Background Previous research has focussed on individual-level determinants of nursing home admission (NHA), although substantial variation in the prevalence of NHA between European countries suggests a substantial impact of country of residence. The aim of this analysis was to assess individual-level determinants and the role of country of residence and specifically a country‘s public institutional long-term care infrastructure on proxy-reported NHA in the last year of life. Methods We analysed data from 7,018 deceased respondents (65+) of the Survey of Health, Ageing and Retirement in Europe (2004–2015, 16 countries) using Bayesian hierarchical logistic regression analysis in order to model proxy-reported NHA. Results In total, 14% of the general older population utilised nursing home care in the last year of life but there was substantial variation across countries (range = 2–30%). On the individual-level, need factors such as functional and cognitive impairment were the strongest predictors of NHA. In total, 18% of the variance of NHA was located at the country-level; public expenditure on institutional care strongly affected the chance of NHA in the last year of life. Conclusion On the individual-level, the strong impact of need factors indicated equitable access to NHA, whereas differences in public spending for institutional care indicated inequitable access across European countries.
Stolz, E., Mayerl, H., Rásky, É., & Freidl, W. (2019). Individual and country-level determinants of nursing home admission in the last year of life in Europe. PLoS ONE, 14(3). https://doi.org/10.1371/journal.pone.0213787