Factors associated with transition from community settings to hospital as place of death for adults aged 75 years or older: a population-based mortality follow-back survey

Bone, Anna E, Gao, Wei, Gomes, Barbara, Sleeman, Katherine E, Maddocks, Matthew, Wright, Juliet, Yi, Deokhee, Higginson, Irene J and Evans, Catherine J (2016) Factors associated with transition from community settings to hospital as place of death for adults aged 75 years or older: a population-based mortality follow-back survey. Journal of the American Geriatrics Society, 64 (11). pp. 2210-2217. ISSN 0002-8614

[img] PDF - Accepted Version
Available under License Creative Commons Attribution.

Download (523kB)
[img] PDF - Supplemental Material
Available under License Creative Commons Attribution.

Download (101kB)
[img] PDF - Published Version
Available under License Creative Commons Attribution.

Download (149kB)

Abstract

Objective: To identify factors associated with end of life (EoL) transition from usual place of care to hospital as place of death for people aged 75 years or older (75+).

Design: Population-based mortality follow-back survey.

Setting: Deaths over six months in 2012 in two unitary authorities in England, covering 800 square miles with over one million residents.

Participants: A random sample of people aged 75+ who died in a care home or hospital and all those who died at home or in a hospice unit. Cases were identified from death registrations. The person who registered the death (a relative for 98.9%) completed the survey.

Measurements: Our main outcome was EoL transition to hospital as place of death versus no EoL transition to hospital. We used multivariable modified Poisson regression to examine factors (illness, demographic and environmental) related to EoL transition to hospital.

Results: 443/882 (50.2%) responded, describing the care received by people who died from mostly non-malignant conditions (76.3%) at mean age 87.4 years (SD= 6.4). 32.3% transitioned to hospital and died there (n=146). Transition was more likely in respiratory disease compared to cancer (Prevalence Ratio [PR] =2.07, 95%CI 1.42- 3.01) and for people with severe breathlessness (PR=1.96, 95%CI 1.12-3.43). Transition was less likely if EoL preferences had been discussed with a healthcare professional (PR=0.60, 95%CI 0.42-0.88) and when there was a key healthcare professional (PR=0.74, 95%CI 0.58-0.95).

Conclusion: To reduce EoL transition to hospital for older people this study suggests a need to improve the symptom management of breathlessness in the community and better access to a key healthcare professional skilled in coordinating care, communication, facilitating complex discussions and in planning for future care.

Item Type: Article
Keywords: Frail elderly, Palliative care, Terminal care, Cross-sectional survey, Mortality follow-back survey
Schools and Departments: Brighton and Sussex Medical School > Division of Medical Education
Subjects: R Medicine
R Medicine > R Medicine (General)
Depositing User: Marie Shelton
Date Deposited: 20 May 2016 06:22
Last Modified: 25 Sep 2017 11:16
URI: http://sro.sussex.ac.uk/id/eprint/60880

View download statistics for this item

📧 Request an update