Disability during the last ten years of life: Evidence from a register-based study in Austria

Abstract Background Many older adults experience disability in activities of daily living during the last years of life, but survey-based analyses suffer from non-representative samples due to selective participation and attrition. Here, we use individual-level register data on the receipt of the Austrian long-term care allowance (ALTCA) as a proxy for late-life disability. Methods In this retrospective mortality follow-back study, we analyse receipt of ALTCA, a cash benefit based on physician assessed disability during the last 10 years of life, among all decedents aged 65 years and over from 2020 in Austria (n = 76,781). The impact of sex, age of death, and cause of death on the duration and probability of receipt of ALTCA was assessed with regression models. Results 10 years before death 10% of older men and 25% of older women received ALTCA, which increased to 27% and 51% at 5 years, 56% and 77% at 1 year, and finally to 70% and 87% at 1 month before death. On average, ALTCA was received for 3.2 years in men and 4.5 years in women. The probability to receive ALTCA and its duration increased sharply with age at death and varied by underlying causes of death: those who died from cancer, myocardial infarction, and external causes of death were less likely to receive ALTCA and experienced shorter durations of it, while those who died from dementia, Parkinson’s disease, chronic heart disease, or chronic obstructive lung disease were more likely to receive ALTCA and longer so. Conclusions Most older adults received ALTCA for multiple years before death, and this increased strongly with age at death and varied across causes of death. Our register-based estimates of late-life disability were twice as high as survey-based estimates, which points to an underestimation in previous studies. Policy-makers should be aware that costs of long-term care will likely increase as life expectancy rises and deaths from dementia and organ failure increase in ageing European societies. Key messages • A large majority of older adults in Austria experience late-life disability. On average, older men were disabled for 3.2 and older women for 4.5 years. • Probability and duration of late-life disability increased steeply with age at death and was higher for those who died from dementia, Parkinson’s disease, or chronic heart or lung disease.