Trends in formal care by age and time to death: the use of healthcare and care-home facilities in Finland between 2005 and 2018.

Population ageing may further increase formal care use. Strong predictors in addition to age include time to death and the cause of death. The aim of this study is to analyse trends in the use of formal care in Finland by these factors. We analysed patterns of care use among all Finnish residents who died at the age of 65 and older between 2005 and 2018 (263 660 men and 315 439 women), linking different administrative registers. We used multinomial logistic models to examine the time spent in healthcare and care-home facilities, stratifying our analyses by gender and time to death. Between 2005 and 2018, formal care use became increasingly concentrated in the last years of life for all causes of death, and the effect of age slightly diminished. However, in 2017-18, decedents aged 65 in their last year of life spent up to seven months less in care than their counterparts aged 105. Over time, unadjusted per-capita care usage in the last seven years of life increased from 9.3 to 10.5 months for men, and from 16.8 to 19.3 months for women. Concurrently, the total time spent in care on the population level increased by 44%. Age and time to death are major determinants of formal care use. An increasing age at death drove the increase in per-capita and total care usage over time. Population ageing will continue to increase future care needs; governments must prepare for this scenario.