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


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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    • "[4] Transitions are common among the care facilities' residents [5] although they interfere with the continuum of care, which again may lead to unnecessary treatments and complications , particularly in patients with severe dementia. [3] [6] [7] The number of transitions increases with the proximity of death. [8] Decisions not to hospitalize a resident are made only when the proximity of death is obvious. "

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    • "iköt), vaikka asiakasrakenne on samankaltaistunut. Pirstaleisuus muotoutuu iäkkään asiakkaan kannalta ongelmalliseksi, mikäli hän joutuu muuttamaan hoitoyksiköstä toiseen, kun hänen toimintakykynsä muuttuu. Tutkimustulosten mukaan iäkkäät ihmiset kokevat viimeisinä elinvuosinaan useita, jopa kymmeniä siirtoja hoitopaikasta toiseen (Jylhä ym. 2008; Aaltonen ym. 2010). Useat siirrot kuvastavat myös palveluketjujen toimimattomuutta: asiakas saattaa joutua jonottamaan erikoissairaanhoidossa vapautuvaa paikkaa vanhainkodissa tai palvelutalossa. Yhtäältä hoito-ja palveluketjut katkeavat herkästi ja toisaalta suurimmat laatupuutteet osuvat eri palveluiden rajapinnoille ja siirtymiin, ns. harmaalle alueel"
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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; "

    Full-text · Article · Mar 2011 · European Journal of Ageing
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