# The association of number and geographic proximity of children with care home use before all-cause and dementia deaths: a register-based study of Finnish older adults

## TL;DR

This study finds that having more children or living closer to them is linked to fewer days in care homes for older adults, but this effect is weaker for those with dementia.

## Contribution

The study provides new insights into how family structure and geography influence care home use in Finland, particularly in the context of dementia.

## Key findings

- Childless individuals spent more days in care homes compared to those with two children.
- Shorter distance to children was associated with fewer care home days for women.
- Having children had little impact on care home use for those who died from dementia.

## Abstract

Demographic trends, including smaller and more geographically dispersed families, may limit the availability of family caregiving as an alternative to care home residence. This study examined how care home residence varies according to the number and geographic proximity of adult children.

Using Finnish register data on cohorts born in 1938–1953, we examined care home days during the 5 years preceding death at age ≥65, or up to December 31, 2018 for survivors. Poisson regression models estimated incidence rate ratios for annual care home days by number of children (nationwide cohort, n = 1,058,184) and geographic proximity of children based on household and ZIP codes (Helsinki metropolitan sample, n = 136,674). To account for health and care needs by design, we conducted separate analyses for the full cohort, decedents, and those who died from dementia-related causes.

Compared to parents with two children, childless women and men spent more days in care homes, while the number of children among parents did not matter when adjusting for marital and socioeconomic status and accounting for proximity to death (deceased subsample). For men without spouses, having children was particularly important. Shorter distance to children was associated with fewer care home days among women. Among individuals who died from dementia, having children was not associated with care home use, and associations with geographic proximity were weak.

Adult children may substitute for care homes in the general population, but their impact appears small in cases of severe cognitive impairment such as dementia.