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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

End of life hospitalisations differ for older Australian women according to death trajectory: a longitudinal data linkage study

Authors: Melissa L. Harris, Xenia Dolja-Gore, Hal Kendig, Julie E. Byles

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. Despite the apparent high use of hospitals at the end of life, limited evidence currently exists regarding reasons for hospitalisation. Understanding complex end of life care needs is required for future health care planning as the global population ages. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use.

Methods

Survey data from 1,205 decedents from the 1921–1926 cohort of the Australian Longitudinal Study on Women’s Health were matched with the state-based hospital records and the National Death Index. Hospital patterns based on COD were graphically summarised and multivariate logistic regression models examined the impact of short-term predictors of length of stay (LOS).

Results

85 % of women had at least one admission in the last year of life; and 8 % had their first observed admission during this time. Reasons for hospitalisation, timing of admissions and LOS differed by COD. Women who died of cancer, diabetes and ‘other’ causes were admitted earlier than women who died of organ failure, dementia and influenza. Women who died of organ failure overall spent the longest time in hospital, and women with cancer had the highest median LOS. Longer LOS was associated with previous short- and medium-term- hospitalisations and type of hospital separation.

Conclusions

Reducing acute care admissions and LOS at the end of life is complex and requires a shift in perceptions and treatment regarding end of life care and chronic disease management.
Appendix
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Literature
1.
United Nations Department of Economic and Social Affairs Population Division. World population ageing 2013. ST/ESA/SERA/348. New York: United Nations; 2013.
2.
Department of Treasury. 2015 Intergenerational Report. Australia in 2055. Canberra: Commonwealth of Australia; 2015.
3.
Appleby J. Spending on health and social care over the next 50 years: why think long term? London: The King’s Fund; 2013.
4.
AIHW. Australia’s hospitals 2012–13 at a glance. Health Services Series No 55 Cat No HSE 146. Canberra: Australian Institute of Health and Welfare; 2014.
5.
AIHW, Karmel R, Lloyd J, Hales C. Older Australians in hospital. Bulletin No 53, Cat AUS 92. Canberra: Australian Institute of Health and Welfare; 2007.
6.
Fries JF. Aging, natural death, and the compression of morbidity. N Engl J Med. 1980;303(3):130–5.PubMedCrossRef
7.
8.
9.
Menec VH, Nowicki S, St John PD. In-region versus out-of-region hospitalizations at the end of life among older rural residents: the relationship between personal and system-related factors. J Gerontol A Biol Sci Med Sci. 2011;66(12):1328–35.PubMedCrossRef
10.
Menec VH, Lix L, Nowicki S, Ekuma O. Health care use at the end of life among older adults: does it vary by age? J Gerontol A Biol Sci Med Sci. 2007;62(4):400–7.PubMedCrossRef
11.
Rosenwax LK, McNamara BA, Murray K, McCabe RJ, Aoun SM, Currow DC. Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care. Med J Aust. 2011;194(11):570–3.PubMed
12.
De Korte-Verhoef MC, Pasman HR, Schweitzer BP, Francke AL, Onwuteaka-Philipsen BD, Deliens L. End-of-life hospital referrals by out-of-hours general practitioners: a retrospective chart study. BMC Fam Pract. 2012;13:89.PubMedPubMedCentralCrossRef
13.
De Korte-Verhoef MC, Pasman HR, Schweitzer BP, Francke AL, Onwuteaka-Philipsen BD, Deliens L. Reasons for hospitalisation at the end of life: differences between cancer and non-cancer patients. Support Care Cancer. 2014;22(3):645–52.PubMedCrossRef
14.
15.
Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003;51(4):451–8.PubMedCrossRef
16.
Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J. Importance of functional measures in predicting mortality among older hospitalized patients. JAMA. 1998;279(15):1187–93.PubMedCrossRef
17.
Kelley AS, Ettner SL, Morrison RS, Du Q, Wenger NS, Sarkisian CA. Determinants of medical expenditures in the last 6 months of life. Ann Intern Med. 2011;154(4):235–42.PubMedPubMedCentralCrossRef
18.
Kelley AS, Ettner SL, Morrison RS, Du Q, Sarkisian CA. Disability and decline in physical function associated with hospital use at end of life. J Gen Intern Med. 2012;27(7):794–800.PubMedPubMedCentralCrossRef
19.
Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of functional decline at the end of life. JAMA. 2003;289(18):2387–92.PubMedCrossRef
20.
Bravell ME, Malmberg B, Berg S. End-of-life care in the oldest old. Palliat Support Care. 2010;8(3):335–44.PubMedCrossRef
21.
22.
Davies E, Higginson IJ. Better palliative care of older people. Geneva: World Health Organization; 2004.
23.
Powers J, Ball J, Adamson L, Dobson A. Effectiveness of the national death index for establishing the vital status of older women in the Australian longitudinal study on Women’s health. Aust N Z J Public Health. 2000;24(5):526–8.PubMedCrossRef
24.
25.
26.
Byles JE, Dobson A. The value of time in longitudinal studies of ageing. Lessons from the Australian Longitudinal Study on Women’s Health. Australas J Ageing. 2011;30 Suppl 2:6–12.
27.
28.
AIHW. Palliative care services in Australia 2013. HWI 123. Canberra: Australian Institute of Health and Welfare; 2013.
29.
AIHW: National health data dictionary. Version 6.0. standard questions on the use of tobacco among adults. Canberra: Australian Institute of Health and Welfare; 1997.
30.
Department of Health and Aged Care. Measuring remoteness: accessibility/remoteness index of Australia (ARIA) revised ed. Canberra: Department of Health and Aged Care; 2001.
31.
Madsen J, Serup-Hansen N, Kristiansen IS. Future health care costs--do health care costs during the last year of life matter? Health Policy. 2002;62(2):161–72.PubMedCrossRef
32.
Stooker T, van Acht JW, van Barneveld EM, van Vliet RC, van Hout BA, Hessing DJ, Busschbach JJ. Costs in the last year of life in The Netherlands. Inquiry. 2001;38(1):73–80.PubMed
33.
Brown WJ, Bryson L, Byles JE, Dobson AJ, Lee C, Mishra G, Schofield M. Women’s Health Australia: recruitment for a national longitudinal cohort study. Women Health. 1998;28(1):23–40.PubMedCrossRef
34.
Reich O, Signorell A, Busato A. Place of death and health care utilization for people in the last 6 months of life in Switzerland: a retrospective analysis using administrative data. BMC Health Serv Res. 2013;13:116.PubMedPubMedCentralCrossRef
35.
Glaser B, Strauss AL. Time for dying. Chicago: Aldine Publishing; 1968.
36.
Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA. 1979;241(19):2035–8.PubMedCrossRef
37.
Byles J, Hockey R, Mc Laughlin D, Dobson A, Brown W, Loxton D, Mishra G. Chronic conditions, physical function and health care use: findings from the Australian Longitudinal Study on Women’s Health. Report prepared for the Australian Government Department of Health; 2015.
38.
Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001;24(3):561–87.PubMedCrossRef
39.
Jack L. Diabetes self-management education research—An international review of intervention methods, theories, community partnerships and outcomes. Dis Manag Health Out. 2003;11(7):415–28.CrossRef
40.
Beverly EA, Fitzgerald S, Sitnikov L, Ganda OP, Caballero AE, Weinger K. Do older adults aged 60–75 years benefit from diabetes behavioral interventions? Diabetes Care. 2013;36(6):1501–6.PubMedPubMedCentralCrossRef
41.
RACGP. General practice management of type 2 diabetes – 2014–15. Melbourne: The Royal Australian College of General Practitioners and Diabetes Australia; 2014.
42.
Scottish Intercollegiate Guidelines Network. Sign 116: management of diabetes. A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network; 2010.
43.
American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care. 2014;37 Suppl 1:S14–80.CrossRef
44.
Munshi MN, Segal AR, Suhl E, Ryan C, Sternthal A, Giusti J, Lee Y, Fitzgerald S, Staum E, Bonsignor P, et al. Assessment of barriers to improve diabetes management in older adults: a randomized controlled study. Diabetes Care. 2013;36(3):543–9.PubMedPubMedCentralCrossRef
45.
Faulenbach M, Uthoff H, Schwegler K, Spinas GA, Schmid C, Wiesli P. Effect of psychological stress on glucose control in patients with type 2 diabetes. Diabet Med. 2012;29(1):128–31.PubMedCrossRef
46.
Khalid JM, Raluy-Callado M, Curtis BH, Boye KS, Maguire A, Reaney M. Rates and risk of hospitalisation among patients with type 2 diabetes: retrospective cohort study using the UK general practice research database linked to English hospital episode statistics. Int J Clin Pract. 2014;68(1):40–8.PubMedCrossRef
47.
Abarshi E, Echteld M, Van den Block L, Donker G, Deliens L, Onwuteaka-Philipsen B. Transitions between care settings at the end of life in the Netherlands: results from a nationwide study. Palliat Med. 2010;24(2):166–74.PubMedCrossRef
48.
Otero-Sabogal R, Arretz D, Siebold S, Hallen E, Lee R, Ketchel A, Li J, Newman J. Physician-community health worker partnering to support diabetes self-management in primary care. Qual Prim Care. 2010;18(6):363–72.PubMed
49.
Gary TL, Hill-Briggs F, Batts-Turner M, Brancati FL. Translational research principles of an effectiveness trial for diabetes care in an urban African American population. Diabetes Educ. 2005;31(6):880–9.PubMedCrossRef
50.
Chetty M, MacKenzie M, Douglas G, Currie GP. Immediate and early discharge for patients with exacerbations of chronic obstructive pulmonary disease: is there a role in “real life”? Int J Chron Obstruct Pulmon Dis. 2006;1(4):401–7.PubMedPubMedCentral
51.
Hillman KM. Failure to recognise patients at the end of life in acute hospitals. Acta Anaesthesiol Scand. 2014;58(1):1–2.PubMedCrossRef
52.
Department of Health and Ageing. Supporting Australians to live well at the end of life: national palliative care strategy. Canberra: DoHA; 2010.
53.
Cartwright C, Shaw K. End-of-life care. In: Caplan G, editor. Geriatric medicine: An introduction. Melbourne: BPA Print Group Pty Ltd; 2014.
54.
Wright AA, Keating NL, Balboni TA, Matulonis UA, Block SD, Prigerson HG. Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers’ mental health. J Clin Oncol. 2010;28(29):4457–64.PubMedPubMedCentralCrossRef
55.
Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Shield R, Mor V. Family perspectives on end-of-life care at the last place of care. JAMA. 2004;291(1):88–93.PubMedCrossRef
56.
Gomes B, Calanzani N, Koffman J, Higginson IJ. Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study. BMC Med. 2015;13:235.PubMedPubMedCentralCrossRef
57.
Weitzen S, Teno JM, Fennell M, Mor V. Factors associated with site of death: a national study of where people die. Med Care. 2003;41(2):323–35.PubMed
58.
Bell CL, Somogyi-Zalud E, Masaki KH. Methodological review: measured and reported congruence between preferred and actual place of death. Palliat Med. 2009;23(6):482–90.PubMedCrossRef
59.
Kaspers PJ, Pasman HR, Onwuteaka-Philipsen BD, Deeg DJ. Changes over a decade in end-of-life care and transfers during the last 3 months of life: a repeated survey among proxies of deceased older people. Palliat Med. 2013;27(6):544–52.PubMedCrossRef
60.
Naylor MD, Kurtzman ET, Pauly MV. Transitions of elders between long-term care and hospitals. Policy Polit Nurs Pract. 2009;10(3):187–94.PubMedCrossRef
61.
Gott M, Seymour J, Bellamy G, Clark D, Ahmedzai S. Older people’s views about home as a place of care at the end of life. Palliat Med. 2004;18(5):460–7.PubMedCrossRef
62.
63.
Wilson DM, Truman CD. Addressing myths about end-of-life care: research into the use of acute care hospitals over the last five years of life. J Palliat Care. 2002;18(1):29–38.PubMed
64.
Goebeler S, Jylha M, Hervonen A. Use of hospitals at age 90. A population-based study. Arch Gerontol Geriatr. 2004;39(1):93–102.PubMedCrossRef
Metadata
Title
End of life hospitalisations differ for older Australian women according to death trajectory: a longitudinal data linkage study
Authors
Melissa L. Harris
Xenia Dolja-Gore
Hal Kendig
Julie E. Byles
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1729-3

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