Morbidity and lack of formal home care drive health service demand among community-dwelling nonagenarians with informal support

Since the early 2000s, Finnish care policy has steered the long-term care system towards home care so that older adults could live at their own homes or home-like environments for as long as possible. This trend is evident even among those aged 90 and above as their share in round-the-clock care has declined by 10% in the past two decades. 

Approximately one-third of women and nearly one-sixth of men born in the 1930s reach the age of 90 in Finland. The demographic shift and the growing number of very old people have wide-reaching implications for society, especially health and social services. Recent debate has focused on who provides care for old people, how it is funded, and what are the societal and personal impacts of the increasing reliance on informal carers.

According to the Vitality 90+ Study, informal carers are the predominant source of support.

Two-thirds of survey respondents mentioned either their children (45%) or spouse (20%) as their main source of support in daily activities. The role of formal home care has declined while the responsibilities of informal carers have grown. 

Recent findings show that nearly two-thirds of those living at home made at least one ED visit during the one-year follow-up period, and one in eight made four or more visits. The most common predictors of ED visits among home dwellers include multimorbidity, reduced functional ability, declining wellbeing and lack of formal home care. A recent research article by Abraham SB et al. confirms that individuals living at home make significantly more ED visits than those in round-the-clock care. (Abraham SB et. al. 2025).

Reliable population-based data on the health and quality of life of the oldest old is scarce. They are underrepresented or even excluded from general population studies, and they have health-related barriers to participation. 

“The Vitality 90+ Study is unique due to its focus on this age group, its exceptionally high response rate, and its 30-yearlong study period. Our ten surveys repeated over decades allow us to track changes over time,” explains principal investigator Linda Enroth. 

Health and functioning are unevenly distributed across the population 

Multimorbidity is highly prevalent among the oldest old. Dementia and depression are some of the most critical diseases influencing health and social service use. Although the share of 90-year-olds with dementia has remained stable at around 40% over the past two decades, the absolute number of people with dementia has doubled due to the expanding cohort size.

“Our research shows that approximately 80% of nonagenarians have at least two concurrent chronic conditions. Multimorbidity is associated with decline in functional ability and perceived health, and it increases the demand for services,” Enroth explains. 

Enroth and her colleagues have demonstrated that health and functional ability are unevenly distributed across the population. 

“Even at very advanced ages, people in lower socioeconomic positions have more functional ability limitations than those in higher socioeconomic groups. Greater care needs, coupled with more constrained social and financial resources, also place informal carers in an unequal position,” Enroth notes.

Since 1995, the Vitality 90+ Study has used a multidisciplinary and mixed-methods approach to investigate the health and functional ability, quality of life, social relationships, care needs, service use, and biological aspects of ageing among nonagenarians.

Although the study focuses on nonagenarians residing in Tampere, Enroth points out that the findings are broadly representative of the 90+ population in Finland. Demographic changes in Tampere – such as the rapid growth of this age group, its increasing relative proportion in the population and gender distribution – mirror national trends. 

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The study was initiated in 1995 by Marja Jylhä and Antti Hervonen and is conducted by Tampere University. The study comprises three research lines that gather data through postal surveys, face-to-face life story interviews, health assessments and blood samples. All data have been linked with national register data on health and social care use. 

To date, nearly 100 peer-reviewed scientific publications have been based on the Vitality 90+ datasets, and the data have been used in 14 doctoral dissertations.

Cohort description (Vitality 90+ Study)

Enroth L, Halonen P, Tiainen K, Raitanen J, Jylhä M. 2023. Cohort profile: The Vitality 90+ Study. A cohort study on health and living conditions of the oldest old in Tampere, Finland. BMJ Open 2023; 13:e068509. 

Research article

Abraham, S.B., Pulkki, J., Aaltonen, M. et al. Frequency and predictors of emergency department visits among the oldest old in Finland: the Vitality 90+ Study. BMC Health Serv Res 25, 807 (2025).