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Excess Mortality Risks in Institutions: The Influence of Health and Disability Status

  • Anne Herm
  • Michel Poulain
  • Jon AnsonEmail author
Chapter
Part of the European Studies of Population book series (ESPO, volume 18)

Abstract

Mortality in the institutionalized aged population is generally recognized as being considerably higher than among those living independently; whereas among those living independently, there is a greater risk of mortality among those living alone than among those living with other adults (generally with spouse and/or children). However, given that the institutionalized population is liable to be poorer, and in poorer health than the independent-living population, it is unclear whether the higher mortality risk among the institutionalized population results from their poorer health, or from other causes associated with institutionalization. The Belgian Census of 2001, coupled with a near-complete follow-up of deaths over the subsequent year (2002), enables us to compute a reasonable measure of health at the time of the census and thus separate out the effects of health status and living conditions on mortality. Taken across the entire population of Belgian nationals resident in Belgium and aged 65 and above at the time of the census (N = 1.64 million cases with full data), and controlling for background characteristics, we find that except at very old ages, those living in old age homes have a higher risk of mortality than those living in private housing, irrespective of health status. We conclude that while much of the apparently higher mortality of the institutionalized aged population may be attributable to the generally poorer health of those living in institutions, there is nonetheless a salutogenic effect of living independently in private housing, whatever the individual’s health status.

Keywords

Belgium Old age Ill-health Institutionalisation Gender differences 

References

  1. Adler, D. (2005). Vioplot: Violin plot. R package version 0.2. http://wsopuppenkiste.wiso.uni-goettingen.de/~dadler. Accessed 9 Feb 2011.
  2. Börsch-Supan, A., Mcfadden, D., & Schnabel, R. (1996). Living arrangements, health and wealth effects. In D. Wise (Ed.), Advances in the economics of aging (pp. 193–218). Chicago: University of Chicago Press.Google Scholar
  3. Breiman, L., Friedman, J. H., Olschen, C. J., & Stone, R. A. (1984). Classification and regression trees. Monterey: Wadsworth.Google Scholar
  4. Breuer, B., Wallenstein, S., Feinberg, C., Camargo, M.-J. F., & Libow, L. S. (1998). Assessing life expectancies of older nursing home residents. Journal of the American Geriatrics Society, 46(8), 954–962.Google Scholar
  5. Cohen-Mansfield, J., Marx, M. S., Lipson, S., & Werner, P. (1999). Predictors of mortality in nursing home residents. Journal of Clinical Epidemiology, 52(4), 273–280.CrossRefGoogle Scholar
  6. Dale, M. C., Burns, A., Panter, L., & Morris, J. (2001). Factors affecting survival of elderly nursing home residents. International Journal of Geriatric Psychiatry, 16(1), 70–76.CrossRefGoogle Scholar
  7. Davis, M. A., Moritz, D. J., Neuhaus, J. M., Barclay, J. D., & Gee, L. (1997). Living arrangements, changes in living arrangements and survival among community dwelling older adults. American Journal of Public Health, 87, 371–377.CrossRefGoogle Scholar
  8. Flacker, J. M., & Kiely, D. K. (2003). Mortality-related factors and 1-year survival in nursing home residents. Journal of the American Geriatrics Society, 51(2), 213–221.CrossRefGoogle Scholar
  9. Grennacre, M., & Blasius, J. (2006). Multiple correspondence analysis and related methods (Statistics in the Social and Behavioral Sciences). NY: Chapman & Hall.CrossRefGoogle Scholar
  10. Grundy, E. (2010). Household transitions and subsequent mortality among older people in England and Wales: Trends over three decades. Journal of Epidemiology & Community Health, 65, 353–359.CrossRefGoogle Scholar
  11. Hintze, J. L., & Nelson, R. D. (1998). Violin plots: A box plot-density trace synergism. The American Statistician, 52(2), 181–184.Google Scholar
  12. Hjaltadattir, I., Halberg, I. R., Ekwall, A. K., & Nyberg, P. (2011). Predicting mortality of residents at admission to nursing home: A longitudinal cohort study. BMC Health Services Research, 11 (Article number 86, pages 1–11.).Google Scholar
  13. Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Health and Social Behavior, 38(1):21–37.CrossRefGoogle Scholar
  14. Kiely, D. K., & Flacker, J. M. (2002). Common and gender specific factors associated with one-year mortality in nursing home residents. Journal of the American Medical Directors Association, 3(5), 302–309.CrossRefGoogle Scholar
  15. Klein, T. (1996). Determinants of institutionalization in old age. In R. Eisen & F. A. Sloan (Eds.), Long-term care: Economic issues and policy solutions (pp. 103–112). Boston: Kluwer Academic Publishers.CrossRefGoogle Scholar
  16. Koskinen, S., Joutsenniemi, K., Martelin, T., & Martikainen, P. (2007). Mortality differences according to living arrangements. International Journal of Epidemiology, 36(6), 1255–1264.CrossRefGoogle Scholar
  17. Lillard, L. A., & Panis, C. W. A. (1996). Marital status and mortality: The role of health. Demography, 33(3), 313–327.CrossRefGoogle Scholar
  18. Lusyne, P., Page, H., & Lievens, J. (2001). Mortality following conjugal bereavement, Belgium 1991–96: The unexpected effect of education. Population Studies, 55(3), 281–289.CrossRefGoogle Scholar
  19. Manor, O., & Eisenbach, Z. (2003). Mortality after spousal loss: Are there socio-demographic differences? Social Science and Medicine, 56(2), 405–413.CrossRefGoogle Scholar
  20. Manzoli, L., Villari, P., Pirone, G. M., & Boccia, A. (2007). Marital status and mortality in the elderly: A systematic review and meta-analysis. Social Science and Medecine, 64, 77–94.CrossRefGoogle Scholar
  21. Molloy, G. J., Stamatakis, E., Randall, G., & Hamer, M. (2009). Marital status, gender and cardiovascular mortality: Behavioural, psychological distress and metabolic explanations. Social Science & Medicine, 69(2), 223–228.CrossRefGoogle Scholar
  22. Murphy, M. (1995). Assessing the link between household and family living arrangements and health. In G. Wunsch & A. Hancioglu (Eds.), Morbidity and mortality data: Problems of comparability. Proceedings of the European Association for Population Studies and the Hacettepe Institute of Population Studies Workshop, Ürgüp, Turkey, 18–20 October 1995.Google Scholar
  23. Nenadic, O. & Greenacre, M. (2007) Correspondence Analysis in R, with two- and three-dimensional graphics: The ca package. Journal of Statistical Software 20(3):1–13.Google Scholar
  24. Nihtila, E., & Martikainen, P. (2008). Why older people living with a spouse are less likely to be institutionalized: The role of socio-economic factors and health characteristics. Scandinavian Journal of Public Health, 36(1), 35–43.CrossRefGoogle Scholar
  25. Raines, J. E., & Wight, J. (2002). The mortality experience of people admitted to nursing homes. Journal of Public Health Medecine, 24(3), 184–199.CrossRefGoogle Scholar
  26. Rendall, M. S., Weden, M. M., Favreault, M. M., & Waldron, H. (2011). The protective effect of marriage for survival: A review and update. Demography, 48(2), 481–506.CrossRefGoogle Scholar
  27. Strobl, C., Malley, J., & Tutz, G. (2009). An introduction to recursive partitioning: Rationale, application, and characteristics of classification and regression trees, bagging, and random forests. Psychological Methods, 14(4), 323–348.CrossRefGoogle Scholar
  28. Therneau, T. M., & Atkinson, B. (2011). Rpart: Recursive Partitioning. R package version 3.1–49. R port by Brian Ripley. http://CRAN.R-project.org/package=rpart. Accessed 8 May 2011.
  29. Tukey, J. W. (1997). Exploratory data analysis. Reading: Addison.Google Scholar
  30. Zunzunegui, M. V., Beland, F., & Otero, A. (2001). Support from children, living arrangements, self-rated health and depressive symptoms of older people in Spain. International Journal of Epidemiology, 30, 1090–1099.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.IACCHOSUniversité catholique de LouvainLouvain-La-NeuveBelgium
  2. 2.Estonian Institute for Population StudiesTallinn UniversityTallinnEstonia
  3. 3.Department of Social WorkBen-Gurion University of the NegevBeer ShevaIsrael

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