Complex health problems and mortality among the oldest old in Sweden: decreased risk for men between 1992 and 2002

Although mortality in older ages generally declined in most countries during the past decades less is known about mortality trends among the most vulnerable subset of the oldest old. The aim of this study was to investigate possible changes between 1992 and 2002 in the relation of complex health problems and mortality in two representative samples of the Swedish population aged 77+ (1992: n = 537; 2002: n = 561). Further, it was examined if trends differed by sex, education, and age. Serious problems in three health domains were identified (diseases/symptoms, mobility, cognition/communication). People with serious problems in two or three domains were considered to have complex health problems. Four-year mortality was analyzed using Cox proportional hazard regressions. Controlled for age, sex, education, and health status mortality risk decreased by 20% during the 10-year period. Complex health problems strongly predicted 4-year mortality in both 1992 and 2002. No single dimension explained the decrease. Men with complex health problems accounted for most of the decrease in mortality risk, so much that the gender difference in mortality risk was almost eliminated among elderly people with complex health problems 2002. A considerable decrease in the mortality risk among men with complex health problems has implications for the individual who may face longer periods of complex health problems and dependency. It will also place increasing demands upon medical and social services as well as informal caregivers.