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End of life hospitalisations differ for older Australian women according to death trajectory: a longitudinal data linkage study

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ABSTRACT

Background: Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. Despite the apparent high use of hospitals at the end of life, limited evidence currently exists regarding reasons for hospitalisation. Understanding complex end of life care needs is required for future health care planning as the global population ages. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use.

Methods: Survey data from 1,205 decedents from the 1921–1926 cohort of the Australian Longitudinal Study on Women’s Health were matched with the state-based hospital records and the National Death Index. Hospital patterns based on COD were graphically summarised and multivariate logistic regression models examined the impact of short-term predictors of length of stay (LOS).

Results: 85 % of women had at least one admission in the last year of life; and 8 % had their first observed admission during this time. Reasons for hospitalisation, timing of admissions and LOS differed by COD. Women who died of cancer, diabetes and ‘other’ causes were admitted earlier than women who died of organ failure, dementia and influenza. Women who died of organ failure overall spent the longest time in hospital, and women with cancer had the highest median LOS. Longer LOS was associated with previous short- and medium-term- hospitalisations and type of hospital separation.

Conclusions: Reducing acute care admissions and LOS at the end of life is complex and requires a shift in perceptions and treatment regarding end of life care and chronic disease management.

Electronic supplementary material: The online version of this article (doi:10.1186/s12913-016-1729-3) contains supplementary material, which is available to authorized users.

No MeSH data available.


Median cumulative overnight length of stay days in the 12 months prior to death for women from the 1921–1926 cohort
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Fig2: Median cumulative overnight length of stay days in the 12 months prior to death for women from the 1921–1926 cohort

Mentions: The median cumulative LOS days for women in their last year of life according to their primary COD is shown in Fig. 2. No significant difference was found across the groups in terms of days in hospital within 274–365 days prior to death. Women who died of cancer had the highest median number of bed days (Median = 23), followed by diabetes (Median = 16), organ failure (Median = 16), influenza/pneumonia (Median = 13), ‘other’ (Median = 11) and dementia/Alzheimer’s disease (Median = 10). The greatest increase in average cumulative LOS days was seen within the last 30 days prior to death for women with a primary COD of cancer (13.9 days) compared to women with organ failure (11.2 days) or influenza (10.1 days). All other COD categories had an average increased stay of less than 10 days within the last 30 days prior to death. Differences were found for COD groups within 1 month of death (Kruskal-Wallis test = 38.4, p-value <0.0001).Fig. 2


End of life hospitalisations differ for older Australian women according to death trajectory: a longitudinal data linkage study
Median cumulative overnight length of stay days in the 12 months prior to death for women from the 1921–1926 cohort
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5017050&req=5

Fig2: Median cumulative overnight length of stay days in the 12 months prior to death for women from the 1921–1926 cohort
Mentions: The median cumulative LOS days for women in their last year of life according to their primary COD is shown in Fig. 2. No significant difference was found across the groups in terms of days in hospital within 274–365 days prior to death. Women who died of cancer had the highest median number of bed days (Median = 23), followed by diabetes (Median = 16), organ failure (Median = 16), influenza/pneumonia (Median = 13), ‘other’ (Median = 11) and dementia/Alzheimer’s disease (Median = 10). The greatest increase in average cumulative LOS days was seen within the last 30 days prior to death for women with a primary COD of cancer (13.9 days) compared to women with organ failure (11.2 days) or influenza (10.1 days). All other COD categories had an average increased stay of less than 10 days within the last 30 days prior to death. Differences were found for COD groups within 1 month of death (Kruskal-Wallis test = 38.4, p-value <0.0001).Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. Despite the apparent high use of hospitals at the end of life, limited evidence currently exists regarding reasons for hospitalisation. Understanding complex end of life care needs is required for future health care planning as the global population ages. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use.

Methods: Survey data from 1,205 decedents from the 1921&ndash;1926 cohort of the Australian Longitudinal Study on Women&rsquo;s Health were matched with the state-based hospital records and the National Death Index. Hospital patterns based on COD were graphically summarised and multivariate logistic regression models examined the impact of short-term predictors of length of stay (LOS).

Results: 85&nbsp;% of women had at least one admission in the last year of life; and 8&nbsp;% had their first observed admission during this time. Reasons for hospitalisation, timing of admissions and LOS differed by COD. Women who died of cancer, diabetes and &lsquo;other&rsquo; causes were admitted earlier than women who died of organ failure, dementia and influenza. Women who died of organ failure overall spent the longest time in hospital, and women with cancer had the highest median LOS. Longer LOS was associated with previous short- and medium-term- hospitalisations and type of hospital separation.

Conclusions: Reducing acute care admissions and LOS at the end of life is complex and requires a shift in perceptions and treatment regarding end of life care and chronic disease management.

Electronic supplementary material: The online version of this article (doi:10.1186/s12913-016-1729-3) contains supplementary material, which is available to authorized users.

No MeSH data available.