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.

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.

Introduction: The growing number of older adults with multiple needs increases the pressure to reform existing healthcare systems. Integrated care may be part of such reforms. The aim of this systematic review was to identify important patient-related outcomes of integrated care provided to older adults. Methods: A systematic search of 5 databases to identify studies comprising older adults assessing hospital admission, length of hospital stay, hospital readmission, patient satisfaction and mortality in integrated care settings. Retrieved literature was analysed employing a narrative synthesis. Results: Twelve studies were included (2 randomised controlled trials, 7 quasi-experimental design, 2 comparison studies, 1 survey evaluation). Five studies investigated patient satisfaction, 9 hospital admission, 7 length of stay, 3 readmission and 5 mortality. Findings show that integrated care tends to have a positive impact on hospital admission rates, some positive impact on length of stay and possibly also on readmission and patient satisfaction but not on mortality. Conclusions: Integrated care may reduce hospital admission rates and lengths of hospital stay. However due to lack of robust findings, the effectiveness of integrated care on patient-related outcomes in later life remain largely unknown. Further research is needed to establish the effect of integrated care on these patient-related outcomes. Prospero registration number: CRD42018110491.