Transitions in health and social service system at the end of life

Abstract

This study focuses on the amount and types of transitions in health and social service system during the last 2 years of life and the places of death and among Finnish people aged 70-79, 80-89 and 90 or older. The data set, derived from multiple national registers, consists of 75,578 people who died between 1998 and 2001. The services included university hospitals, general hospitals, health centres and residential care facilities. The most common place of death was the municipal health centre: half of the whole research population died in a health centre. The place of death varied by age and gender: men and people in younger age groups died more often in general or in university hospital or at home, while dying in health centres or in residential care homes was more common among women or the very old. Number of transitions varied from zero to over a hundred transitions during the last 2 years. Number of transitions increased as death approached. Men and younger age groups had more transitions than women and older age groups. Among men and younger age groups transitions between home and general or university hospital were common while transitions between home and health centre or residential care were more common to women and older people. The results indicate that municipal health centres have a major role as care providers as death approaches. Differences between gender and age in numbers and types of transitions were clear. Future research is needed to clarify the causes to these differences.

Ageing and transitions: looking back and looking forward

“…Addressing questions such as what triggers the use of informal care versus formal home care, or admission to a care institution, should help target the provision of care to those who need it (Geerts and Van den Bosch 2011;Hallberg and Lagergren 2009). In particular, insight into transitions through the health and social care system at the end of life is of great importance to support older people in dying with dignity (Aaltonen et al 2010). In the pathway preceding the use of care are transitions from functioning well to disability, and transitions in healthy lifestyles such as smoking and physical activity (Trias-Llimós et al 2016;Wong et al 2008;Zingmark et al 2016).…”

Training nursing home staff to improve residents’ end-of-life care: design and baseline findings from a randomized controlled trial

“…Among the ill-effects are delirium, the use of restraints, pressure ulcers, the use of feeding tubes and functional impairment [10][11][12][13]. Despite guidelines to the contrary, most older people living in long-term care in Finland die in hospitals and not in their own nursing homes [14].…”

“When I Said I Wanted to Die at Home I Didn’t Mean a Nursing Home”: Care Trajectories at the End of Life

“…Studies have also focused on the characteristics of those likely to experience multiple transitions in care as well as of those whose lives end in various settings. Research evidence suggests that older women are less likely to experience one or more care transitions at the EOL ( Aaltonen, Forma, Rissanen, Raitanen, & Jylhä, 2010 ; Aaltonen, Rissanen, Forma, Raitanen, & Jylhä, 2012 ; Abarshi et al, 2010 ). In addition, socioeconomic factors (education, income), marital status, informal support, health status (e.g., dementia vs. other causes of death), the availability of palliative care or other health services, and several other factors also appear to influence where people die ( Forma, Rissanen, Noro, Raitanen, & Jylhä, 2007 ; Fowler & Hammer, 2013 ; Martikainen, Moustgaard, Einiö, & Murphy, 2014 ; Menec et al, 2007 , 2009 ; Wilson et al, 2009 ), including the likelihood of transition (e.g., to hospital) at the EOL ( Aaltonen et al, 2010 ; Menec et al, 2007 ; Motiwala et al, 2006 ).…”