Transitions in health and social service system at the end of life

European Journal of Ageing (Impact Factor: 1.27). 06/2010; 7(2):91-100. DOI: 10.1007/s10433-010-0155-3

ABSTRACT This study focuses on the amount and types of transitions in health and social service system during the last 2years of life
and the places of death and among Finnish people aged 70–79, 80–89 and 90 or older. The data set, derived from multiple national
registers, consists of 75,578 people who died between 1998 and 2001. The services included university hospitals, general hospitals,
health centres and residential care facilities. The most common place of death was the municipal health centre: half of the
whole research population died in a health centre. The place of death varied by age and gender: men and people in younger
age groups died more often in general or in university hospital or at home, while dying in health centres or in residential
care homes was more common among women or the very old. Number of transitions varied from zero to over a hundred transitions
during the last 2years. Number of transitions increased as death approached. Men and younger age groups had more transitions
than women and older age groups. Among men and younger age groups transitions between home and general or university hospital
were common while transitions between home and health centre or residential care were more common to women and older people.
The results indicate that municipal health centres have a major role as care providers as death approaches. Differences between
gender and age in numbers and types of transitions were clear. Future research is needed to clarify the causes to these differences.

KeywordsTransitions in health and social service system-Place of death-Last years of life-Register study-Ageing

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    • "As is argued in the article, the generally preferred ''reduction'' to English language in cross-country qualitative research seems to have its limits and the way out is far from trivial and deserves much more research investments. We are also happy that we were able to contribute with research published in the European Journal of Ageing to ongoing key themes of the international ageing research literature such as distance-to-death and end-of-life related research (Aaltonen et al. 2010; Kotter-Grühn et al. 2010), driving forces of retirement incomes (Hershey et al. 2010), disability prevention issues (Daniels et al. 2010) and the interrelations between socio-structural variables and health (Schöllgen et al. 2010). The 5 most cited papers within the recent 90 days were two from the area of social gerontology (de Jong Gierveld and van Tilburg 2010; 223 downloads ; Dykstra, 2009; 186 downloads), followed by two behavioural papers (Allemand et al. 2010; 152 downloads; Jopp and Schmitt 2010; 143 downloads) and a biodemographic paper (Oksuzyan et al. 2010; "
    European Journal of Ageing 03/2011; 8(1):1-2. DOI:10.1007/s10433-011-0183-7 · 1.27 Impact Factor
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    ABSTRACT: Background: Centenarians are a rapidly growing demographic group worldwide, yet their health and social care needs are seldom considered. This study aims to examine trends in place of death and associations for centenarians in England over 10 years to consider policy implications of extreme longevity. Methods and findings: This is a population-based observational study using death registration data linked with area-level indices of multiple deprivations for people aged ≥100 years who died 2001 to 2010 in England, compared with those dying at ages 80-99. We used linear regression to examine the time trends in number of deaths and place of death, and Poisson regression to evaluate factors associated with centenarians' place of death. The cohort totalled 35,867 people with a median age at death of 101 years (range: 100-115 years). Centenarian deaths increased 56% (95% CI 53.8%-57.4%) in 10 years. Most died in a care home with (26.7%, 95% CI 26.3%-27.2%) or without nursing (34.5%, 95% CI 34.0%-35.0%) or in hospital (27.2%, 95% CI 26.7%-27.6%). The proportion of deaths in nursing homes decreased over 10 years (-0.36% annually, 95% CI -0.63% to -0.09%, p = 0.014), while hospital deaths changed little (0.25% annually, 95% CI -0.06% to 0.57%, p = 0.09). Dying with frailty was common with "old age" stated in 75.6% of death certifications. Centenarians were more likely to die of pneumonia (e.g., 17.7% [95% CI 17.3%-18.1%] versus 6.0% [5.9%-6.0%] for those aged 80-84 years) and old age/frailty (28.1% [27.6%-28.5%] versus 0.9% [0.9%-0.9%] for those aged 80-84 years) and less likely to die of cancer (4.4% [4.2%-4.6%] versus 24.5% [24.6%-25.4%] for those aged 80-84 years) and ischemic heart disease (8.6% [8.3%-8.9%] versus 19.0% [18.9%-19.0%] for those aged 80-84 years) than were younger elderly patients. More care home beds available per 1,000 population were associated with fewer deaths in hospital (PR 0.98, 95% CI 0.98-0.99, p<0.001). Conclusions: Centenarians are more likely to have causes of death certified as pneumonia and frailty and less likely to have causes of death of cancer or ischemic heart disease, compared with younger elderly patients. To reduce reliance on hospital care at the end of life requires recognition of centenarians' increased likelihood to "acute" decline, notably from pneumonia, and wider provision of anticipatory care to enable people to remain in their usual residence, and increasing care home bed capacity.
    PLoS Medicine 06/2014; 11(6). DOI:10.1371/journal.pmed.1001653 · 14.43 Impact Factor
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    ABSTRACT: Objectives: The purpose of the study was to examine the frequency of burdensome care transitions at the end of life, the difference between different types of residential care facilities, and the changes occurring between 2002 and 2008. Design: A nationwide, register-based retrospective study. Setting: Residential care facilities offering long-term care, including traditional nursing homes, sheltered housing with 24-hour assistance, and long-term care facilities specialized in care for people with dementia. Study group: All people in Finland who died at the age of 70 or older, had dementia, and were in residential care during their last months of life. Main outcome measures: Three types of potentially burdensome care transition: (1) any transition to another care facility in the last 3 days of life; (2) a lack of continuity with respect to a residential care facility before and after hospitalization in the last 90 days of life; (3) multiple hospitalizations (more than 2) in the last 90 days of life. The 3 types were studied separately and as a whole. Results: One-tenth (9.5%) had burdensome care transitions. Multiple hospitalizations in the last 90 days were the most frequent, followed by any transitions in the last 3 days of life. The frequency varied between residents who lived in different baseline care facilities being higher in sheltered housing and long-term specialist care for people with dementia than in traditional nursing homes. During the study years, the number of transitions fluctuated but showed a slight decrease since 2005. Conclusions: The ongoing change in long-term care from institutional care to housing services causes major challenges to the continuity of end-of-life care. To guarantee good quality during the last days of life for people with dementia, the underlying reasons behind transitions at the end of life should be investigated more thoroughly. (C) 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
    Journal of the American Medical Directors Association 06/2014; 15(9). DOI:10.1016/j.jamda.2014.04.018 · 4.94 Impact Factor