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.
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Notes
- 1.
Presumably most of these people did not return the census form due to incapacity, and indeed the mortality risk for this group was very high, bearing out this assumption. However, given the small number of non-returns we decided it was preferable to avoid such assumptions and to exclude this group from the analysis.
- 2.$$CDR=\frac{Deaths}{Population-0.5\cdot Deaths}$$
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References
Adler, D. (2005). Vioplot: Violin plot. R package version 0.2. http://wsopuppenkiste.wiso.uni-goettingen.de/~dadler. Accessed 9 Feb 2011.
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.
Breiman, L., Friedman, J. H., Olschen, C. J., & Stone, R. A. (1984). Classification and regression trees. Monterey: Wadsworth.
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.
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.
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.
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.
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.
Grennacre, M., & Blasius, J. (2006). Multiple correspondence analysis and related methods (Statistics in the Social and Behavioral Sciences). NY: Chapman & Hall.
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.
Hintze, J. L., & Nelson, R. D. (1998). Violin plots: A box plot-density trace synergism. The American Statistician, 52(2), 181–184.
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.).
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.
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.
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.
Koskinen, S., Joutsenniemi, K., Martelin, T., & Martikainen, P. (2007). Mortality differences according to living arrangements. International Journal of Epidemiology, 36(6), 1255–1264.
Lillard, L. A., & Panis, C. W. A. (1996). Marital status and mortality: The role of health. Demography, 33(3), 313–327.
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.
Manor, O., & Eisenbach, Z. (2003). Mortality after spousal loss: Are there socio-demographic differences? Social Science and Medicine, 56(2), 405–413.
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.
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.
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.
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.
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.
Raines, J. E., & Wight, J. (2002). The mortality experience of people admitted to nursing homes. Journal of Public Health Medecine, 24(3), 184–199.
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.
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.
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.
Tukey, J. W. (1997). Exploratory data analysis. Reading: Addison.
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.
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Herm, A., Poulain, M., Anson, J. (2014). Excess Mortality Risks in Institutions: The Influence of Health and Disability Status. In: Anson, J., Luy, M. (eds) Mortality in an International Perspective. European Studies of Population, vol 18. Springer, Cham. https://doi.org/10.1007/978-3-319-03029-6_10
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