Disability level and use of long-term care services in Norway: a nation-wide registry study.

AIMS: In Norway, disability level is an important criterion when deciding the type and level of long-term care services. Each care recipient can be scored on 20 different disability level measures. Our aims were to investigate completeness in disability level information in the Norwegian Registry of Primary Health Care (NRPHC), to group disability level measures into meaningful groups, and to study the relationship between grouped disability scores and the type of services received. METHODS: We retrieved information on type of care and disability level from the NRPHC on individuals who received long-term care services in 2022. Type of care was divided into hierarchical and mutually exclusive groups, with long-term institutional care as the most complex service group. We used principal components analysis to summarise and visualise the information in the 20 different disability level measures, and to create grouped scores. RESULTS: A total of 386,697 persons aged 0-104 years were registered as recipients of long-term care services in Norway on 31 December 2022. Information on disability measures were of high completeness (72.4 % of the population were registered with all 20 measures) but was lower for younger age groups in which the number of recipients was lower. Principal components analyses identified two groups of measures, which we termed physical and cognitive functioning. Physical and cognitive functioning were poorest for individuals receiving the most complex and extensive services. CONCLUSIONS: NRPHC disability data are reasonably complete, the 20 measures readily fall into two distinct categories, and seem to reflect real life differences in disability.

The influence of individual and municipality characteristics on allocation of long-term care services: a register-based cross-sectional study.

BACKGROUND: Variation in service allocation between municipalities may arise as a result of prioritisation. Both individual and societal characteristics determine service allocation, but previous literature has often investigated these factors separately. The present study aims to map variation in allocation of long-term care services and investigate the extent to which service allocation is associated with characteristics related to the individual care recipient and the municipality. METHODS: This cross-sectional study used register data from the Norwegian Registry for Primary Health Care on all 250 687 individuals receiving municipal health and care services in Norway on 31 December 2019. These individual level data were paired with municipal level data from the Municipality-State-Reporting register and information on the care models in Norwegian long-term care services, derived from a nationwide survey. Multilevel analyses were used to identify individual and municipal factors that were associated with allocation of home care, practical assistance and long-term stay in institutions. RESULTS: In total, 164 634 people received home care services and 97 380 received practical assistance per 31 December 2019. Furthermore, 64 404 received both types of home-based services and 31 342 people had a long-term stay in an institution. Increased disability was strongly associated with being allocated more hours of home care and practical assistance, as well as allocation of a long-term institutional stay. The amount of home care and practical assistance declined with increasing age, but the odds of institutional stay increased with age. Care recipients living alone received more home-based services, and women had higher odds of a long-term institutional stay. Significant associations between the proportion of elderly in nursing homes and allocation of a long-term institutional stay and more practical assistance emerged. Other associations with municipalities' structural characteristics and care service models were weak. CONCLUSIONS: The influence of individual characteristics outweighed the contribution of municipality characteristics, and the results point to a limited influence of municipality characteristics on allocation of long-term care services.

Parental death by external causes during childhood and risk of psychiatric disorders in bereaved offspring.

BACKGROUND: Previous studies have reported increased risks of psychiatric disorders in offspring who have lost a parent, but knowledge is lacking on the risks of several specific disorders and comorbidity. The present study investigated the influence of parental death by external causes during childhood and adolescence on risk of a range of psychiatric disorders and comorbidity. METHOD: The study cohort comprised 655,477 individuals born 1970-2012 with a link to both parents. Data on deceased parent's cause and date of death between 1970 and 2012 and offspring's psychiatric disorders between 2008 and 2012 were retrieved from four longitudinal Norwegian registers. Data were analyzed with Cox regression. RESULTS: Compared to nonexposed offspring, offspring exposed to parental death by external causes had a significantly increased risk of depressive disorders, reactions to stress, anxiety disorders, substance use disorders, developmental disorders, childhood behavioral and emotional disorders, psychotic disorders, bipolar disorder, personality disorders, and psychiatric comorbidity, but not eating disorders. These increased risks were especially evident following parental suicide and accidental falls and poisoning. No differences were evident depending on gender of the deceased or age at bereavement, and generally no significant interactions with gender of the bereaved offspring were evident. CONCLUSIONS: The improved insight into several different psychiatric disorders and psychiatric comorbidity should guide postvention measures aimed at children and adolescents at greatest risk of future sequelae.

Parental death by external causes and risk of hospital-treated deliberate self-harm in bereaved offspring.

Previous studies have reported an increased risk of hospital-treated deliberate self-harm (DSH) in offspring who have lost a parent, but inconclusive findings regarding differences between loss from suicide and accidents. The present study aimed to investigate the association between parental death by external causes before age 18 and hospital-treated DSH, and potential differences between different accidents and suicide. This nested-case-control study was based on data from longitudinal Norwegian registers. Subjects comprised 12,526 people born between 1970 and 2003 who received acute somatic treatment because of DSH at hospitals and associated services between 2008 and 2013 (cases), and 222,362 controls matched for gender and date of birth with no recorded DSH treatment. Information concerning deceased parent's death and offspring's DSH treatment and socioeconomic data was merged. Data were analysed with conditional logistic regression. Results indicated that offspring who had lost a parent to suicide (OR 2.32, 95% CI 1.92-2.80) and death by accidents such as falls, poisoning, and drowning (OR 1.79, 95% CI 1.38-2.33) had a significantly increased risk of hospital-treated DSH compared to offspring who had not experienced such loss. Parental bereavement from transport accidents and other external causes were not associated with significantly increased risks. No differences were evident for different genders of deceased, ages at bereavement, or genders of bereaved. The improved identification of bereaved offspring at particular risk of hospital-treated DSH should be utilized to implement effective prevention and treatment programs in specialist healthcare aimed at the individuals at highest risk.

Educational attainment in offspring bereaved by sudden parental death from external causes: a national cohort study from birth and throughout adulthood.

PURPOSE: Previous research has linked loss of a parent during childhood to reduced educational aspirations, school performance, and educational attainment later in life. The potential effect of maternal and paternal bereavement on attainment at all educational levels is, however, unknown. The present study aimed to investigate the potential influence of parental death by external causes on completion of compulsory education, high school, vocational education, and University or College education. METHODS: The study was based on data from three national longitudinal registers in Norway. The study population comprised 373,104 individuals born between January 1st 1970 and December 31st 1994. Information concerning deceased parents' cause and date of death and offspring's education and sociodemographic data were retrieved. Data were analysed with Cox regression. RESULTS: Children who had experienced parental death by external causes had a significantly reduced hazard ratio (HR) of completing all educational levels compared to children who did not have such experiences. The largest effects were evident for completion of high school (HR 0.68, 95% CI 0.65-0.71) and University or College education (HR 0.75, 95% CI 0.70-0.80). No differences were evident for different causes of death, genders of deceased or ages at bereavement, and generally no significant interactions between gender of the bereaved offspring and predictor variables were evident for completion of all educational levels. CONCLUSION: Parental death by external causes has vast and long-lasting impacts on offspring's educational attainment at all levels. Health care interventions aimed at supporting bereaved children and adolescents should focus on challenges related to educational progress.

Allocation of Adult Day Care Services to Different User Groups: A Register-Based Cross-Sectional Study.

The international policy of active ageing emphasises activities and social relations for long-term care recipients, for example through adult day care. Knowledge about who are allocated such services is, however, sparse. We aimed to investigate characteristics that contribute to determine allocation of adult day care for care recipients with and without dementia. This study selected all 250 687 individuals who received long-term care services on 31 December 2019 from the Norwegian Register for Primary Health Care. We added municipal level data from the Municipality-State-Reporting register and a national survey. Multilevel analyses comparing allocation of adult day care services to other services found that municipal clustering was around 20%. Care recipients who lived alone had higher odds of receiving adult day care, while the odds of receiving adult day care decreased as age increased. Disability level and gender were also significantly associated with allocation of adult day care, but in different directions for different user groups. As the unrestricted revenues of municipalities increased, the odds of allocating adult day care to people without dementia decreased. Other municipality characteristics did not significantly impact the allocation of adult day care. In conclusion, individual characteristics were more influential in allocation of adult day care than municipality characteristics, and the results uncovered clear differences between care recipients with and without dementia.

Quality of Municipal Long-Term Care in Different Models of Care: A Cross-Sectional Study From Norway.

The quality of care remains a critical concern for health systems around the globe, especially in an era of unprecedented financial challenges and rising demands. Previous research indicates large variation in several indicators of quality in the long-term care setting, highlighting the need for further investigation into the factors contributing to such disparities. As different ways of delivering long-term care services likely affect quality of care, the objectives of our study is to investigate (1) variation in structure, process and outcome quality between municipalities, and (2) to what extent variation in quality is associated with municipal models of care and structural characteristics. The study had a cross-sectional approach and we utilized data on the municipal level from 3 sources: (1) a survey for models of care (2) Statistics Norway for municipal structural characteristics and (3) the National Health Care Quality Indicator System. Descriptive statistics showed that the Norwegian long-term care sector performs better (measured as percentage or probability) on structure (85.53) and outcome (84.86) quality than process (37.85) quality. Hierarchical linear regressions indicated that municipal structural characteristics and model of care had very limited effect on the quality of long-term care. A deeper understanding of variation in service quality may be found at the micro level in healthcare workers' day-to-day practice.

Co-occurrence of psychosocial sequelae in bereaved offspring.

BACKGROUND: Previous studies have found that people who have lost a parent to external causes of death during childhood and adolescence have increased risks of psychosocial sequelae. However, we lack information on the potential co-occurrence of these problems. This study aims to investigate the co-occurrence of psychiatric disorders, deliberate self-harm (DSH) hospitalization, and high school non-completion in people who have lost a parent to external causes of death during childhood and adolescence compared to people who have not experienced such loss. METHODS: The study cohort comprised 655 477 individuals born 1970-2012 with a link to both parents. Data on psychiatric disorders, DSH hospitalization, high school completion and parental death were retrieved from four longitudinal Norwegian registers. Chi-square tests of independence investigated potential differences in co-occurrence between bereaved and non-bereaved people. RESULTS: Altogether, 4756 people had experienced the death of a parent due to external causes of death before their 18th birthday. These bereaved offspring had a significantly higher likelihood of having one, two and three adverse outcomes compared to people who had not experienced such loss. Specifically, bereaved offspring had a significantly higher co-occurrence of psychiatric disorders and high school non-completion, but not significantly higher co-occurrences of DSH hospitalization and high school non-completion or DSH hospitalization and psychiatric disorders. LIMITATIONS: Information concerning DSH hospitalization and psychiatric disorders was only available from 2008 onwards CONCLUSIONS: : The significantly higher co-occurrence in bereaved offspring suggests that the relatively small group of people suffering from extensive sequelae should be particularly targeted for postvention measures.

Sudden parental death from external causes and risk of suicide in the bereaved offspring: A national study.

Previous research has revealed an association between parental bereavement from external causes and risk of suicide in offspring. Few studies have however provided insights into specific influences of cause of death, gender of the deceased and bereaved, age at bereavement and suicide, and time since bereavement. The present nested case-control study was based on data from three longitudinal registers. Subjects comprised 19 015 persons who died from suicide at an age of 11-64 years during 1969-2012 (cases), and 332 046 live comparison individuals matched for gender and date of birth. Information about deceased parents' cause and date of death, and sociodemographic data was retrieved and merged. Data were analysed with conditional logistic regression. Losing a parent to suicide, transport accidents and other external causes of death was associated with an increased suicide risk in offspring. Parental suicide was associated with a substantially higher suicide risk than transport accidents and other external causes. These effects were equally strong for daughters and sons, and for the loss of a mother, father or both parents. Suicide risk was highest in younger bereaved offspring, and bereavement had both short and long-term impacts on suicide risk. In conclusion, all offspring exposed to parental death by external causes have an increased suicide risk, independent of factors related to the exposure. The consequences are long lasting, and offspring should be offered follow-up in primary healthcare. Younger offspring bereaved by parental suicide have the highest risk and may be targeted for prevention and intervention programs in specialist healthcare.

Risk factors for suicide in offspring bereaved by sudden parental death from external causes.

BACKGROUND: Parentally bereaved offspring have an increased suicide risk as a group, but the ability to identify specific individuals at risk on the basis of risk and protective factors is limited. The present study aimed to investigate to what degree different risk factors influence suicide risk in offspring bereaved by parental death from external causes. METHODS: Based on Norwegian registers, individual-level data were retrieved for 375 parentally bereaved suicide cases and 7500 parentally bereaved gender- and age-matched living controls. Data were analysed with conditional logistic regression. RESULTS: Bereaved offspring with low social support, indicated by offspring's single status and repeated changes in marital status and residence, had a significantly increased suicide risk compared to bereaved offspring with high social support. Moreover, low socioeconomic status, having an immigration background, having lost both parents and loss due to suicide significantly increased suicide risk. LIMITATIONS: Several variables relevant to bereavement outcome, such as coping mechanisms and the quality of the parent-offspring relationship are impossible to examine by utilizing population registers. Moreover, the availability of data did not enable the measurement of marital stability and residence stability across the entire lifespan for older individuals. CONCLUSIONS: Healthcare professionals should be aware of the additional risk posed by the identified risk factors and incorporate this knowledge into existing practice and risk assessment in order to identify individuals at risk and effectively target bereaved family and friends for prevention and intervention programs. Ideal follow-up for bereaved families should include a specific focus on mobilizing social support.