Socio-Demographic Variations in Rates of Movement into Institutions Among Elderly People in England and Wales: An Analysis of Linked Census and Mortality Data 1971–1985

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Abstract
Data from the 1971 and 1981 census records of the OPCS Longitudinal Study (LS) members have been used to examine socio-demographic variations in the proportions of elderly people who lived in private households in 1971, but in institutions ten years later. Information on deaths of sample members 1971–85 has also been used as an indicator of the health status of various sub-groups of the LS population. The results show institutionalization rates to increase with age, to be highest for the single, and lowest for the currently married. Living arrangements in 1971 were also associated with differentials in institutionalization. Regression models which included a family/household variable fitted the data rather less well than models that included a marital-status term. Among men aged 65–74 in 1971, higher social class was associated with lower institutionalization. However, among older men aged 75 and over institutionalization rates were lowest for those from Social Class IIIM. An examination of 1971–81 mortality differentials lent no support to the hypothesis that this change in the relationship between social class and institutionalization might reflect selective survival effects. Differences in institutionalization by housing tenure showed that the lowest proportion in institutions in 1981 was found among owner-occupiers, while rates among private renters were the highest. Among men the institutionalization odds-ratio for private renters compared with owner-occupiers was 1.9 (95% confidence-interval 1.4–2.6), for women 1.3 (1.1–1.5). Between 1971 and 1981, mortality among local authority tenants was higher, and by inference health poorer, than among owner occupiers, so their higher rate of institutionalization might be expected. However, standardized mortality ratios for private renters in 1971–81 were lower than those for local authority tenants, implying better health, although rates of institutionalization were higher. An examination of variations in rates of institutional residence by availability of housing amenities suggested that housing-quality factors alone were unlikely to account for this. Differentials in the mortality between 1981 and 1985 of the 1981 institutional population suggested that mortality of those who had been private renters was lower than that of members of other tenure groups (although this difference was not statistically significant); these findings suggest that factors other than health status may contribute to the high institutionalization rates observed among private renters. Contrary to expectation, the mortality of the 1981 institutional population who ten years earlier had lived ‘not in a family but with others’ (generally relatives) was also low. Possible reasons for these findings are discussed.

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