Where older people die: a retrospective population-based study

Ahmad, Sartaj; O'Mahony, M Sinead

doi:10.1093/qjmed/hci138

Cited by 37 publications

(31 citation statements)

References 17 publications

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“…21 In Wales, trends over two decades showed the numbers of hospital deaths in individuals aged ≥85 years had doubled, care home deaths tripled, and deaths in the community were down by one-third. 13 Research from Europe -notably the Belgian Sentinel Network and the Dutch Longitudinal Aging Study Amsterdam (LASA) -has contributed detailed information on transitions before death, both using retrospective methods and including younger oldage ranges. LASA interviewed relatives of deceased participants concerning care and transitions in the last 3 months of life.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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Place of death for the ‘oldest old’: ≥85-year-olds in the CC75C population-based cohort

Fleming

Zhao²,

Farquhar³

et al. 2010

Br J Gen Pract

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Deaths are rising fastest among the oldest old but data on their transitions in place of care at the end of life are scarce. AimTo examine the place of residence or care of ≥85 yearolds less than a year before death, and their place of death, and to map individual changes between the two. Design of studyPopulation-based cohort study. SettingCambridge City over-75s Cohort (CC75C) study, UK. MethodRetrospective analysis of prospective data from males and females aged ≥85 years at death who died within a year of taking part in any CC75C survey (n = 320); death certificate linkage. ResultsOnly 7% changed their address in their last year of life, yet 52% died somewhere other than their usual address at the time of death. Over two-thirds were living in the community when interviewed <1 year before death, but less than one-third who had lived at home died there (less than one-fifth in sheltered housing). Care homes were the usual address of most people dying there (77% in residential homes, 87% in nursing homes) but 15% of deaths in acute hospital came from care homes. ConclusionMore than half the study sample of individuals of advanced old age had a change in their place of residence or care in their last year of life. These findings add weight to calls for improved end-of-life care in all settings, regardless of age, to avoid unnecessary transfers. The study data provide a baseline that can help plan and monitor initiatives to promote choice in location of care at the end of life for the very old. Keywords aged; aged 80 or over; aging in place; frail elderly; terminal care. INTRODUCTIONEnd-of-life care for older people is now an acknowledged priority.1 Recent UK policy initiatives and reports recognise the increasing number of people who will be dying in very old age.2-5 Emphasis on a care pathway approach highlights the importance of the place of care, place of death, and transitions between them.6-8 The NHS End of Life Care Programme's aims include reducing emergency admissions and transfers from care homes to hospital in the last week of life, alongside providing the support needed to enable people to die where they choose. 9 The policy drive to facilitate 'good deaths' at home envisages savings on costly acute care, enhancing value for money at the same time as choice, quality, and equality. 2,10,11 In many developed countries, deaths, including inhospital deaths, are rising fastest among ≥85-year olds. 1,12,13 Data are scarce on older people's place of care trajectories before death,

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Section: Comparison With Existing Literaturementioning

confidence: 99%

“…2,10,11 In many developed countries, deaths, including inhospital deaths, are rising fastest among ≥85-year olds. 1,12,13 Data are scarce on older people's place of care trajectories before death, …”

mentioning

confidence: 99%

Place of death for the ‘oldest old’: ≥85-year-olds in the CC75C population-based cohort

Fleming

Zhao²,

Farquhar³

et al. 2010

Br J Gen Pract

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“…22 While hospice referrals for this patient population are increasing, the average length of stay on hospice is short 23 and aggressive care near the end of life remains common and may be increasing. [24][25][26][27] Improving the quality of care of these patients while decreasing the costs due to unnecessary and burdensome medical interventions is an important priority for Medicare and other payers. Early integration of palliative care services into the care of those with advanced malignancies is increasingly viewed as an important tool in achieving this goal.…”

Section: Discussionmentioning

confidence: 99%

CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic

Blackhall

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Stukenborg

et al. 2016

Journal of Palliative Medicine

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Background: Studies suggest that outpatient palliative care can reduce hospitalization and increase hospice utilization for patients with cancer, however there are insufficient resources to provide palliative care to all patients from time of diagnosis. It is also unclear whether inpatient consultation alone provides similar benefits. A better understanding of the timing, setting, and impact of palliative care for patients with cancer is needed. Objectives: The purpose of this study was to measure timing of referral to outpatient palliative care and impact on end-of-life (EOL) care. Design: The Comprehensive Assessment with Rapid Evaluation and Treatment (CARE Track) program is a phased intervention integrating outpatient palliative care into cancer care. In Year 1 patients were referred at the discretion of their oncologist. Setting: Academic medical center. Measurements: We compared EOL hospitalization, hospice utilization, and costs of care for CARE Track patients compared to those never seen by palliative care or seen only in hospital. Results: Patients were referred a median of 72.5 days prior to death. CARE Track patients had few hospitalizations at end of life, were less likely to die in hospital, had increased hospice utilization, and decreased costs of care; these results were significant even after controlling for differences between groups. Inpatient consultation alone did not impact these variables. However, only approximately half of patients with incurable cancers were referred to this program. Conclusion: Referral outpatient palliative care within 3 months of death improved EOL care and reduced costs, benefits not seen with inpatient care only. However, many patients were never referred, and methods of systematically identifying appropriate patients are needed.

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“…(12) In hospitals, patients who die in the wards are historically older than those who die in the ICU. (4,(13)(14)(15) . Nowadays, chronic diseases are responsible for the majority of deaths, (16,(17)(18)(19)(20)(21) and acceptance of therapeutic limitation of cancer patients is more common.…”

Section: Discussionmentioning

confidence: 99%

“…(3)(4)(5)(6) This study proposes to assess medical practices adopted at the end-of-life of patients who died in the HU/UFSC and compare these practices and the epidemiological profile of those who died in the ICU with those who died in the clinical medicine (MW) and surgical wards (SW).…”

Section: Introductionmentioning

confidence: 99%