Background
Methods
Study population
Assessments
Combined field survey of disability and services
Register linkage study. Official dependency assessment and service plan
Assessment status as per official functional dependency scale. Degree, level, and score shown in brackets | Number of persons in WHODAS-2 36 items and proportion [percentages] of screened sample | ||||
---|---|---|---|---|---|
Low/no problem 0–4 | Mild disability 5–24 | Moderate disability 25–49 | Severe/extreme disability 50–100 | All scoreintervals 0–100 | |
Degree Ia Both levels (25–49) | 0 | 0 | 5 | 5 | 10 |
Degree IIb Lower level (50–64) | 0 | 3 | 2 | 6 | 11 |
Degree IIb Higher level (65–74) | 0 | 0 | 2 | 4 | 6 |
Degree IIIc Lower level (75–89) | 0 | 0 | 5 | 11 | 16 |
Degree IIIc Higher level (90–100) | 0 | 0 | 1 | 23 | 24 |
Assessed with degree assigned | 0 | 3 | 15 | 49 | 67 |
Assessed without any degree assigned | 0 | 3 | 1 | 3 | 7 |
All officially assessed | 0 [0] | 6 [2] | 16 [8] | 52 [56] | 74 [12] |
All not officially assessed | 19 [100] | 312 [98] | 179 [92] | 41 [44] | 551 [88] |
All assessed and unassessed | 19 | 318 | 195 | 93 | 625 |
Data-analysis
Results
Calendar time intervals for disability, service use and official dependency assessments
The view of disability vs. officially assessed dependency at visit date
Social services approved and implemented by disability and dependency groups under the 2006 Act
Service users as a result of implementation of the 2006 Act | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
WHODAS-36 score or age-group | Dependency Degree II beneficiaries | Dependency Degree III beneficiaries | Overall service beneficiaries | Prevalence of ISPP beneficiaries in populations [%] | ||||||
Financial support for professional or non-professional home care | Financial support for residential care | Financial support for day care center | Financial support for professional or non-professional home care | Financial support for residential care | Among population screened positive for disability | Among population aged >50 years including persons screened negative for disability | ||||
Approved | Implemented | Approved | Implemented | |||||||
0–4 | - | - | - | - | - | - | 0/19 [0] | 0 [0] | 0/610 [0] | 0/610 [0] |
5–24 | 3 (0) | - | - | - | - | 3 | 3/318 [1] | 0 [0] | 3/318 [1] | 0/318 [0] |
25–49 | - | 4 (1) | - | 1 (0) | 5 (3) | 10 (4) | 10/195 [5] | 4/195 [2] | 10/195 [5] | 4/195 [1] |
50–95 | 7 (0) | 2 (0) | 1 (0) | 23 (16) | 10 (9) | 43 (25) | 43/92 [47] | 25/92 [27] | 43/92 [47] | 25/92 [11] |
96–100 | - | - | - | 1 (1) | - | 1 (1) | 1/1 [100] | 1/1 [100] | 1/1 [100] | 1/1 [100] |
Total | 10 (0) | 6 (1) | 1 (0) | 25 (17) | 15 (12) | 57 (30) | 57/625 [9] | 30/625 [5] | 57/1216 [5] | 30/1216 [2] |
Population and prevalence | ||||||||||
50–59y | - | - | 1 | - | 1 (1) | 2 (1) | - | 1/101 [2] | - | 1/299 [1] |
60–69y | 4 | 1 | - | - | - | 5 (0) | - | 0/116 [0] | - | 0/305 [0] |
70–79y | 1 | 1 | - | 6 (4) | 2 (1) | 10 (5) | - | 5/198 [6] | - | 5/352 [3] |
80–89y | 2 | 3 | - | 11 (8) | 10 (9) | 26 (17) | - | 17/174 [19] | - | 17/221 [14] |
≥90y | 3 | 1 (1) | - | 8 (5) | 2 (1) | 14 (7) | - | 7/34 [42] | - | 7/37 [37] |
All | 10 (0) | 5 (1) | 1 (0) | 25 (17) | 15 (12) | 57 (30) | - | 30/623 [9] | - | 30/1214 [5] |
Overall service use and distribution by relevant groups
Number of LTC service users | ||||||||
---|---|---|---|---|---|---|---|---|
WHODAS-36 score or age group | Study participants using services unrelated to officially assessed dependency (in brackets those with publicly-funded support (PFS)) | Dependency Degree II+ III beneficiaries | All users | Prevalence of PFS service users [%] | ||||
Declared professional or non-professional home help for home care | Residential care | Day care center (DCC) | Professional or non-professional home care | Residential care | Among population screened positive for disability | Among surveyed population including persons screened negative for disability | ||
0–4 | - | 1 (0) | - | - | - | 1 | 0/19 [0] | 0/610 [0] |
5–24 | 38 (12) | 12 (6) | 5 (0) | - | - | 55 (18) | 18/318 [6] | 18/318 [6] |
25–49 | 36 (21) | 15 (8) | 3 (2) | - | (4) | 58 (35) | 35/195 [18] | 35/195 [18] |
50–95 | 12 (8) | 9 (2) | 2 (1) | (16) | (9) | 48 (36) | 36/92 [39] | 36/92 [39] |
96–100 | - | - | - | (1) | - | 1 (1) | 1/1 [100] | 1/1 [100] |
Total | 86 (41) | 37 (16) | 10 (3) | (17) | (13) | 163 (90) | 90/625 [14] | 90/1216 [7] |
Number of users, population, and prevalence | ||||||||
50–59y | 7 (2) | 2 (1) | - | - | (1) | 10 (4) | 4/101 [10] | 4/299 [3] |
60–69y | 7 (1) | 2 (2) | - | - | - | 9 (3) | 3/106 [6] | 3/305 [2] |
70–79y | 24 (10) | 11 (5) | 5 (1) | (4) | (1) | 45 (21) | 21/198 [22] | 21/352 [12] |
80–89y | 43 (23) | 17 (6) | 5 (2) | (8) | (9) | 82 (48) | 48/174 [57] | 48/221 [44] |
≥90y | 5 (5) | 3 (1) | - | (5) | (2) | 15 (13) | 13/34 [66] | 13/37 [60] |
All | 86 (41) | 35 (15) | 10 (3) | (17) | (13) | 161 (89) | 89/623 [29] | 89/1214 [14] |
Crude prevalence of LTC users by service category and funding sources
Patterns of service use by age and disability
The analytical perspective of social service use
Service or service-linked resource used | Dependency not assesseda
-Users -Non-users | Dependency assessed -Users -Non-users | No. of records in modelsa
| WHODAS-36 per point | DD I ref. unassessed | DD II ref. unassessed | DD-III ref. unassessed | Etiologic fraction with 95% CI |
---|---|---|---|---|---|---|---|---|
Contact with Social Care Office | 57 498 | 14 53 | 619 | 1.03 (1.01–1.04) | 0.72 (0.08–6.31) | 5.80 (1.92–17.52) | 0.76 (0.23–2.51) | 5.77 (-11.92–18.39) |
Official dependency assessment | 7 (without DD) 551 | 67 | 625 | 1.08 (1.06–1.09) | - | - | - | - |
Residential living | 34 524 | 23 44 | 622 | 0.99 (0.97–1.01) | 1.90 (0.22–16.54) | 8.60 (2.63–28.07) | 12.13 (3.86–38.16) | 36.19 (20.35–50.97) |
Residential living with PFS (declared) | 13 544 | 13 54 | 612 | 0.99 (0.96–1.01) | 1.00 (1.00–1.00) | 12.15 (2.56–57.77) | 25.50 (5.35–121.61) | 47.49 (26.50–68.75) |
Residential living supported by 2006 Act (registered)b
| 0 595 | 13 17 | 521 | 0.96 (-0.91–1.02) | - | - | - | - |
Residential living with PFS (declared or under 2006 Act)b
| 16 579 | 13 17 | 621 | 0.99 (-0.96–1.02) | - | - | 41.18 (8.40–201.84) | 39.40 (20.33–58.13) |
Home help for domestic tasks (declared) | 58 466 | 8 36 | 567 | 1.01 (0.99–1.03) | 1.51 (0.17–13.81) | 1.42 (0.25–8.02) | 1.25 (0.31–5.05) | 3.2 (-10.62–14.15) |
Home help for personal care (declared) | 15 509 | 8 37 | 567 | 1.03 (1.00–1.05) | 3.19 (0.32–32.14) | 9.62 (1.91–48.50) | 2.07 (0.36–11.96) | 24.11 (-15.74–49.48) |
Home help for personal care or domestic tasks with PFS (declared) | 33 491 | 7 37 | 567 | 1.03 (1.00–1.05) | 2.58 (0.25–26.40) | 2.23 (0.35–14.27) | 0.85 (0.16–4.41) | 3.52 (-35.4–20.97) |
Available non-professional carer (declared) | 86 438 | 36 71 | 567 | 1.04 (1.02–1.06) | 4.47 (0.93–21.50) | 7.50 (1.59–35.32) | 10.99 (1.28–94.53) | 19.4 (2.31–33.73) |
Non-professional carer with PFS (declared) | 2 522 | 15 28 | 471 | 1.05 (1.01–1.09) | - | 36.57 (4.74–281.96) | 26.30 (3.36–205.88) | 83.16 (-0.61–94.97) |
Professional carer (declared) | 41 483 | 9 34 | 558 | 1.02 (1.00–1.04) | - | 2.56 (0.58–11.31) | 0.97 (0.26–3.61) | 2.66 (-36.1–21.21) |
Carer (declared) | 115 409 | 37 6 | 567 | 1.04 (1.03–1.06) | 2.81 (0.58–13.57) | 8.47 (1.55–46.16) | 6.35 (0.75–54.05) | 12.96 (-0.57–26.15) |
Carer with PFS (declared) | 22 502 | 20 23 | 558 | 1.04 (1.02–1.06) | 1.67 (0.16–16.95) | 7.83 (1.58–38.77) | 6.41 (1.73–23.70) | 39.85 (18.00–59.13) |
Carer supported under 2006 Actb
| 0 524 | 16 c
27 | 567 | 1.05 (1.02–1.07) | - | - | - | - |
Carer with PFS (declared or supported under 2006 Act)b
| 22 502 | 34 1 | 567 | 2.13 (-1.15–3.93) | - | - | 1.13 (-1.06–1.20) | 4.06 (0.71–8.16) |
Equity among the severely/extremely disabled
Personal, socio-demographic, clinical and residential features | Used at least one service: home help, day care, professional carer or had an individual support service plan (ISSP) implemented | Social service benefit non-users |
P-values for differences of proportions or means |
---|---|---|---|
Number of individuals (n = 74) | 31 (100) | 43 (100) | |
Social and demographic features | |||
Gender % (female) | 22 (70.97) | 34 (79.07) | 0.423 |
Age in years. Mean (SD), | 82.6 (9.02) | 79.34 (10.80) | 0.035 |
Academic qualification. None, incomplete primary, % | 12 (38.71) | 22 (51.16) | 0.289 |
“Can hardly make ends meet”a
| 7 (23.33) | 13 (30.90) | |
Living aloneb
| 2 (6.67) | 4 (9.30) | 0.657 |
Average number of household members. Mean (SD), | 2.9 (1.32) | 2.7 (1.04) | 0.291 |
Available non-professional carer | 24 (77.42) | 26 (60.47) | 0.121 |
Available professional carer | 15 (48.39) | 0 (0) | <0.001 |
Contact with social services unit (denoted as Centro Base) | 7 (22.58) | 4 (9.30) | 0.1132 |
Diagnoses registered in primary care medical recordsb
| |||
History of depression | 9 (29.03) | 10 (23.26) | 0.575 |
Dementia | 14 (45.16) | 7 (16.28) | 0.108 |
Chronic obstructive pulmonary disease | 4 (12.9) | 4 (9.30) | 0.623 |
Urinary incontinence | 6 (19.35) | 3 (6.98) | 0.108 |
Stroke | 18 (58.06) | 5 (11.63) | <0.001 |
Neurodegenerative disease | 3 (9.68) | 1 (2.33) | 0.168 |
Average number of chronic conditions. Mean (SD) | 3.45 (1.41) | 2.90 (1.53) | 0.140 |
Mini-Mental Status Examination score <24 at survey datec
| 11 (57.81) | 24 (60.00) | 0.084 |
Prevalence of depressive symptoms EURO-D score ≥4d
| 16 (47.1) | 16 (51.6) | 0.714 |
WHODAS-36 score | |||
Mean (SD) | 70.25 (15.58) | 61.54 (10.33) | 0.005 |
Severe/extreme difficulties in “Getting out of home”e
| 27 (87.10) | 35 (81.40) | 0.512 |
Municipality size | |||
<500 inhabitants | 13 (41.91) | 16 (37.21) | 0.681 |
500-14000 inhabitants | 12 (38.70) | 24 (55.81) | 0.146 |
>14000 inhabitants | 6 (19.35) | 13 (6.98) | 0.108 |
Individual support service plan implemented | 17 (54.83) | 0 (0) | <0.001 |
Individual support service plan not implemented. | 4 (12.90) | 10 (23.26) | 0.262 |
Service use by persons grouped in diagnostic categories
Service used | Dementia | Severe mental disease | Cerebrovascular disease | Neurodegenerative diseases |
---|---|---|---|---|
Residential living | 3.70 (1.62–8.44) 16.74 (3.56–29.96) | 21.74 (4.71–100.24) 11.19 (0.00–20.91) | 1.37 (0.59–3.15) 5.01 (-11.67–17.98) | 4.31 (1.41–13.16) 9.04 (0.88–19.54) |
Residential care supported by the 2006 Act. | 12.52 (3.58–43.82) 49.68 (14.71–79.27) | 8.23 (0.96–70.31) 12.54 (0–37.74) | 1.35 (0.31–5.93) 6.40 (-43.69–43.71) | 3.60 (0.45–28.63) 9.46 (-2.86–32.81) |
Household adaptation | 1.56 (0.70–3.46) 2.50 (-2.39–7.25) | - | 1.57 (0.90–2.76) 5.46 (-2.18–13.32) | 1.59 (0.51–5.02) 1.11 (-1.59–4.82) |
Home help (declared) | 0.63 (0.18–2.26) -2.37 (-7.76–4.00) | - | 2.60 (1.30–5.21) 11.82 (2.02–22.73) | 2.22 (0.58–8.43) 2.16 (-1.19–8.28) |
Available carer (declared, any type of carer) | 7.95 (3.32–19.03) 13.98 (7.67–20.10) | 25.38 (0.41–71.34) 0.10 (-0.09–2.97) | 4.81 (2.69–8.60) 19.30 (11.82–27.03) | 4.68 (1.52–14.42) 3.82 (0.27–7.93) |
Non-professional carer (declared) | 11.11 (4.61–26.81) 17.52 (10.27–24.47) | 7.84 (0.56–109.73) 0.33 (0.00–3.40) | 4.78 (2.63–8.68) 21.31 (11.46–29.93) | 3.71 (1.16–11.88) 3.53 (-0.02–7.42) |
Professional carer (declared) | 0.93 (0.27–3.25) -0.97 (-22.04–11.85) | - | 5.42 (2.69–10.94) 27.06 (12.45–41.63) | 3.62 (0.92–14.23) 4.11 (-0.20–11.96) |
Personal care supported by the 2006 Act | 48.06 (12.88–179.29) 63.36 (30.20–80.77) | - | 12.70 (3.53–45.65) 54.19 (18.64–74.21) | 9.19 (0.84–100.95) 5.24 (-6.75–15.89) |