Longer lives, healthier lives? Patterns of severe health problems and dependency in the last years of life

PI: Bettina Meinow

The relatively healthy period after retirement, the so-called “third age,” lasts longer than it did a few decades ago. Yet, the length of the “fourth age,” a period with poor health and dependence on long-term care (i.e., home-help services or institutional care) before death, remains unclear. The project examines whether this last stage in life has been compressed into a shorter time or whether it has expanded, as more recent cohorts survive longer despite health problems.

We use two approaches to learn more about the fourth age.

First, we will use information from registers such as the Swedish national Social Services Register and the Causes of Death Register to examine long-term care use as an indicator of dependency in the fourth age. We will analyze the entrance into and duration of long-term care use for self-care activities of daily living, examining whether patterns vary by gender, education, civil status, and the age of entrance into long-term care.

Second, we will use health indicators from a nationally representative survey of people aged 70+ (SWEOLD; n=2477) to estimate changes between 2004 and 2014 in how long people can expect, on average, to live in poor health or dependency after the age of 70. Study questions include: Which indicators of poor health were compressed into a shorter period before death? Which expanded and were experienced for a longer period prior to death? Which were experienced for an equally long time but starting at an older age? We will also analyze whether trends differ by gender and educational level.

The results of the study will contribute to our understanding of aging processes over the course of the human life span. The findings will have important implications for estimating future care needs and for the structure and organization of care services.

This project is funded by grants from the Swedish Research Council for Health, Working Life, and Welfare (Forte) and the Swedish Research Council.