The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access published online on February 4, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, doi:10.1093/gerona/gln034
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Hospitalizations at the End of Life Among Long-Term Care Residents
1 Department of Community Health Sciences
2 Centre on Aging, The University of Manitoba, Winnipeg, Canada
Address correspondence to Verena H. Menec, PhD, Department of Community Health Sciences, University of Mannitoba, Winnipeg, Manitoba, Canada. Email: menec{at}cc.umanitoba.ca
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Abstract |
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Background.: Concerns have been raised over transfers into acute care hospitals at the end of life. The objective of this study was to examine (a) the extent of and (b) factors related to hospitalization in the last 180 days before death among long-term care (LTC) residents.
Methods.: The study included all LTC residents from 60 facilities in the province of Manitoba, Canada, who died in 2003/04 (N = 2,379), with data derived from administrative health care records. Multilevel regression analyses were conducted to examine the relationship between resident and facility characteristics and the following: location of death (in hospital vs the LTC facility); whether individuals were hospitalized in the last 180 days before death; and number of hospital days in the last 180 days.
Results.: Overall, 19.1% of LTC residents died in hospital; however, 40.7% were hospitalized at least once in the last 6 months before death. Several resident characteristics (age, trajectory group, and level of care) were related to the outcome measures. Living in a not-for-profit LTC facility decreased the odds of dying in hospital (adjusted odds ratio [OR] = 0.589; 95% confidence interval [CI] = 0.402–0.863) or being hospitalized (adjusted OR = 0.647; 95% CI = 0.452–0.926).
Conclusions.: Hospitalization at the end of life is common among LTC residents, and the likelihood of hospital transfers is increased for residents who are younger, have organ failure, lower care level needs, as well as among those who live in for-profit facilities. Particular emphasis should, therefore, be placed on targeting these groups to determine the appropriateness of hospital admission and possible ways of reducing transfers.
Keywords End-of-life care; Hospital use; Long-term care; Administrative data; Multilevel models
Received: November 15, 2007; Accepted: June 21, 2008