Dr. Dennis Shea, professor of health policy and administration and first author of the study team's report, says, "Our results show that the system of long-term, community-based care for the oldest old favored in Sweden is much more effective at meeting people's needs than the short-term post acute care or institutional care typically offered in the U.S. "
Although both countries provide support to about 40 percent of the over 75 population, that statistic masks the disparity in services that become evident when the researchers focused only on people who have long term chronic needs for help with activities of daily living (ADLs). These activities include either personal ADLs such feeding, bathing or dressing or instrumental ADLS such as managing money, housekeeping, or shopping.
The researchers wrote, "One of the clear patterns is that few people in Sweden who report a specific ADL need fail to receive assistance for it; in the United States, a substantial portion of people with needs receive no assistance and many people who report no long term ADL need do receive assistance."
"The U.S. elderly who do receive assistance usually receive it during a short period of acute need after a hospitalization," Shea adds.
The researchers detailed their findings in a paper, "Exploring Assistance in Sweden and the United States," published in the October issue of The Gerontologist, a journal of the Gerontological Society of America. The authors are Shea; Dr. Adam Davey, Department of Child and Family Development, University of Georgia; Dr. Elia E. Femia and Dr. Steven Zarit, Department of Human Development and Family Studies, Penn State; Dr. Gerdt Sundstrom and Dr. Stig Berg, Institute of Gerontology, Jonkoping, Sweden; and Dr. Michael A. Smyer, Graduate School of Arts and Sciences, Boston College.
U.S. data for the study came from 4,583 community-dwelling Medicare beneficiaries aged 75 and older. The Swedish data came from 1.378 people aged 75 and older living in community housing.
The researchers found that more than one-fifth of the Americans surveyed had at least one instrumental ADL (IADL) need for which they received no help; more than two-fifths of the Americans had at least one personal ADL (PADL) need for which they received no help and almost three fifths of the Americans had either an IADL or PADL need for which they received no help. In all cases, the level of unmet need among Swedish elders was less than four percent.
Shea says, "Baby boomers who are assisting their parents or preparing for their own retirement need to be aware of the consequences of current national health care policy. We direct very few of our public resources towards providing help with these needs out in the community."
Some U.S. states have moved their support into more Swedish-style, long-term, community-based services. Shea plans a new study to see if those states have lower levels of unmet need.
The current study was supported by a grant to Zarit from the AARP Andrus Foundation.
Journal
The Gerontologist