Patterns of long-term care utilization during the last five years of life among Swedish older adults with and without dementia.

AIMS: The aims of this study were to compare the patterns of long-term care (LTC) use (no care, homecare, residential care) among people with and without dementia aged 70+ in Sweden during their last five years of life and its association with sociodemographic factors (age, gender, education, cohabitation status) and time with a dementia diagnosis. METHODS: This retrospective cohort study included all people who died in November 2019 aged 70 years and older (n = 6294) derived from several national registers. A multinomial logistic regression was conducted to identify which sociodemographic factors predicted the patterns of LTC use. RESULTS: Results showed that the time with a dementia diagnosis and cohabitation status were important predictors that influence the patterns of LTC use during the last five years of life. Nearly three-quarters of people living with dementia (PlwD) used residential care during the last five years of life. PlwD were more likely to reside in residential care close to death. Women who lived alone, with or without dementia, used residential care to a higher degree compared to married or cohabiting women. CONCLUSIONS: Among people without a dementia diagnosis, as well as those who were newly diagnosed, it was common to have no LTC at all, or use LTC only for a brief period close to death. During the last five years of life, PlwD and those living alone more often entered LTC early and used residential care for a longer time compared to people without dementia and people living alone, respectively.

History of working conditions and the risk of old-age dependency: a nationwide Swedish register-based study.

AIMS: There is substantial evidence that previous working conditions influence post-retirement health, yet little is known about previous working conditions' association with old-age dependency. We examined job strain, hazardous and physical demands across working life, in relation to the risk of entering old-age dependency of care. METHODS: Individually linked nationwide Swedish registers were used to identify people aged 70+ who were not receiving long-term care (residential care or homecare) at baseline (January 2014). Register information on job titles between the years 1970 and 2010 was linked with a job exposure matrix of working conditions. Random effects growth curve models were used to calculate intra-individual trajectories of working conditions. Cox regression models with age as the timescale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios for entering old-age dependency during the 24 months of follow-up (n = 931,819). RESULTS: Having initial adverse working conditions followed by an accumulation throughout working life encompassed the highest risk of entering old-age dependency across the categories (job strain: HR 1.23, 95% CI 1.19-1.27; physical demands: HR 1.36, 95% CI 1.31-1.40, and hazardous work: HR 1.35, 95% CI 1.30-1.40). Initially high physical demands or hazardous work followed by a stable trajectory, or initially low-level physical demand or hazardous work followed by an accumulation throughout working life also encompassed a higher risk of dependency. CONCLUSIONS: A history of adverse working conditions increased the risk of old-age dependency. Reducing the accumulation of adverse working conditions across the working life may contribute to postponing old-age dependency.

Length of the period with late life dependency: Does the age of onset make a difference?

There is a gap in knowledge about factors associated with the duration of late life dependency. In this study, we measured how the age at onset of late life dependency relates to the time spent with late life dependency. Using Swedish register data, we identified people 70 + who entered the period of late life dependency (measured by entering long-term care for help with PADLs) between June and December 2008. We followed this cohort (n = 17,515) for 7 years, or until death. We used Laplace regression models to estimate the median number of months with late life dependency by age group, gender, level of education and country of birth. We also calculated the crude percentiles (p10, p25, p50, p75 and p90) of month with late life dependency, by age group, gender and cohabitation status. Results show that the majority spent a rather long period with dependency, the median number of months were 40.0 (3.3 years) for women and 22.6 (1.9 year) for men. A higher age at entry was associated with a shorter duration of dependency, an association that was robust to adjustment for cohabiting at baseline, gender, education and country of birth. Our results suggest that older adults who postpone the start of dependency also compress the time with dependency, this lends support to the ambitions of public health initiatives and interventions targeting maintained independence in older adults.

Educational differences in long-term care use in Sweden during the last two years of life.

Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged ⩾67 years who died in Sweden in November 2015 (N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p<0.001). In the adjusted model, educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8-17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8-16.8)). Conclusions: Older adults spend considerable time in their last two years of life with long-term care. Only minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Sweden's publicly financed long-term system achieves relatively equitable use of long-term care at the end of life.

Long-term care use among people living with dementia: a retrospective register-based study from Sweden.

BACKGROUND: Although many people with dementia need progressive support during their last years of life little is known to what extent they use formal long-term care (LTC). This study investigates the use of LTC, including residential care and homecare, in the month preceding death, as well as the number of months spent in residential care, among Swedish older decedents with a dementia diagnosis, compared with those without a dementia diagnosis. METHODOLOGY: This retrospective cohort study identified all people who died in November 2019 in Sweden aged 70 years and older (n = 6294). Dementia diagnoses were collected from the National Patient Register (before death) and the National Cause of Death Register (death certificate). The use of LTC was based on the Social Services Register and sociodemographic factors were provided by Statistics Sweden. We performed regression models (multinomial and linear logistic regression models) to examine the association between the utilization of LTC and the independent variables. RESULTS: Not only dementia diagnosis but also time spent with the diagnosis was crucial for the use of LTC in the month preceding death, in particular residential care. Three out of four of the decedents with dementia and one fourth of those without dementia lived in a residential care facility in the month preceding death. People who were diagnosed more recently were more likely to use homecare (e.g., diagnosis for 1 year or less: home care 29%, residential care 56%), while the predicted proportion of using residential care increased substantially for those who had lived longer with a diagnosis (e.g., diagnosis for 7 + years: home care 11%, residential care 85%). On average, people with a dementia diagnosis stayed six months longer in residential care, compared with people without a diagnosis. CONCLUSIONS: People living with dementia use more LTC and spend longer time in residential care than those without dementia. The use of LTC is primarily influenced by the time with a dementia diagnosis. Our study suggests conducting more research to investigate differences between people living with different dementia diagnoses with co-morbidities.

Trends over two decades in life expectancy with complex health problems among older Swedes: implications for the provision of integrated health care and social care.

BACKGROUND: Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years. METHODS: CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged ≥ 77 years with waves in 1992, 2002 and 2011 (n≈2000), was used to estimate the prevalence of CHP. Age- and gender-specific death rates were obtained from the Human Mortality Database. The Sullivan method was deployed to calculate the remaining life expectancy with and without CHP. The estimates were decomposed to calculate the contribution of changes from morbidity and mortality to the overall trends in LE without CHP. RESULTS: Between 1992 and 2011, both total LE (+ 1.69 years [95% CI 1.56;1.83] and LE without CHP (+ 0.84 years [-0,87;2.55]) at age 77 increased for men, whereas LE at age 77 increased for women (+ 1.33 [1.21;1.47]) but not LE without CHP (-0.06 years [-1.39;1.26]). When decomposing the trend, we found that the increase in LE with CHP was mainly driven by an increase in the prevalence of CHP. Among individuals with CHP the proportion residing in care homes was lower in 2011 (37%) compared to 2002 (58%) and 1992 (53%). CONCLUSIONS: The findings, that an increasing number of older people are expected to live more years with CHP, and increasingly live in the community, point towards a challenge for individuals and families, as well as for society in financing and organizing coordinated and coherent medical and social services.

Long-Term Care Use During the Last 2 Years of Life in Sweden: Implications for Policy to Address Increased Population Aging.

OBJECTIVES: To map out the total use of long-term care (LTC; ie, home care or institutional care) during the last 2 years of life and to investigate to what extent gender differences in LTC use were explained by cohabitation status and age at death. DESIGN: The National Cause of Death Register was used to identify decedents. Use of LTC was based on the Social Services Register (SSR) and sociodemographic factors were provided by Statistics Sweden. SETTING AND PARTICIPANTS: All persons living in Sweden who died in November 2015 aged ≥67 years (n = 5948). METHODS: Zero inflated negative binomial regression was used to estimate the relative impact of age, gender, and cohabitation status on the use of LTC. RESULTS: Women used LTC to a larger extent [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.92-2.50] and for a longer period [risk ratio (RR) 1.14, 95% CI 1.11-1.18] than men. When controlling for age at death and cohabitation status, gender differences in LTC attenuated (OR 1.47, 95% CI 1.28-1.72) and vanished in regard to the duration. In the controlled model, women used LTC for 15.6 months (95% CI 15.2-16.0) and men for 14.1 months (95% CI 13.7-14.5) out of 24 months. The length of stay in institutional care was 7.2 (95% CI 6.8-7.5) and 6.2 months (95% CI 5.8-6.6), respectively. CONCLUSIONS AND IMPLICATIONS: A substantial part of women's greater use of LTC was due to their higher age at death and because they more often lived alone. Given that survival continues to increase, the association between older age at death and LTC use suggests that policy makers will have to deal with an increased pressure on the LTC sector. Yet, increased survival among men could imply that more women will have access to spousal caregivers, although very old couples may have limited capacity for extensive caregiving at the end of life.

Unplanned Hospital Care Use in Older Adults: The Role of Psychological and Social Well-Being.

OBJECTIVES: To explore the association of psychological and social well-being with unplanned hospital utilization in an older Swedish population. DESIGN: Data for this study were gathered from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Information on hospital care use was extracted from the Stockholm County Council Inpatient Register for up to 4 years after the baseline SNAC-K assessment (2001-2007). Participants with dementia or living in institutions were excluded from the study sample. SETTING: Community-based study of randomly selected adults, aged 60 years or older, living in the Kungsholmen district of Stockholm. PARTICIPANTS: A complete case analysis was performed on 2139 individuals. MEASUREMENTS: We created standardized indexes of psychological well-being (integrating life satisfaction and positive and negative affect) and social well-being (integrating social connections, support, and participation). Negative binomial models were used to estimate the association of psychosocial well-being with unplanned admissions, hospital days, and 30-day readmissions, considering potential sociodemographic, lifestyle, personality, and clinical confounders. RESULTS: Individuals with psychological well-being scores above the median had lower rates of unplanned hospital admissions (incidence rate ratio [IRR] = 0.67; 95% confidence interval [CI] = 0.55-0.82) and hospital days (IRR = 0.67; 95% CI = 0.49-0.92) compared to those with scores below the median. High levels of social well-being were also protective for unplanned admissions and hospital days, but the statistical significance was lost in the fully adjusted models. Relative to individuals with low well-being on both indexes, the rate of unplanned admissions and hospital days was lowest in those with both high psychological and social well-being (IRR = 0.72; 95% CI = 0.55-0.93; and IRR = 0.57; 95% CI = 0.39-0.85, respectively). For 30-day readmissions, a statistically significant negative association was found with psychological well-being, but only when operationalized as a continuous variable. CONCLUSION: Given their association with unplanned admissions and hospital days, targeting aspects of psychosocial well-being could be a viable strategy for reducing healthcare use and, eventually, costs. J Am Geriatr Soc 68:272-280, 2020.

Using an Integrated Clinical and Functional Assessment Tool to Describe the Use of Social and Medical Care in an Urban Community-Dwelling Swedish Older Population.

OBJECTIVES: To describe the use of social and medical care services in a community-dwelling older population from Stockholm, Sweden, using an integrated clinical and functional assessment tool. DESIGN: Study based on data from the longitudinal community-based Swedish National Study on Aging and Care in Kungsholmen. SETTING AND PARTICIPANTS: Random sample of people >65 years of age living in the community in central Stockholm between March 2001 and June 2004 (N = 2368). MEASURES: Health status was measured with a health assessment tool (HAT), which combines 5 indicators (gait speed, cognitive function, chronic multimorbidity, mild disability, severe disability) collected during Swedish National Study on Aging and Care in Kungsholmen clinical examinations. The amount of formal and informal social care was self-reported in hours per month and recorded by trained nurses at baseline and the 3-year follow-up for those ≥78 years of age at baseline. Data on hospital admissions, 30-day readmissions, days spent in the hospital, primary care visits, and specialist visits were obtained from Stockholm County Council registers (2001-2007). RESULTS: At baseline, 10% of the sample received formal social care and 11% received informal care. Annually between baseline and the 3-year follow-up, 15% were admitted to the hospital, 5% were readmitted, 78% visited a specialist, and 89% visited primary care. Those with the best HAT scores received 0.02 hours/month of formal care; those with the worst, 34 h/mo. The corresponding numbers for other variables were 0.02 vs 73 h/mo of informal care, 2 vs 11 hospital admissions per 10 persons/year, 44 vs 226 hospital days per 10 persons/y, 0.4 vs 2 30-day readmissions per 10 persons/y, 37 vs 78 specialist visits per 10 persons/y, and 50 vs 327 primary care visits per 10 persons/y. CONCLUSIONS/IMPLICATIONS: Because of its high discriminative power, the easy-to-use HAT index could help decision makers to plan medical and social care services.

Coexisting chronic conditions in the older population: Variation by health indicators.

BACKGROUND: This study analyzes the prevalence and patterns of coexisting chronic conditions in older adults. DESIGN: Cross-sectional. PARTICIPANT AND SETTING: A sample of 3363 people ≥60years living in Stockholm were examined from March 2001 through August 2004. MEASUREMENTS: Chronic conditions were measured with: 1) multimorbidity (≥2 concurrent chronic diseases); 2) the Cumulative Illness Rating Scale, 3) polypharmacy (≥5 prescribed drugs), and 4) complex health problems (chronic diseases and/or symptoms along with cognitive and/or functional limitations). RESULTS: A total of 55.6% of 60-74year olds and 13.4% of those ≥85years did not have chronic conditions according to the four indicators. Multimorbidity and polypharmacy were the most prevalent indicators: 38% aged 60-74 and 76% aged ≥85 had multimorbidity; 24.3% aged 60-74 and 59% aged ≥85 had polypharmacy. Prevalence of chronic conditions as indicated by the comorbidity index and complex health problems ranged from 16.5% and 1.5% in the 60-74year olds to 38% and 36% in the 85+ year olds, respectively. Prevalence of participants with 4 indicators was low, varying from 1.6% in those aged 60-74 to 14.9% in those aged ≥85years. Older age was associated with higher odds of each of the 4 indicators; being a woman, with all indicators but multimorbidity; and lower educational level, only with complex health problems. CONCLUSIONS: Prevalence of coexisting chronic conditions varies greatly by health indicator used. Variation increases when age, sex, and educational level are taken into account. These findings underscore the need of different indicators to capture health complexity in older adults.

Complex health problems among the oldest old in Sweden: increased prevalence rates between 1992 and 2002 and stable rates thereafter.

Studies of health trends in older populations usually focus on single health indicators. We include multiple medical and functional indicators, which together indicate the broader impact of health problems experienced by individuals and the need for integrated care from several providers of medical and long-term care. The study identified severe problems in three health domains (diseases/symptoms, mobility, and cognition/communication) in three nationally representative samples of the Swedish population aged 77+ in 1992, 2002, and 2011 (n ≈ 1900; response rate >85 %). Institutionalized people and proxy interviews were included. People with severe problems in two or three domains were considered to have complex health problems. Results showed a significant increase of older adults with complex health problems from 19 % in 1992 to 26 % in 2002 and no change thereafter. Changes over time remained when controlling for age and sex. When stratified by education, complex health problems increased significantly for people with lower education between 1992 and 2002 and did not change significantly between 2002 and 2011. For higher-educated people, there was no significant change over time. Among the people with severe problems in the symptoms/disease domain, about half had no severe problems in the other domains. People with severe mobility problems, on the other hand, were more likely to also have severe problems in other domains. Even stable rates may imply an increasing number of very old people with complex health problems, resulting in a need for improved coordination between providers of medical care and social services.

Associations between work-related stress in late midlife, educational attainment, and serious health problems in old age: a longitudinal study with over 20 years of follow-up.

BACKGROUND: People spend a considerable amount of time at work over the course of their lives, which makes the workplace important to health and aging. However, little is known about the potential long-term effects of work-related stress on late-life health. This study aims to examine work-related stress in late midlife and educational attainment in relation to serious health problems in old age. METHODS: Data from nationally representative Swedish surveys were used in the analyses (n = 1,502). Follow-up time was 20-24 years. Logistic regressions were used to examine work-related stress (self-reported job demands, job control, and job strain) in relation to serious health problems measured as none, serious problems in one health domain, and serious problems in two or three health domains (complex health problems). RESULTS: While not all results were statistically significant, high job demands were associated with higher odds of serious health problems among women but lower odds of serious health problems among men. Job control was negatively associated with serious health problems. The strongest association in this study was between high job strain and complex health problems. After adjustment for educational attainment some of the associations became statistically nonsignificant. However, high job demands, remained related to lower odds of serious problems in one health domain among men, and low job control remained associated with higher odds of complex health problems among men. High job demands were associated with lower odds of complex health problems among men with low education, but not among men with high education, or among women regardless of level of education. CONCLUSIONS: The results underscore the importance of work-related stress for long-term health. Modification to work environment to reduce work stress (e.g., providing opportunities for self-direction/monitoring levels of psychological job demands) may serve as a springboard for the development of preventive strategies to improve public health both before and after retirement.

Consumers of eldercare in Sweden: the semblance of choice.

In Sweden and other countries, the benefits of user choice and market forces are often voiced in relation to the provision of medical care and social services. Policy makers increasingly view people as customers and consumers of care services. Among very old people-the most frequent care users-how many have the capacity necessary to find information and make decisions concerning providers of medical and social services? Using a nationally representative sample of Swedes aged 77+ (SWEOLD) in 2002 this study describes the prevalence of cognitive, physical and sensory resources associated with the capacity to make and carry out informed choices concerning medical and social care providers. Results showed that one third of a nationally representative sample of persons aged 77+ scored low on a cognitive test or they were so cognitively impaired that they could not be interviewed directly. Another 22% scored poorly on a test of the ability to find and process information. A further 32% had adequate cognition but had limitations in sensory function or mental vitality or were unable to go outside on their own. A total of 10% did not report any of the measured problems. In general, care utilisation increases with age. As health problems increase, physical and cognitive abilities decline. Results suggest that those elderly people who are most dependent on care services and who could benefit most from a "good choice", are also those who have the highest prevalence of cognitive and physical limitations associated with the capacity to act as a rational consumer of care services.

Aging with multimorbidity: a systematic review of the literature.

A literature search was carried out to summarize the existing scientific evidence concerning occurrence, causes, and consequences of multimorbidity (the coexistence of multiple chronic diseases) in the elderly as well as models and quality of care of persons with multimorbidity. According to pre-established inclusion criteria, and using different search strategies, 41 articles were included (four of these were methodological papers only). Prevalence of multimorbidity in older persons ranges from 55 to 98%. In cross-sectional studies, older age, female gender, and low socioeconomic status are factors associated with multimorbidity, confirmed by longitudinal studies as well. Major consequences of multimorbidity are disability and functional decline, poor quality of life, and high health care costs. Controversial results were found on multimorbidity and mortality risk. Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders. New insights in this field can lead to the identification of preventive strategies and better treatment of multimorbid patients.

Complex health problems and mortality among the oldest old in Sweden: decreased risk for men between 1992 and 2002.

Although mortality in older ages generally declined in most countries during the past decades less is known about mortality trends among the most vulnerable subset of the oldest old. The aim of this study was to investigate possible changes between 1992 and 2002 in the relation of complex health problems and mortality in two representative samples of the Swedish population aged 77+ (1992: n = 537; 2002: n = 561). Further, it was examined if trends differed by sex, education, and age. Serious problems in three health domains were identified (diseases/symptoms, mobility, cognition/communication). People with serious problems in two or three domains were considered to have complex health problems. Four-year mortality was analyzed using Cox proportional hazard regressions. Controlled for age, sex, education, and health status mortality risk decreased by 20% during the 10-year period. Complex health problems strongly predicted 4-year mortality in both 1992 and 2002. No single dimension explained the decrease. Men with complex health problems accounted for most of the decrease in mortality risk, so much that the gender difference in mortality risk was almost eliminated among elderly people with complex health problems 2002. A considerable decrease in the mortality risk among men with complex health problems has implications for the individual who may face longer periods of complex health problems and dependency. It will also place increasing demands upon medical and social services as well as informal caregivers.

Complex health problems in the oldest old in Sweden 1992-2002.

Most studies on health trends in the elderly population focus on specific conditions, studied one at a time. However, health problems are often interrelated and exist simultaneously in late life. Individuals with health problems in several domains present special challenges to care services. To estimate future needs for care it may be relevant to study trends of complex health problems as well as single health items. This study identified serious problems in three domains (diseases/symptoms, mobility, cognition/communication) in two representative samples of the Swedish population aged 77 and older (1992: n=537; 2002: n=561). People with serious problems in two or three domains were considered to have complex health problems. Changes between 1992 and 2002 in the prevalence of persons having serious problems in no, one and two/three domains were analyzed with logistic regressions. When examining each domain separately all three showed a significant increase of serious problems. For diseases/symptoms the increase remained significant after controlling for different age and gender distributions in the two surveys. Results showed a significant increase in the prevalence of having problems in one domain, as well as having problems in two or three domains (complex problems). Results persisted when adjusting for different distributions in age, gender and education between 1992 and 2002. Results suggest a worsening of health during the 10-year period and an increase of complex problems. This emphasizes the necessity of cooperation and collaboration between different kinds of medical and social services for elderly people.

According to need? Predicting the amount of municipal home help allocated to elderly recipients in an urban area of Sweden.

Given the cutbacks which have been carried out in the Swedish welfare state despite the unchanged official policy of allocation of home help services according to needs, it is essential to evaluate the factors which guide the allocation of home help today. Whereas numerous studies have identified factors which predict entry into the home help system, the present paper concentrates on predictors of the amount of home help amongst those allocated assistance. Data were obtained from the population-based care and services section of the 2002 Swedish National Study of Aging and Care-Kungsholmen (SNAC-K). All home help recipients (> or = 65 years of age) living in an inner city district of Stockholm (Kungsholmen) were analysed with ordinary least squares regressions to identify predictors of the number of hours of home help (n = 943). Need indicators, i.e. dependency in activities of daily living (ADLs) and instrumental ADLs (IADLs), and cognitive impairment (Berger scale) were the strongest predictors of more hours of home help. The addition of sociodemographic (i.e. age, gender and income), environmental (i.e. informal care, housing adaptations and housing accessibility) and structural (i.e. variations in allocation decisions between one care manager and another) factors contributed only marginally to the explained variance. Hours of help entitlement increased slightly with greater age. Co-residing individuals were allocated significantly fewer home help hours than those living alone. Income and regular access to informal care were not significant predictors. The fact that services are provided according to need criteria does not necessarily mean that the provided services are adequate to meet needs. On the macro level, social policy decisions and available economic and manpower resources determine the allotment of municipal home help. However, this study in an urban sample suggests that, within the available resources, the amount of home help allocated is guided mainly by need indicators amongst those given assistance.

The effect of the duration of follow-up in mortality analysis: the temporal pattern of different predictors.

OBJECTIVES: This study presents a model of the mechanisms affecting how time since baseline affects the correlation between mortality and commonly used predictors. METHODS: In 1986, 421 persons (aged 75 years or older) in a Swedish community were interviewed. Fifteen-year mortality rates were analyzed by using hazard regressions. Rather than using average risk over the whole follow-up time, this study looks at temporal differences in predictor strength. RESULTS: All studied health variables, living conditions, and life satisfaction were much stronger predictors of mortality during the first 1 or 2 years of follow-up than during later years. Gender, social contacts, and mental status were about equally correlated to mortality throughout the period. DISCUSSION: Of the presented mechanisms affecting predictive strength, results suggest the importance of the instability of predictors over time. Especially in old populations, predictors that can change rapidly (e.g., health) are strongest for the short term, revealing a lower average mortality risk for longer follow-ups. Rather stable variables (e.g., gender or social contacts) are not affected by the length of follow-up. When average risk is studied over a longer follow-up, insignificant results may hide significant effects during a part of the follow-up. These findings are relevant for studies that examine any kind of outcome after a follow-up.