Health- and social care in the last year of life among older adults in Sweden

Abstract

Background In the last years of life, burden of disease and disability and need of health- and social care often increase. Social, functional and psychological factors may be important in regard to social- and health care utilization. This study aims to describe use of health- and social care during the last year of life among persons living in ordinary housing or in assisted living facilities. Methods A retrospective study examining health- and social care utilization during their last year of life, using a subsample from the Swedish twin registries individually linked to several Swedish national quality registries (NQR). Persons that died during 2008–2009 and 2011–2012 (n = 1518) were selected. Results Mean age at death was 85.9 ± 7.3 (range 65.1–109.0). Among the 1518 participants (women n = 888, 58.5%), of which 741 (49%) were living in assisted living facilities and 1061 (69.9%) had at least one hospitalization during last year of life. The most common causes of death were cardiovascular disease (43.8%) and tumors (15.3%). A multivariable logistic regression revealed that living in ordinary housing, younger age and higher numbers of NQR’s increased the likelihood of hospitalization. Conclusions Persons in their last year of life consumed high amount of health- and social care although 12% did not receive any home care. Married persons received less home care than never married. Persons living in ordinary housing had higher numbers of hospitalizations compared to participants in assisted living facilities. Older persons and persons registered in fewer NQR’s were less hospitalized.

Socioeconomic differences in inpatient care expenditure in the last year of life among older people: a retrospective population-based study in Stockholm County

“… 31 Similarly, a Swedish study found that older people living in their own homes were hospitalised more frequently in the last 10 weeks of life. 32 …”

“…33 ED visits were a driver of higher ICE, possibly due to subsequent unplanned hospitalisations and treatment in inpatient care. 32 However, if care received in the home is sufficiently meeting needs, as found in a systematic review, receiving appropriate palliative home-based care should lower ED use among dying patients. 34 Nevertheless, a previous Swedish study found that receiving home-healthcare was associated with frequent ED use.…”

“…31 Similarly, a Swedish study found that older people living in their own homes were hospitalised more frequently in the last 10 weeks of life. 32 Older people are now increasingly 'ageing in place', and their care needs shall be met at home. There is a greater need for advanced care planning near the EOL, as most decedents in were receiving municipal social care and even those receiving home healthcare incurred high ICE.…”

A good death from the perspective of healthcare providers from the internal medicine department in Shanghai: A qualitative study

“…To date, patients with terminal chronic illnesses do not die exclusively in hospice care settings. With the deterioration of the disease, they are frequently admitted to hospitals at the end-of-life stage [ [10] , [11] , [12] , [13] ]. As a result, many patients die in acute-care hospitals [ [13] , [14] , [15] , [16] ].…”

Long-term care use among people living with dementia: a retrospective register-based study from Sweden

“…Previous studies on the use of LTC among PlwD were restricted focused primarily on local data [ 17 , 27 ] and provided to cross-sectional snapshots [ 28 , 29 ]. Moreover, it is unclear for how long people with dementia live in residential care after being diagnosed.…”