This project has several advantages. It is expected to generate a rich data base relevant for future research on aging and care and to have a direct impact on the future Swedish system of care and services for the elderly.

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.

There is limited knowledge about older people's length of stay (time until death) in institutional care and how it has changed over time. The aim of this study was to analyse changes in the length of stay for older people in institutional care between 2006 and 2012. Sample: All persons 65+ living in Kungsholmen (an urban area of Stockholm), who moved to an institution between 2006 and 2012 were included (n=1103). Data source: The care system part of the longitudinal database the Swedish National Study of Aging and Care (SNAC). The average length of stay was analysed using Laplace regression for the 10 th to the 50 th percentile for the years 2006 to 2012. The regressions showed that in 2006 it took an average of 764 days before 50 percent of those who had moved in to institutional care had died. The corresponding figure for 2012 was 595 days, which amounts to a 22.1 percent decrease over the period studied (p=0.078). For the lower percentiles the decrease was even more rapid, e.g., for the 30 th percentile the length of stay reduced from 335 days in 2006 to 119 days in 2012, a decrease of 64.3 percent (p<0.001). The most rapid increase was found in the proportion that moved to an institution and died within a short time period. In 2006 the first 10 percent had on average died after 85 days, in 2012 after only 8 days, a decrease in the length of stay of 90.5 percent (p=0.002). In general, there was a significant decrease in the length of stay in institutional care between 2006 and 2012. The most dramatic change over the period studied was an increase in the proportion of people that moved in to an institution and died shortly afterwards. Keywords: Institutional care, Residential homes, Length of stay, Older peopleWhat is known about this topic • Many older people will move into institutional care but little is known about how long they will actually live there before dying.• There is limited knowledge on how the length of stay in institutions has changed over time.• Most previous studies have used cross-sectional analyses and these tend to under-represent shorter lengths of stay. What this paper adds • Detailed analyses regarding the length of stay in institutional care using data from the SNACstudy.• Insight into the complex demands being placed on institutional care by the observed decreases in the length of stay.• An understanding of the dynamic nature of eldercare provision over time and the subsequent policy implications for future planning.

Sweden has a well-developed welfare system following the Nordic model and it maintains - even though there have been some reductions in the last decade - good economic security and comprehensive services for the elderly. The national policy for the elderly aims at enabling older persons to live independently with a high quality of life. A great majority of the elderly in Sweden live in ordinary homes - very few live with their grown-up children. The municipalities are responsible for providing long-term social services and care for the frail elderly in the form of home help services for those that live in ordinary housing, and special housing accommodation for those with extensive needs. The county councils are responsible for health care and provide home nursing care and rehabilitation. Sweden used to have the oldest population in the world. The proportion of 80+ years old in the population increased from 3% to over 5% between 1980 and 2000. Due to financial restrictions as a result of the economic recession in the last decade, the health and social services for the elderly have not been able to keep up with the population development. The previous generous allocation of care has been replaced by a more restrictive approach. This has mainly affected persons with lesser needs for help, younger elderly, and married persons. The number of elderly persons is expected to increase rapidly in the coming decades. However, due to improved health among the elderly, this will lead to a relatively limited increase of needs. Depending on assumptions concerning the health development, the required increase in volume of health and social services is expected to fall somewhere between 10-30% during the coming 30-year period.

Living alone is associated with elevated mortality, especially among men and an increased risk of institutionalization. Over a 6-year period, living alone was related to a half year reduction in survival among elderly people in Sweden.

The female advantage in life expectancy (LE) is found worldwide, despite differences in living conditions, the status of women and other factors. However, this advantage has decreased in recent years in low-mortality countries. Few researchers have looked at the gender gap in LE in old age (age 65) in a longer historical perspective. Have women always had an advantage in LE at old age and do different countries share the same trends? Life expectancy data for 17 countries were assessed from Human Mortality Database from 1751 to 2007. Since most of the changes in LE taking place today are driven by reductions of old age mortality the gender difference in LE was calculated at age 65. Most low-mortality countries show the same historical trend, a rise and fall of women’s advantage in LE at age 65. Three phases that all but two countries passed through were discerned. After a long phase with a female advantage in LE at 65 of <1 year, the gender gap increased significantly during the twentieth century. The increase occurred in all countries but at different time points. Some countries such as England and France had an early rise in female advantage (1900–1919), while it occurred 50 years later in Sweden, Norway and in the Netherlands. The rise was followed by a more simultaneous fall in female advantage in the studied countries towards the end of the century, with exceptions of Japan and Spain. The different timing regarding the increase of women’s advantage indicates that country-specific factors may have driven the rise in female advantage, while factors shared by all countries may underlie the simultaneous fall. More comprehensive, multi-disciplinary study of the evolution of the gender gap in old age could provide new hypotheses concerning the determinants of gendered differences in mortality.

Statistics Sweden has interviewed representative samples of the population annually since 1980. This study looks at ages 65-84 (n & 3,000 per year) and presents prevalence rates for functional ability (walking and running ability, vision and hearing, and disability) for different age groups and for men and women. Prevalence rates of functional problems increase with age, for all indicators and for men and women. With the exception of hearing, women have poorer function than men. Different function indicators showed different trends over time. For example, vision (reading text) improved over the studied time period, while hearing (a conversation between two or more people) showed a clear worsening over the time period. Seen over the entire time period 1980-2005, mobility items (running, walking) and disability indicators showed improvement. However, figures suggested that most of this improvement occurred during the 1980s and early 1990s. Regression analyses of the estimated trends up until 1996 show for the most part significant improvement, but this positive development seems to cease after 1996 and in some cases there seems to be a significant upswing in problems. On other hand, for hearing, the negative trend of increased problems seems to have been broken after 1996. Results emphasize the necessity to follow population trends over long periods of time with multiple waves and multiple indicators.

There is a variation in time use in institutional settings due to differences in ADL dependency but also whether dementia is present or not. This variation has implications for costs of institutional care.