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How does availability of county-level healthcare services shape terminal decline in well-being?

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Abstract

Both lifespan psychology and life course sociology highlight that contextual factors influence individual functioning and development. In the current study, we operationalize context as county-level care services in inpatient and outpatient facilities (e.g., number of care facilities, privacy in facilities) and investigate how the care context shapes well-being in the last years of life. To do so, we combine 29 waves of individual-level longitudinal data on life satisfaction from now deceased participants in the nationwide German Socio-Economic Panel Study (N = 4557; age at death: M = 73.35, SD = 14.20; 47% women) with county-level data from the Federal Statistical Office. Results from three-level growth models revealed that having more inpatient care facilities, more employees per resident, and more staff in administration are each uniquely associated with higher late-life well-being, independent of key individual (age at death, gender, education, disability) and county (affluence, demographic composition) characteristics. Number of employees in physical care, residential comfort, and flexibility and care indicators in outpatient institutions were not found to be associated with levels or change in well-being. We take our results to provide empirical evidence that some contextual factors shape well-being in the last years of life and discuss possible routes how local care services might alleviate terminal decline.

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Acknowledgements

This work was supported by the first author’s fellowship in the International Max Planck Research School on the Life Course (LIFE, www.imprs-life.mpg.de), and Grant by the Robert Bosch Stiftung (2012/2013): “Blickwechsel—Junge Forscher gestalten neues Alter”; and Nilam Ram’s contributions were supported by the Penn State Social Science Research Institute and UL TR000127 from the National Institute for Research Resources and the National Center for Advancing Translational Sciences. Work on the article was supported by the German Research Foundation (Grant GE 1896/3-1).

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  1. Nina Vogel

    Present address: The German Environment Agency, Berlin, Germany

Authors and Affiliations

  1. German Institute for Economic Research (DIW Berlin), Mohrenstraße 58, 10117, Berlin, Germany

    Nina Vogel, Nilam Ram, Jan Goebel, Gert G. Wagner & Denis Gerstorf

  2. Department of Psychology, Humboldt University Berlin, Unter den Linden 6, 10099, Berlin, Germany

    Nina Vogel & Denis Gerstorf

  3. Pennsylvania State University, HDFS, 417 BBH Building, University Park, PA, 16802, USA

    Nilam Ram & Denis Gerstorf

  4. Max Planck Institute for Human Development, Berlin, Germany

    Gert G. Wagner

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  1. Nina Vogel
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Correspondence to Nina Vogel.

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Responsible editor: H.-W. Wahl.

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Vogel, N., Ram, N., Goebel, J. et al. How does availability of county-level healthcare services shape terminal decline in well-being?. Eur J Ageing 15, 111–122 (2018). https://doi.org/10.1007/s10433-017-0425-4

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