The determinants of home and nursing home death: a systematic review and meta-analysis

Abstract

BackgroundMost Canadians die in hospital, and yet, many express a preference to die at home. Place of death is the result of the interaction among sociodemographic, illness- and healthcare-related factors. Although home death is sometimes considered a potential indicator of end-of-life/palliative care quality, some determinants of place of death are more modifiable than others. The objective of this systematic review was to evaluate the determinants of home and nursing home death in adult patients diagnosed with an advanced, life-limiting illness.MethodsA systematic literature search was performed for studies in English published from January 1, 2004 to September 24, 2013 that evaluated the determinants of home or nursing home death compared to hospital death in adult patients with an advanced, life-limiting condition. The adjusted odds ratios, relative risks, and 95 % confidence intervals of each determinant were extracted from the studies. Meta-analyses were performed if appropriate. The quality of individual studies was assessed using the Newcastle-Ottawa scale and the body of evidence was assessed according to the GRADE Working Group criteria.ResultsOf the 5,900 citations identified, 26 retrospective cohort studies were eligible. The risk of bias in the studies identified was considered low. Factors associated with an increased likelihood of home versus hospital death included multidisciplinary home palliative care, preference for home death, cancer as opposed to other diagnoses, early referral to palliative care, not living alone, having a caregiver, and the caregiver’s coping skills.ConclusionsKnowledge about the determinants of place of death can be used to inform care planning between healthcare providers, patients and family members regarding the feasibility of dying in the preferred location and may help explain the incongruence between preferred and actual place of death.Modifiable factors such as early referral to palliative care, presence of a multidisciplinary home palliative care team were identified, which may be amenable to interventions that improve the likelihood of a patient dying in the preferred location. Place of death may not be a very good indicator of the quality of end-of-life/palliative care since it is determined by multiple factors and is therefore dependent on individual circumstances.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0077-8) contains supplementary material, which is available to authorized users.

Time Trends and Educational Inequalities in Out‐of‐Hospital Coronary Deaths in Norway 1995–2009: A Cardiovascular Disease in Norway (CVDNOR) Project

“…Nursing home residents encompass a vulnerable population in which comorbidities and frailty are common, and as previously shown, 70% to 80% of nursing home residents in Norway suffer from cognitive impairment or dementia . As pointed out in a recently published meta‐analysis, these comorbidities and other factors, unrelated to SES status, play an important role in determining the place of death in this population subset . Hence, the association of education and OHCD risk is less decisive among older women compared to older men who die more often at home.…”

“…28 As pointed out in a recently published metaanalysis, these comorbidities and other factors, unrelated to SES status, play an important role in determining the place of death in this population subset. 29 Hence, the association of education and OHCD risk is less decisive among older women compared to older men who die more often at home. Another possible explanation is that level of education in older women might not capture SES as well as in men or younger people.…”

Quality assessment of palliative home care in Italy

“…For example, concerning the “home death” indicator as well established, factors increasing its likelihood included (other than a worse functional status and social aspects such as not living alone and presence of an informal caregiver) intensity of nurse and physician home visits, multidisciplinary home palliative care teams, and timing of referral to palliative care.…”

Integrating early palliative care into routine practice for patients with cancer: A mixed methods evaluation of the INTEGRATE Project

“…INTEGRATE focused on early delivery of general palliative care by oncology providers and early linkages to hospital‐ and community‐based resources, including specialized palliative care providers. Many Canadians only receive palliative care in the last month of life, and most continue to die in hospital . Weak links between hospitals and community‐based providers exacerbate limited access to and integration of palliative care for patients with cancer .…”

“…Many Canadians only receive palliative care in the last month of life, and most continue to die in hospital. [14][15][16] Weak links between hospitals and community-based providers exacerbate limited access to and integration of palliative care for patients with cancer. [17][18][19] The overall goals of INTEGRATE were to (a) enhance provider knowledge and confidence in palliative care delivery, (b) identify patients with cancer who might benefit from palliative care earlier in their disease trajectory, and (c) increase the provision of palliative care and use of palliative care tools.…”