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Institutionalisation and subjective wellbeing for old-age individuals: is life really miserable in care homes?



In this paper we examine whether there are systematic differences in the quality of life, depending on whether an individual is institutionalised or not, holding health status and income level constant. In doing this we use a nationally representative data set, the Health 2000 in Finland. When controlling for health and functional status, demographics and income level, we find that individuals who are living in old-age homes actually report significantly higher levels of subjective wellbeing than those who are living at home. We argue that this finding emerges from queuing for care homes. This implies that there are individuals living at home who are so frail that they should really be living in an old-age institution, but because of the queues for that particular mode of living, they are living at home with a decreased quality of life as a consequence.


Corresponding author

Address for correspondence: Petri Böckerman, Labour Institute for Economic Research, Pitkänsillanranta 3A, FI-00530 Helsinki, Finland. E-mail:


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Aromaa, A. and Koskinen, S. (eds) 2004. Health and Functional Capacity in Finland. Baseline Results of the Health 2000 Health Examination Survey. National Public Health Institute, Helsinki.
Brown, S. H. M. and Abdelhafiz, A. H. 2011. Institutionalization of older people: prediction and prevention. Ageing Health, 7, 2, 187203.
Böckerman, P., Johansson, E. and Saarni, S. I. 2011. Do established health-related quality-of-life measures adequately capture the impact of chronic conditions on subjective well-being? Health Policy, 100, 1, 91–5.
Donnenwerth, G. V. and Petersen, L. R. 1992. Institutionalization and well-being among the elderly. Sociological Inquiry, 62, 4, 437–49.
Ferrer-i-Carbonell, A. and van Praag, B. M. S. 2002. The subjective costs of health losses due to chronic diseases. An alternative model for monetary appraisal. Health Economics, 11, 8, 709–22.
Gaugler, J. E., Duval, S., Anderson, K. A. and Kane, R. L. 2007. Predicting nursing home admission in the U.S: a meta-analysis. BMC Geriatrics, 7, 13.
Greene, W. H. 2003. Econometric Analysis. Fifth edition, Prentice Hall, Upper Saddle River, New Jersey.
Häkkinen, U. and Lehto, J. 2005. Reform, change and continuity in Finnish health care. Journal of Health Politics, Policy & Law, 30, 1/2, 7996.
Hawthorne, G., Richardson, J. and Day, N. A. 2001. A comparison of the assessment of quality of life (AQoL) with four other generic utility instruments. Annals of Medicine, 33, 5, 358–70.
Heistaro, S. (ed.) 2008. Methodology Report. Health 2000 Survey. National Public Health Institute, Helsinki.
Luppa, M., Luck, T., Weyerer, S., Konig, H., Brahler, E. and Riedel-Heller, S. G. 2010. Prediction of institutionalization in the elderly. A systematic review. Age and Ageing, 39, 1, 31–8.
Martikainen, P., Moustgaard, H., Murphy, M., Einiö, E., Koskinen, S., Martelin, T. and Noro, A. 2009. Gender, living arrangements, and social circumstances as determinants of entry into and exit from long-term institutional care at older ages: a 6-year follow-up study of older Finns. The Gerontologist, 49, 1, 3445.
Ministry of Social Affairs and Health 2008. National Framework for High-quality Services for Older People 2008. Ministry of Social Affairs and Health, Helsinki.
Nihtilä, E. and Martikainen, P. 2007. Household income and other socio-economic determinants of long-term institutional care among older adults in Finland. Population Studies: A Journal of Demography, 61, 3, 299314.
Nihtilä, E. and Martikainen, P. 2008 a. Institutionalization of older adults after the death of a spouse. American Journal of Public Health, 98, 7, 1228–34.
Nihtilä, E. and Martikainen, P. 2008 b. Why older people living with a spouse are less likely to be institutionalized: the role of socioeconomic factors and health characteristics. Scandinavian Journal of Public Health, 36, 1, 3543.
Nihtilä, E. K., Martikainen, P. T., Koskinen, S. V., Reunanen, A. R., Noro, A. M. and Häkkinen, U. T. 2008. Chronic conditions and the risk of long-term institutionalization among older people. European Journal of Public Health, 18, 1, 7784.
Nuotio, M., Tammela, T. L. J., Luukkaala, T. and Jylhä, M. 2003. Predictors of institutionalization in an older population during a 13-year period: the effect of urge incontinence. Journals of Gerontology: Biological Sciences and Medical Sciences, 58A, 8, 756–62.
Organisation for Economic Co-operation and Development 1982. The OECD List of Social Indicators. Organisation for Economic Co-operation and Development, Paris.
Oswald, A. 1997. Happiness and economic performance. Economic Journal, 107, 1815–31.
Oswald, A. 2010. Emotional prosperity and the Stiglitz commission. British Journal of Industrial Relations, 48, 4, 651–69.
Pinquart, M. and Sörensen, S. 2000. Influences of socioeconomic status, social network, and competence on subjective well-being in later life: a meta-analysis. Psychology and Aging, 15, 2, 187224.
Powdthavee, N. and van den Berg, B. 2011. Putting different price tags on the same health condition: re-evaluating the well-being valuation approach. Discussion Paper No. 5493, IZA, Bonn.
Saarni, S. I., Härkänen, T., Sintonen, H., Suvisaari, J., Koskinen, S., Aromaa, A. and Lönnqvist, J. 2006. The impact of 29 chronic conditions on health-related quality of life: a general population survey in Finland using 15D and EQ-5D. Quality of Life Research, 15, 8, 1403–14.
Saarni, S. I., Suvisaari, J., Sintonen, H., Koskinen, S., Härkänen, T. and Lönnqvist, J. 2007. The health-related quality-of-life impact of chronic conditions varied with age in general population. Journal of Clinical Epidemiology, 60, 12, 1288–97.
Sintonen, H. 1994. The 15D measure of health-related quality of life: reliability, validity and sensitivity of its health state descriptive system. Working Paper 41, Centre for Health Program Evaluation, Monash University, Melbourne.
Sintonen, H. 1995. The 15D measure of health-related quality of life. II. Feasibility, reliability and validity of its valuation system. Working Paper 42, Centre for Health Program Evaluation, Monash University, Melbourne.
Sintonen, H. 2001. The 15D instrument of health-related quality of life: properties and applications. Annals of Medicine, 33, 5, 328–36.
Stakes 2006. Hoivan ja hoidon taloudellinen kestävyys. Arvioita sosiaali- ja terveyspalveluiden kustannusten kehityksestä. Stakes, Helsinki.
Stakes 2008. Statistical Yearbook on Social Welfare and Health Care 2008. Stakes, Helsinki.
Stavem, K., Bjornaes, H. and Lossius, M. I. 2001. Properties of the 15D and EQ-5D utility measures in a community sample of people with epilepsy. Epilepsy Research, 44, 2/3, 179–89.
Stiglitz, J., Sen, A. and Fitoussi, J. P. 2009. Report by the Commission on the Measurement of Economic Performance and Social Progress. Available online at [Accessed 19 April 2010].
Webb, E., Blane, D., McMunn, A. and Netuveli, G. 2011. Proximal predictors of change in quality of life at older ages. Journal of Epidemology and Community Health, 65, 6, 542–7.
Wittchen, H. U., Lachner, G., Wunderlich, U. and Pfister, H. 1998. Test–retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Social Psychiatry and Psychiatric Epidemiology, 33, 11, 568–78.
World Health Organization 1946. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June; signed on 22 July by the representatives of 61 States. Official Records of the World Health Organization, No. 2.


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Institutionalisation and subjective wellbeing for old-age individuals: is life really miserable in care homes?



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