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

Analyses of late-life disability based on survey data of the oldest old often suffer from non-representative samples due to selective participation and attrition. Here, we use register data on the Austrian long-term care allowance (ALTCA) as a proxy for late-life disability. In this retrospective mortality follow-back study, we analyze receipt of ALTCA, a universal cash benefit based on physician-assessed disability in activities of daily living during the last 10 years of life, among all decedents aged 65 years and over from 2020 in Austria (n = 76,781) and its association with sex, age at death, and underlying cause of death. We find that on average, ALTCA was received for 3.5 and 5.3 years in men and women. At 10 years before death, 10% of men and 25% of women received ALTCA, which increased to 56% and 77% at one year before death. Both the probability and duration of ALTCA increased with age at death and varied by cause of death: Those who died from cancer, myocardial infarction, and external causes of death were less likely to receive ALTCA and for shorter durations, while those who died from dementia, Parkinson's disease, chronic heart disease, or chronic lung disease were more likely to receive it and longer so. Overall, our register-based estimates of the prevalence of late-life disability were higher than previous survey-based estimates. Policy-makers should be aware that costs of long-term care will rise as life expectancy rises and deaths from dementia and chronic heart disease will likely increase in the rapidly aging European societies.