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2 Last Years of Long Lives
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3111 Last Years of Long Lives is a unique account of that period of old age
4 which precedes death. Based on 400 complete individual histories and
5 covering a twenty-year period, it examines the experiences of people over
6 eighty years of age in three important areas: disability, family life and
7 health care. Using the life-course approach to research, it reveals rich data
8 about the contributions of formal and informal care and how life expectancy
9 and experiences of disability interact with experiences of care.
20111 The reader is invited to conceptualise these phenomena as processes in
1 continuous time – processes that are sometimes long and complex, some-
2 times short and simple – and learns about the four types of disability career
3 before death. At the same time, the author presents a three-stage model of
4 informal care and examines the main patterns of formal service use.
5 Last Years of Long Lives presents a new way of looking at old age for
6 students, researchers, practitioners and policy makers and gives a compre-
7 hensive picture of what has been called ‘the fourth age’.
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9 Tor Inge Romoren is Senior Research Scientist at NOVA Social Policy
30111 Research Institute, Oslo, Norway. He has worked as a physician in elder
1 care and as a healthcare administrator, served as an adviser to Norwegian
2 government at local and federal level and written widely in his field.
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2 Last Years of Long Lives
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4 The Larvik study
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First published in Norwegian as Den fjerde alderen in 2001
by Gyldendal Akademisk
Postboks 6730 St Olavs plass, 0130 Oslo
First published in English as Last Years of Long Lives in 2003
by Routledge
11 New Fetter Lane, London EC4P 4EE
Simultaneously published in the USA and Canada
by Routledge
29 West 35th Street, New York, NY 10001
Routledge gratefully acknowledges financial assistance from MUNIN
(Marketing Unit for Norwegian International Non-fiction) for the
translation of this book
Routledge is an imprint of the Taylor & Francis Group
This edition published in the Taylor & Francis e-Library, 2004.
© Gyldendal Norsk Forlag AS 2001
1.utgave. 1. opplag 2001
All rights reserved. No part of this book may be reprinted
or reproduced or utilized in any form or by any electronic,
mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information
storage or retrieval system, without permission in writing
from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book has been requested
ISBN 0-203-71653-1 Master e-book ISBN
ISBN 0-203-34547-9 (Adobe eReader Format)
ISBN 0–415–30198–X (Print Edition)
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2 Contents
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3111 List of illustrations vii
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1 Introduction 1
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7 The basic theme and purpose of the Larvik study 2
8 Limitations of the study 6
9 Plan of the book 7
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1 2 Larvik: context and case 8
2 Some facts about Norway 8
3 Larvik: the town 10
4 Larvik: the framework 12
5111 Serving the population 18
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7 3 Research design, data, and key concepts 22
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Establishing the study population 25
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Data collection 26
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Disability: definitions and measures 29
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Caregiving and the caregivers: definitions and measures 33
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3 4 The study population: its basic characteristics 41
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Gender and age 41
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Family structure 43
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Occupations and socio-economic status 47
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Causes of death 50
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Notes 52
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5 Courses of disability 53
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2 Background 53
3 Models and terminology 56
44 Life expectancy without disability and life expectancy
45111 with disability 58
vi Contents
ADL careers 61
A typology 69
Diseases and ADL states 76
Conclusion 80
6 Courses of family care 82
Primary and secondary caregivers 84
Caregiving careers 93
Caregiving by offspring: the caregiving careers of sons
and daughters 106
Did it ever become too much for you? 118
Conclusion 129
Note 130
7 Courses of formal service use 131
Total use of separate services before death 133
The dynamics of the use of services 137
Individual careers 145
The probability and duration of different kinds of
institutionalization 154
Conclusion 160
8 Looking back and summing up 161
Men and women 162
The generalizable value of the Larvik study 164
Implications for policy and planning 168
Final remarks: the fourth age 169
Appendix A 173
Appendix B 185
References 198
Index 207
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2 Illustrations
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Figures
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6 2.1 Map of Europe showing Norway and Larvik 9
7 2.2 Map of Larvik 11
8 3.1 Mrs Nygaard: courses of disability, informal care, and
9 service use 23
20111 3.2 Age- and cohort-composition of the study population 25
1 3.3 The relationship of caregiving activities to each other 35
2 4.1 Age at death in the study population 42
3 5.1 The disablement process 57
4 5.2 Life expectancy without disability 59
5111 5.3 Life expectancy with disability 60
6 5.4 Dementia in the Larvik study, the Oslo study, and in Eurodem 74
7 6.1 (a) Activities and phases in the caregiving career;
8 (b) sequences in the caregiving career 96
9 6.2 The most frequent transitions between caregiving phases 105
30111 6.3 Duration of total home care when the caregiver is a son
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2 6.4 Pearlin’s stress process model 120
3 7.1 Transitions between home, institutional use, and death 138
4 8.1 The last years of the life course 163
5 B.1 Genogramme for Case 351 186
6 B.2 Card for Mrs Nygaard 197
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1 aged 80+ in Norway, 1981 44
2 4.2 The proportion of individuals with 0–4+ children 45
3 4.3 The proportion with 0–4+ children in the Larvik area
44 at time of death 46
45111 4.4 Household status in the study population 47
viii Illustrations
4.5 Occupations in the whole sample and in some sub-groups 48
4.6 Distribution of various sub-groups by socio-economic
status 49
4.7 Primary cause of death 50
5.1 ADL careers without improvement 66
5.2 ADL careers with improvement 67
5.3 A four-part typology for dependency trajectories 71
5.4 Duration of ADL limitations by primary medical cause 78
6.1 The distribution of primary caregivers 84
6.2 The distribution of elderly persons with 0–4+ secondary
caregivers 89
6.3 Primary caregiving activities during the main support
phase 98
6.4 Primary caregiving activities during the escalation phase 100
6.5 Distribution by type of institution, frequency of visiting,
and duration 103
6.6 The life situation of caregiving sons and daughters 108
6.7 Sons and daughters who are primary caregivers; main
support phase 110
6.8 Sons and daughters who are primary caregivers;
escalation phase 111
6.9 Sons and daughters who are primary caregivers;
institution phase 117
7.1 Probability, duration, and number of stays in institutions 134
7.2 Probability and duration of use of home help and home
nursing services 135
7.3 The function of the hospital in relation to the study
population 141
7.4 Medical reasons for need of care during nursing home
episodes 144
7.5 Six institutional careers 147
A.1 Formal eldercare, Larvik and Norway, 1970–95: home
nursing and home help 173
A.2 Care measures, Larvik and Norway, 1970–95: institutional
care 174
A.3 The study population by birth cohort and gender 175
A.4 Next-of-kin who participated and who refused to be
interviewed 175
A.5 The probability of experiencing four types of disability
trajectories 176
A.6 ADL careers among study participants with serious
dementia 177
A.7 Total duration of informal in-home care; effect of
variables 178
A.8 Did it ever become too much for you? 179
Illustrations ix
1111 A.9 Institutional career by EP characteristics 180
2 A.10 The effect of selected independent variables on the
3 probability of hospital admissions 181
4 A.11 The effect of selected independent variables on the duration
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6 A.12 The effect of selected independent variables on the
7 probability of nursing home admissions 183
8 A.13 The effect of selected independent variables on the duration
9 of nursing home stays 184
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