What Impact Do Setting and Transitions Have on the Quality of Life at the End of Life and the Quality of the Dying Process?

Mezey, Mathy; Dubler, Nancy Neveloff; Mitty, Ethel; Brody, Abraham A.

doi:10.1093/geront/42.suppl_3.54

Cited by 78 publications

(61 citation statements)

References 63 publications

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“…Recent Swedish research has questioned whether the lower utilisation of medical healthcare among people living in institutional care is a consequence of better supervision of medical conditions or a sign that staff in institutional care are acting as 'gatekeepers' for hospital care (Condelius et al 2010). However, it is well known that transitions between care facilities may have a negative impact on older people's well-being (Mezey et al 2002) and that hospital admission of nursing home residents can be detrimental to their health (Caplan et al 2006).…”

Section: Discussionmentioning

confidence: 99%

Care utilisation in the last years of life in Sweden: the effects of gender and marital status differ by type of care

2014

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The effects of gender and marital status on care utilisation in the last years of life are highly correlated. This study analysed whether gender differences in use of eldercare (home help services or institutional care) or hospital care in the last 5 years of life, and the place of death, could be attributed to differences in marital status and thereby to potential access to informal care. A longitudinal Swedish study provided register data on 567 participants (aged 83 +) who died between 1995 and 2004. A higher proportion of unmarried than married people used home help services; this was true of both men and women. The likelihood of receiving home help was lower for those living with their spouse (OR = 0.38) and for those with children (OR = 0.60). In the 2 years preceding death, the proportion receiving home help services decreased and the proportion in institutional care increased. Women were significantly more likely to die in institutional care (OR = 1.88) than men. Although men were less likely to live in institutional care than women and more likely to be inpatients in the 3 months preceding death, after controlling for residence in institutional care, neither gender nor marital status was statistically significant when included in the same model. In summary, the determining factor for home help utilisation seemed to be access to informal care, whereas gender differences in health status could explain women's higher probability of dying in institutional care.

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Section: Discussionmentioning

confidence: 99%

Care utilisation in the last years of life in Sweden: the effects of gender and marital status differ by type of care

2014

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“…7,8 Although it is known that a person's quality of life in the final phase of life and quality of death can be affected by the care setting, studies often do not directly compare care setting or place of residence. 9 Those that do make a direct comparison focus primarily on subjective measures of care, such as the family's satisfaction with care. 10 How the care received by older people living at home compares with that received by those living in a residential home is yet unknown.…”

Section: Introductionmentioning

confidence: 99%

Comparison of end-of-life care for older people living at home and in residential homes: a mortality follow-back study among GPs in the Netherlands

et al. 2015

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BackgroundThe proportion of older people is increasing, therefore their place of residence and place of care at the end of life are becoming increasingly important. AimTo compare aspects of end-of-life care among older people in residential homes and home settings in the Netherlands. Design and settingNationwide representative mortality followback study among GPs in the Netherlands. MethodThe study included patients aged ≥65 years who died non-suddenly, whose longest place of residence in their last year of life was at home or in a residential home (n = 498). Differences were analysed using Pearson's χ 2 test, MannWhitney U tests, and multivariate logistic regression. ResultsControlling for the differences between the populations in home settings and residential homes, no differences were found in treatment goals, communication about end-of-life care, or use of specialised palliative care between the two settings. However, people living in a residential home were more likely to have received palliative care from a GP than people living at home (OR 2.84, 95% confidence interval [CI] = 1.41 to 5.07). In residential homes, people more often experienced no transfer between care settings (OR 2.76, 95% CI = 1.35 to 5.63) and no hospitalisations (OR 2.2, 95% CI = 1.04 to 4.67) in the last 3 months of life, and died in hospital less often (OR 0.78, 95% CI = 0.63 to 0.97) than those people living at home. ConclusionDespite similar treatment goals, care in residential homes seems more successful in avoiding transfers and hospitalisation at the end of life. Especially since older people are encouraged to stay at home longer, measures should be taken to ensure they are not at higher risk of transfers and hospitalisations in this setting. Keywordsend of life care; general practitioner; palliative care; residential facilities; terminal care.

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“…The thought of moving away from one's own home to a care facility at the end of life may cause negative feelings (Lee 1997). Yet most older people in Europe and in North America die somewhere else than at home; nowadays dying is extensively institutionalized and hospitals and long-term care facilities are the common places of death (Ahmad and O'Mahony 2005;Fischer et al 2004;Jakobsson et al 2006;Klinkenberg et al 2005; Van den Block et al 2007;Wilson et al 2001) From the perspective of quality of life, different research findings describe the strengths and weaknesses of different places of death (Mezey et al 2002), also illustrating the complexity of the concept of the quality of life at the end of life. Transitions may have a negative effect on the quality of life because transitions between settings include the possibility of medical errors or unnecessary treatments (Meier and Beresford 2008), and stress in a patient as consequence of changing location and facing difficulties in the continuum of care (Naylor et al 2005).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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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.

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What Impact Do Setting and Transitions Have on the Quality of Life at the End of Life and the Quality of the Dying Process?

Abstract: Research recommendations for each setting and across settings are provided. The National Institutes of Health should clarify criteria for enrollment of persons with diminished, fluctuating, and absent decisional capacity in research.

Cited by 78 publications

References 63 publications

Care utilisation in the last years of life in Sweden: the effects of gender and marital status differ by type of care

Care utilisation in the last years of life in Sweden: the effects of gender and marital status differ by type of care

Comparison of end-of-life care for older people living at home and in residential homes: a mortality follow-back study among GPs in the Netherlands

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

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