Hospitalizations and emergency department visits trends among elderly individuals in proximity to death: a retrospective population-based study

Abstract

Acute healthcare services are extremely important, particularly during the COVID-19 pandemic, as healthcare demand has rapidly intensified, and resources have become insufficient. Studies on specific prepandemic hospitalization and emergency department visit (EDV) trends in proximity to death are limited. We examined time-trend specificities based on sex, age, and cause of death in the last 2 years of life. Datasets containing all hospitalizations and EDVs of elderly residents in Friuli-Venezia Giulia, Italy (N = 411,812), who died between 2002 and 2014 at ≥ 65 years, have been collected. We performed subgroup change-point analysis of monthly trends in the 2 years preceding death according to sex, age at death (65–74, 75–84, 85–94, and ≥ 95 years), and main cause of death (cancer, cardiovascular, or respiratory disease). The proportion of decedents (N = 142,834) accessing acute healthcare services increased exponentially in proximity to death (hospitalizations = 4.7, EDVs = 3.9 months before death). This was inversely related to age, with changes among the youngest and eldest decedents at 6.6 and 3.5 months for hospitalizations and at 4.6 and 3.3 months for EDVs, respectively. Healthcare use among cancer patients intensified earlier in life (hospitalizations = 6.8, EDVs = 5.8 months before death). Decedents from respiratory diseases were most likely to access hospital-based services during the last month of life. No sex-based differences were found. The greater use of acute healthcare services among younger decedents and cancer patients suggests that policies potentiating primary care support targeting these at-risk groups may reduce pressure on hospital-based services.

Epidemiology of patients who died in the emergency departments and need of end-of-life care in Korea from 2016 to 2019

“…People in proximity to death use more acute healthcare services than people who are not 14 . Among them, patients diagnosed with cancer and respiratory diseases are more likely to use acute-based healthcare service such as ED 15 . More than half of elderly patients who passed away in the ED had serious chronic illnesses and required palliative care 16 , 17 .…”

Factors Associated With Emergency Department Visits Among Patients Receiving Publicly-funded Homecare Services: A Retrospective Chart Review From Southern Taiwan Regional Hospital

“…Second, published evidence indicated sharp increase in the number of patients who utilized ED or acute healthcare recourses as approaching death. 37 , 38 As we limited the retrospective cohort study to patients receiving more than three months of publicly-funded integrated homecare services within the observation period, patient facing a rapid deterioration in health with imminent death in an emergency medicine setting and receiving less than three months of homecare services were removed from the current database. Our inability to consider another important clinical issue regarding imminent death in an emergency medicine setting might probably bias the findings in unpredictable ways.…”