Unplanned hospitalisations in older people: illness trajectories in the last year of life

Szilcz, Máté; Wastesson, Jonas W.; Johnell, Kristina; Morin, Lucas

doi:10.1136/bmjspcare-2020-002778

Cited by 6 publications

(4 citation statements)

References 42 publications

(37 reference statements)

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“…We further displayed that those who were not hospitalised are less likely to initiate treatment. This confirms the expectation that hospitalised patients receive more anticancer therapy at the end of life (20), which might be concerning given the increasing hospitalisation rates close to death (42). We showed a higher probability of endocrine treatment initiation and continuation if patients were also prescribed CDK4/6 treatment, which implies that they were in their earlier stages of the treatment course because CDK4/6 is recommended in first or second line (43).…”

Section: Interpretation and Implicationssupporting

confidence: 85%

Endocrine treatment near the end of life among older women with metastatic breast cancer: a nationwide cohort study

Szilcz,

Wastesson,

Calderón-Larrañaga

et al. 2023

Front. Oncol.

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BackgroundThe appropriate time to discontinue chemotherapy at the end of life has been widely discussed. In contrast, few studies have investigated the patterns of endocrine treatment near death. In this study, we aimed to investigate the end-of-life endocrine treatment patterns of older women with metastatic breast cancer and explore characteristics associated with treatment.MethodsA retrospective cohort study of all older women (age ≥65 years) with hormone receptor-positive breast cancer who died in Sweden, 2016 − 2020. We used routinely collected administrative and health data with national coverage. Treatment initiation was defined as dispensing during the last three months of life with a nine-month washout period, while continuation and discontinuation were assessed by previous use during the same period. We used log-binomial models to explore factors associated with the continuation and initiation of endocrine treatments.ResultsWe included 3098 deceased older women with hormone receptor-positive breast cancer (median age 78). Overall, endocrine treatment was continued by 39% and initiated by 5% and of women during their last three months of life, while 31% discontinued and 24% did not use endocrine treatment during their last year of life. Endocrine treatment continuation was more likely among older and less educated women, and among women who had multi-dose drug dispensing, chemotherapy, and CDK4/6 use. Only treatment-related factors were associated with treatment initiation.ConclusionMore than a third of women with metastatic breast cancer continue endocrine treatments potentially past the point of benefit, whereas late initiation is less frequent. Further research is warranted to determine whether our results reflect overtreatment at the end of life once patients’ preferences and survival prognosis are considered.

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Section: Interpretation and Implicationssupporting

confidence: 85%

Endocrine treatment near the end of life among older women with metastatic breast cancer: a nationwide cohort study

Szilcz,

Wastesson,

Calderón-Larrañaga

et al. 2023

Front. Oncol.

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“…Comparisons of the hospitalisation rates of people with dementia and those other life-limiting conditions have shown mixed results [ 8 , 28 , 29 ]. Rates of unplanned hospital admissions of people with other life-limiting illnesses such as cancer and organ failure also increase towards death [ 30 , 31 ]. An overlap between dementia and other factors (e.g.…”

Section: Discussionmentioning

confidence: 99%

Patterns of unplanned hospital admissions among people with dementia: from diagnosis to the end of life

Yorganci

2022

Age and Ageing

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Background hospitalisations are sentinel events for people with dementia. How patterns of unplanned hospital admissions change among people with dementia after diagnosis is relatively unknown. Objective to describe patterns of unplanned hospital admissions of people with dementia from diagnosis until death/study end. Methods retrospective cohort study using mental healthcare provider data of people diagnosed with dementia in London, UK (1995–2017), linked to mortality and hospital data. The primary outcome was the rate of unplanned hospital admissions after diagnosis until death/study end. We calculated the cumulative incidence of unplanned hospital admissions. The rates of unplanned hospital admissions and the percentage of time spent as an inpatient were stratified by time from first dementia diagnosis. Results for 19,221 people with dementia (61.4% female, mean age at diagnosis 81.0 years (standard deviation, SD 8.5)), the cumulative incidence of unplanned hospital admissions (n = 14,759) was 76.8% (95% CI 76.3%–77.3%). Individuals remained in the study for mean 3.0 (SD 2.6) years, and 12,667 (65.9%) died. Rates and lengths of unplanned hospital admissions remained relatively low and short in the months after the dementia diagnosis, increasing only as people approached the end of life. Percentage of time spent as an inpatient was <3% for people who were alive at the study end but was on average 19.6 and 13.3% for the decedents in the last 6 and 12 months of life, respectively. Conclusions the steep rise in hospitalisations before death highlights the need for improved community care and services for people with dementia who are approaching the end of life.

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“…Of people accessing home care packages, 39.8% [95% CI 39.6-40.1] had an unplanned hospitalisation which was higher than for people accessing permanent residential aged care (33.4% [95% CI 33.2-33.6]). While the total days in hospital for unplanned hospitalisations was high in all people receiving long-term care, the total number of days was higher in people receiving home care packages than those in permanent residential aged care (990,561 vs 639,115 days, median (IQR) length of stay per person 11 (4-27) vs 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) days). This equated to 7745 days/1000 individuals receiving home care packages and 3049 days/ 1000 individuals accessing residential aged care.…”

Section: Unplanned Hospitalisations and Days In Hospitalsmentioning

confidence: 98%

“…1 Unplanned hospitalisations can be burdensome for older people, disrupt their continuity of care, cause further deconditioning and contribute to growing demands for health services. [2][3][4] Currently, one in six Australians are aged ≥65 years, and this is expected to increase to almost one in four by 2066, placing increased demands on aged care services. [5][6][7] In Australia and internationally, government-subsidised long-term aged care services are critical to support older people requiring help with personal and health care.…”

Section: Introductionmentioning

confidence: 99%

Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia

Harrison,

Lang,

Eshetie

et al. 2024

Aust. Health Rev.

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Objective The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8–43.3], vs 37.8% [37.6–38.0]), unplanned hospitalisation (39.8% [39.6–40.1] vs 33.4% [33.2–33.6]) and potentially preventable hospitalisation (11.8% [11.6–12.0] vs 8.2% [8.1–8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency.

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Unplanned hospitalisations in older people: illness trajectories in the last year of life

Cited by 6 publications

References 42 publications

Endocrine treatment near the end of life among older women with metastatic breast cancer: a nationwide cohort study

Endocrine treatment near the end of life among older women with metastatic breast cancer: a nationwide cohort study

Patterns of unplanned hospital admissions among people with dementia: from diagnosis to the end of life

Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia

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