Journal, 174, 5, 627–33.CrossRefGoogle ScholarPubMed
Hogan, C., Lunney, J., Gabel, J. and Lynn, J. 2001. Medicare beneficiaries' costs of care in the last year of life. Health Affairs, 20, 4, 188–95.CrossRefGoogle ScholarPubMed
Huisman, M., Kunst, A. E. and Mackenbach, J. P. 2003. Socioeconomic inequalities in morbidity among the elderly: a European overview. Social Science and Medicine, 57, 5, 861–73.CrossRefGoogle ScholarPubMed
Idler, E. L., Kasl, S. V. and Hays, J. C. 2001. Patterns of religious practice and belief in the last year of life. Journal of Gerontology Series B: Social Sciences, 56, 6, S326–34.CrossRefGoogle ScholarPubMed
Imhof, S. and Kaskie, B. 2008. How can we make the pain go away? Public policies to manage pain at the end of life. The Gerontologist, 48, 4, 423–31.CrossRefGoogle ScholarPubMed
Jakobsson, E., Johnsson, T., Persson, L.-O. and Gaston-Johansson, F. 2006. End-of-life in a Swedish population: demographics, social conditions and characteristics of places of death. Scandinavian Journal of Caring Sciences, 20, 1, 10–17.CrossRefGoogle Scholar
Jürges, H. 2010. Health inequalities by education, income, and wealth: a comparison of 11 European countries and the US. Applied Economics Letters, 17, 1, 87–92.CrossRefGoogle Scholar
Klevmarken, A., Hesselius, P. and Swensson, B. 2005. The SHARE sampling procedures and calibrated design weights. In Börsch-Supan, A. and Jürges, H. (eds), The Survey of Health, Ageing and Retirement in Europe: Methodology. Mannheim Research Institute for the Economics of Aging, Mannheim, Germany, 28–69.Google Scholar
Klinkenberg, M., Visser, G., Broese van Groenou, M. I., van der Wal, G., Deeg, D. J. H. and Willems, D. L. 2005. The last 3 months of life: care, transitions and the place of death of older people. Health and Social Care in the Community, 13, 5, 420–30.CrossRefGoogle ScholarPubMed
Kohli, M., Hank, K. and Künemund, H. 2009. The social connectedness of older Europeans: patterns, dynamics and contexts. Journal of European Social Policy, 19, 4, 327–40.CrossRefGoogle Scholar
Lawrence, R. H. 1995. The structure of physical health status: comparing proxies and self-respondents. Journal of Aging and Health, 7, 1, 74–98.CrossRefGoogle ScholarPubMed
Lentzner, H. R., Pamuk, E. R., Rhodenhiser, E. P., Rothenberg, R. and Powell-Griner, E. 1992. The quality of life in the year before death. American Journal of Public Health, 82, 8, 1093–8.CrossRefGoogle ScholarPubMed
Liao, Y., McGee, D. L., Cao, G. and Cooper, R. S. 2000. Quality of the last year of life of older adults: 1986 vs 1993. Journal of the American Medical Association, 283, 4, 512–18.CrossRefGoogle ScholarPubMed
Lunney, J. R., Lynn, J., Foley, D. J., Lipson, S. and Guralnik, J. M. 2003. Patterns of functional decline at the end of life. Journal of the American Medical Association, 289, 18, 2387–92.CrossRefGoogle ScholarPubMed
Mackenbach, J., Avendano, M., Andersen-Ranberg, K. and Aro, A. R. 2005. Physical health. In Börsch-Supan, A., Brugiavini, A., Jürges, H., Mackenbach, J., Siegrist, J. and Weber, G. (eds), Health, Ageing and Retirement in Europe: First Results from the Survey of Health, Ageing and Retirement in Europe. Mannheim Research Institute for the Economics of Aging, Mannheim, Germany, 82–8.Google Scholar
Motel-Klingebiel, A., Tesch-Römer, C. and von Kondratowitz, H.-J. 2005. Welfare states do not crowd out the family: evidence for mixed responsibility from comparative analyses. Ageing & Society, 25, 6, 863–82.CrossRefGoogle Scholar
Munn, J. C., Dobbs, D., Meier, A., Williams, C. S., Biola, H. and Zimmerman, S. 2008. The end-of-life experience in long-term care: five themes identified from focus groups with residents, family members, and staff. The Gerontologist, 48, 4, 485–94.CrossRefGoogle ScholarPubMed
Oeppen, J. and Vaupel, J. 2002. Broken limits to life expectancy. Science, 296, 5570, 1029–31.CrossRefGoogle ScholarPubMed
Palmore, E. B. and Burchett, B. M. 1997. Predictors of disability in the final year of life. Journal of Aging and Health, 9, 3, 283–97.CrossRefGoogle ScholarPubMed
Parker, M. G. and Thorslund, M. 2007. Health trends in the elderly: getting better and getting worse. The Gerontologist, 47, 2, 150–8.CrossRefGoogle ScholarPubMed
Reher, D. S. 1998. Family ties in western Europe: persistent contrasts. Population and Development Review, 24, 2, 203–34.CrossRefGoogle Scholar
Rice, D. P. and Fineman, N. 2004. Economic implications of increased longevity in the United States. Annual Review of Public Health, 25, 457–73.CrossRefGoogle ScholarPubMed
Romoren, T. I. 2003. Last Years of Long Lives: The Larvik Study. Routledge, London.Google Scholar
Schröder, M. 2008. Attrition. In Börsch-Supan, A., Brugiavini, A., Jürges, H., Kaypteyn, A., Mackenbach, J., Siegrist, J. and Weber, G. (eds), Health, Ageing and Retirement in Europe (2004–2007): Starting the Longitudinal Dimension. Mannheim Research Institute for the Economics of Aging, Mannheim, Germany, 327–32.Google Scholar
Stuart, M. and Hansen, E. B. 2006. Danish home care policy and the family: implications for the United States. Journal of Aging and Social Policy, 18, 1, 27–42.Google ScholarPubMed
Tomassini, C., Glaser, K., Wolf, D. A., Broese van Groenou, M. and Grundy, E. 2004. Living arrangements among older people: an overview of trends in Europe and the USA. Population Trends, 115, 24–34.Google Scholar
Wendorf, C. A. 2004. Primer on multiple regression coding: common forms and the additional case of repeated contrasts. Understanding Statistics, 3, 1, 47–57.CrossRefGoogle Scholar
Wetle, T., Shield, R., Teno, J., Miller, S. C. and Welch, L. 2005. Family perspectives on end-of-life care experiences in nursing homes. The Gerontologist, 45, 5, 642–50.CrossRefGoogle ScholarPubMed
Zhao, J., Barclay, S., Farquhar, M., Kinmonth, A. L., Brayne, C. and Fleming, J. 2010. The oldest old in the last year of life: population-based findings from Cambridge City over-75s Cohort Study participants aged 85 and older at death. Journal of the American Geriatrics Society, 58, 1, 1–11.CrossRefGoogle ScholarPubMed