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Trends in long-term care use among Dutch older men and women between 1995 and 2016: is the gender gap changing? AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
This study examines whether the gender gap in long-term care use in the Netherlands has changed between 1995 and 2016. Previous research has shown that women use more formal care services than men, while men use more informal care. In the past decades, there have been changes in the individual determinants of care use, such as health and social resources, and care provision. This raises the question of whether gender differences in care use have also changed over time. The Longitudinal Aging Study Amsterdam (LASA) involved respondents aged 70–88 in seven waves: 1995/96, 1998/99, 2002/03, 2005/06, 2008/09, 2011/12 and 2015/16 (N = 6,527 observations). Generalised estimating equations (GEE) were used to analyse changes in the impact of gender on the use of informal and formal home care, residential care and private home care, and the non-use of care. Men used more informal care provided by a partner than women, but women used other sources of care more than men. Individual social resources explained the gender gap in informal and formal home care use, and health and social resources explained the gap in residential care. In the non-use of care and, to some extent, in residential care use, the gender gap widened over the years to the disadvantage of men and was not explained by health and social resources. The persistent and even increasing gender gap in the non-use of care over time warrants an exploration of the role of gender in seeking care and access to care, and a closer examination of the role of long-term care policies in maintaining this gap.
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Barbiellini Amidei C, Macciò S, Cantarutti A, Gessoni F, Bardin A, Zanier L, Canova C, Simonato L. Hospitalizations and emergency department visits trends among elderly individuals in proximity to death: a retrospective population-based study. Sci Rep 2021; 11:21472. [PMID: 34728661 PMCID: PMC8563963 DOI: 10.1038/s41598-021-00648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
Acute healthcare services are extremely important, particularly during the COVID-19 pandemic, as healthcare demand has rapidly intensified, and resources have become insufficient. Studies on specific prepandemic hospitalization and emergency department visit (EDV) trends in proximity to death are limited. We examined time-trend specificities based on sex, age, and cause of death in the last 2 years of life. Datasets containing all hospitalizations and EDVs of elderly residents in Friuli-Venezia Giulia, Italy (N = 411,812), who died between 2002 and 2014 at ≥ 65 years, have been collected. We performed subgroup change-point analysis of monthly trends in the 2 years preceding death according to sex, age at death (65-74, 75-84, 85-94, and ≥ 95 years), and main cause of death (cancer, cardiovascular, or respiratory disease). The proportion of decedents (N = 142,834) accessing acute healthcare services increased exponentially in proximity to death (hospitalizations = 4.7, EDVs = 3.9 months before death). This was inversely related to age, with changes among the youngest and eldest decedents at 6.6 and 3.5 months for hospitalizations and at 4.6 and 3.3 months for EDVs, respectively. Healthcare use among cancer patients intensified earlier in life (hospitalizations = 6.8, EDVs = 5.8 months before death). Decedents from respiratory diseases were most likely to access hospital-based services during the last month of life. No sex-based differences were found. The greater use of acute healthcare services among younger decedents and cancer patients suggests that policies potentiating primary care support targeting these at-risk groups may reduce pressure on hospital-based services.
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Affiliation(s)
- Claudio Barbiellini Amidei
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy.
| | - Silvia Macciò
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy
| | - Anna Cantarutti
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Francesca Gessoni
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy
| | - Andrea Bardin
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy
| | - Loris Zanier
- Epidemiological Service, Health Directorate, Friuli-Venezia Giulia Region, Udine, Italy
| | - Cristina Canova
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy.
| | - Lorenzo Simonato
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131, Padua, Italy
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Steel A, Bertfield D. Increasing advance care planning in the secondary care setting: A quality improvement project. Future Healthc J 2020; 7:137-142. [PMID: 32550281 DOI: 10.7861/fhj.2019-0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Advance care plans (ACP) provide patients the opportunity to communicate their goals and wishes for future care. LOCAL PROBLEM A retrospective case note review of 50 inpatient deaths in 2017 confirmed a doctor had discussed expected death in 90%, however only 2% had an ACP. METHODS Patients appropriate for ACP were identified on a single geriatrics ward. Interventions were implemented with monthly data collection. Patients with an ACP were followed prospectively. The initiatives were subsequently applied across six geriatrics wards. INTERVENTIONS Interventions included improved identification of patients appropriate for ACP, doctor education and improved communication to general practitioners and healthcare providers. RESULTS Before initiation of interventions on the pilot ward, ACP was completed for 38% of appropriate patients; this increased to a mean of 78.6% over 4 months post-interventions. During the pilot, 44 patients had an ACP. Of those discharged, 75% avoided readmission over the following 6 months. After applying the interventions across all geriatric wards, ACPs increased to a mean of 81.2% and was maintained 12 months later at 72%. CONCLUSIONS The initiatives formed a structure to promote the use of ACP on the wards. Care plans focused on individualising care and effective communication resulted in reduction of readmissions.
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Mori H, Ishizaki T, Takahashi R. Association of long-term care needs, approaching death and age with medical and long-term care expenditures in the last year of life: An analysis of insurance claims data. Geriatr Gerontol Int 2020; 20:277-284. [PMID: 31977156 DOI: 10.1111/ggi.13865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/03/2019] [Accepted: 12/21/2019] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to examine whether long-term care needs, approaching death and age were associated with the use of medical and long-term care resources (care/service use and expenditures) in the last year of life among older Japanese individuals. METHODS Using data on insurance claims and death certificates, we described the use of medical and long-term care resources in the last year of life by residents of Soma City in Japan aged ≥65 years who died between September 2006 and October 2009. Using a generalized estimating equation, we examined whether long-term care needs, approaching death and age were associated with resource use during each 3-month period in the last year of life. RESULTS Resource use in medical and long-term care among 882 non-survivors and 8504 survivors were analyzed. Analyses for the non-survivors showed statistically significant associations between: (i) severe long-term care needs and greater service use in outpatient care, higher expenditures for outpatient care and higher expenditures for in-home/facility services; (ii) approaching death and greater use in both inpatient care and facility services; and (iii) being aged 65-74 years and greater service use in outpatient/in-hospital care and in-home/facility services, higher expenditures in outpatient/inpatient care, and lower expenditures for in-home/facility services. CONCLUSIONS The present study showed that severe long-term care needs and approaching death, rather than advancing age, were significantly and independently associated with greater use of resources in both medical and long-term care services. Geriatr Gerontol Int 2020; 20: 277-284.
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Affiliation(s)
- Hiroko Mori
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ryutaro Takahashi
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Tamadaira-no-mori Hospital, Tokyo, Japan
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Caring for the elderly: A person-centered segmentation approach for exploring the association between health care needs, mental health care use, and costs in Germany. PLoS One 2019; 14:e0226510. [PMID: 31856192 PMCID: PMC6922348 DOI: 10.1371/journal.pone.0226510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/27/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Person-centered care demands the evaluation of needs and preferences of the patients. In this study, we conducted a segmentation analysis of a large sample of older people based on their bio-psycho-social-needs and functioning. The aim of this study was to clarify differences in health care use and costs of the elderly in Germany. METHODS Data was derived from the 8-year follow-up of the ESTHER study-a German epidemiological study of the elderly population. Trained medical doctors visited n = 3124 participants aged 57 to 84 years in their home. Bio-psycho-social health care needs were assessed using the INTERMED for the Elderly (IM-E) interview. Further information was measured using questionnaires or assessment scales (Barthel index, Patients Health Questionnaire (PHQ) etc.). The segmentation analysis applied a factor mixture model (FMM) that combined both a confirmatory factor analysis and a latent class analysis. RESULTS In total, n = 3017 persons were included in the study. Results of the latent class analysis indicated that a five-cluster-model best fit the data. The largest cluster (48%) can be described as healthy, one cluster (13.9%) shows minor physical complaints and higher social support, while the third cluster (24.3%) includes persons with only a few physical and psychological difficulties ("minor physical and psychological complaints"). One of the profiles (10.5%) showed high and complex bio-psycho-social health care needs ("complex needs") while another profile (2.5%) can be labelled as "frail". Mean values of all psychosomatic variables-including the variable health care costs-gradually increased over the five clusters. Use of mental health care was comparatively low in the more burdened clusters. In the profiles "minor physical and psychological complaints" and "complex needs", only half of the persons suffering from a mental disorder were treated by a mental health professional; in the frail cluster, only a third of those with a depression or anxiety disorder received mental health care. CONCLUSIONS The segmentation of the older people of this study sample led to five different clusters that vary profoundly regarding their bio-psycho-social needs. Results indicate that elderly persons with complex bio-psycho-social needs do not receive appropriate mental health care.
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Stolz E, Mayerl H, Rásky É, Freidl W. Individual and country-level determinants of nursing home admission in the last year of life in Europe. PLoS One 2019; 14:e0213787. [PMID: 30870521 PMCID: PMC6417724 DOI: 10.1371/journal.pone.0213787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/28/2019] [Indexed: 12/04/2022] Open
Abstract
Background Previous research has focussed on individual-level determinants of nursing home admission (NHA), although substantial variation in the prevalence of NHA between European countries suggests a substantial impact of country of residence. The aim of this analysis was to assess individual-level determinants and the role of country of residence and specifically a country`s public institutional long-term care infrastructure on proxy-reported NHA in the last year of life. Methods We analysed data from 7,018 deceased respondents (65+) of the Survey of Health, Ageing and Retirement in Europe (2004–2015, 16 countries) using Bayesian hierarchical logistic regression analysis in order to model proxy-reported NHA. Results In total, 14% of the general older population utilised nursing home care in the last year of life but there was substantial variation across countries (range = 2–30%). On the individual-level, need factors such as functional and cognitive impairment were the strongest predictors of NHA. In total, 18% of the variance of NHA was located at the country-level; public expenditure on institutional care strongly affected the chance of NHA in the last year of life. Conclusion On the individual-level, the strong impact of need factors indicated equitable access to NHA, whereas differences in public spending for institutional care indicated inequitable access across European countries.
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Affiliation(s)
- Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Éva Rásky
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
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Hyttinen V, Jyrkkä J, Saastamoinen LK, Vartiainen AK, Valtonen H. The association of potentially inappropriate medication use on health outcomes and hospital costs in community-dwelling older persons: a longitudinal 12-year study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:233-243. [PMID: 29978444 DOI: 10.1007/s10198-018-0992-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/03/2018] [Indexed: 05/21/2023]
Abstract
AIMS To determine (1) whether potentially inappropriate medication (PIM) use defined by the Meds75 + database is associated with fracture-specific hospitalisations and all-cause mortality, and (2) the association between PIM use and all-cause hospitalisation costs in a 12-year follow-up of a nationwide sample of people aged ≥ 65 years in Finland. METHODS This is a longitudinal study of 20,666 community-dwelling older persons with no prior purchases of PIMs within a 2-year period preceding the index date (1 Jan 2002), who were followed until the end of 2013. Data were obtained from the Finnish Prescription Register, and it was accompanied by information on inpatient care, causes of deaths and socioeconomic status from other national registers. Propensity score matching (PSM) analysis was used to account for potential selection effect in PIM use. Cox proportional hazards regression was used to identify the time to the first fracture or death by comparing PIM-users (n = 10,333) with non-users (n = 10,333). The association between PIM use and hospital costs was analysed with a fixed effects linear model. RESULTS PIM use was weakly associated with an increased risk of fractures and death. The association was stronger in the first PIM-use periods. Hospitalised PIM-users had 15% higher hospital costs compared to non-users during the 12-year follow-up. CONCLUSION PIM initiation was associated with an increased risk of fracture-specific hospitalisation and mortality and PIM-users had higher hospital costs than non-users. Health care providers should carefully consider these issues when prescribing PIM for older persons.
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Affiliation(s)
- Virva Hyttinen
- Department of Health and Social Management, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Johanna Jyrkkä
- Assessment of Pharmacotherapies, Finnish Medicines Agency, Kuopio, Finland
| | | | - Anna-Kaisa Vartiainen
- Department of Health and Social Management, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Hannu Valtonen
- Department of Health and Social Management, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
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Canova C, Anello P, Barbiellini Amidei C, Parolin V, Zanier L, Simonato L. Use of healthcare services at the end of life in decedents compared to their surviving counterparts: A case-control study among adults born before 1946 in Friuli Venezia Giulia. PLoS One 2019; 14:e0212086. [PMID: 30730965 PMCID: PMC6366789 DOI: 10.1371/journal.pone.0212086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/28/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is a heterogeneous literature on healthcare utilization patterns at the end of life. The objective of this study is to examine the impact of closeness to death on the utilization of acute hospital-based healthcare services and some primary healthcare services and compare differences in gender, age groups and major causes of death disease specific mortality. METHODS A matched case-control study, nested in a cohort of 411,812 subjects, linked to administrative databases was conducted. All subjects were residents in the Friuli Venezia Giulia Region (Italy), born before 1946, alive in January 2000 and were followed up to December 2014. Overall, 158,571 decedents/cases were matched by gender and year of birth to one control, alive at least one year after their matched case's death (index-date). Hospital admissions, emergency department visits, drug prescriptions, specialist visits and laboratory tests that occurred 365 days before death/index-date, have been evaluated. Odds Ratios (ORs) for healthcare utilization were estimated through conditional regression models, further adjusted for Charlson Comorbidity Index and stratified by gender, age groups and major causes of death. RESULTS Decedents were significantly more likely of having at least one hospital admission (OR 7.0, 6.9-7.1), emergency department visit (OR 5.2, 5.1-5.3), drug prescription (OR 2.8, 2.7-2.9), specialist visit (OR 1.4, 1.4-1.4) and laboratory test (OR 2.7, 2.6-2.7) than their matched surviving counterparts. The ORs were generally lower in the oldest age group (95+) than in the youngest (55-74). Healthcare utilization did not vary by sex, but was higher in subjects who died of cancer. CONCLUSION Closeness to death appeared to be strongly associated with healthcare utilization in adult/elderly subjects. The risk seems to be greater among younger age groups than older ones, especially for acute based services. Reducing acute healthcare at the EOL represents an important issue to improve the quality of life in proximity to death.
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Affiliation(s)
- Cristina Canova
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
- * E-mail:
| | - Paola Anello
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Vito Parolin
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Loris Zanier
- Epidemiological Service, Health Directorate, Friuli Venezia Giulia Region, Udine, Italy
| | - Lorenzo Simonato
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Wilson DM, Birch S. A scoping review of research to assess the frequency, types, and reasons for end-of-life care setting transitions. Scand J Public Health 2018; 48:376-381. [PMID: 30102574 DOI: 10.1177/1403494818785042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Most people approaching the end of life develop care needs, which typically change over time. Moves between care settings may be required as health deteriorates. However, in some cases, care setting transitions may have little to do with end-of-life care needs and instead reflect the needs, demands, availability, or funding provisions of the country or funding body and organizations providing care. This paper is a scoping review of the international peer-reviewed research literature to gain evidence on the frequency and types of end-of-life care setting transitions, and the reasons for these moves. Methods: All relevant print and open access research articles published in 2000+ were sought using the Directory of Open Access Journals and EBSCO Discovery Host. Results: A total of 39 research articles were identified and reviewed. However, minimal useful evidence was revealed. Most articles focused solely on hospital admissions near death, and some focused on nursing home admissions, with other moves infrequently studied. Conclusions: This review demonstrates the need to quantify and justify end-of-life care setting transitions as it appears dying people are frequently moved, often as death nears. This research is needed to distinguish transitions related to end-of-life care needs and those arising from pressures on or from care providers and others unrelated to the person's care needs.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Canada
- Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - Stephen Birch
- Centre for Health Economics and Policy Analysis, McMaster University, Canada
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Forma L, Aaltonen M, Pulkki J, Raitanen J, Rissanen P, Jylhä M. Long-term care is increasingly concentrated in the last years of life: a change from 2000 to 2011. Eur J Public Health 2018; 27:665-669. [PMID: 28339763 DOI: 10.1093/eurpub/ckw260] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The use of long-term care (LTC) is common in very old age and in the last years of life. It is not known how the use pattern is changing as death is being postponed to increasingly old age. The aim is to analyze the association between the use of LTC and approaching death among old people and the change in this association from 2000 to 2011. Methods The data were derived from national registers. The study population consists of 315 458 case-control pairs. Cases (decedents) were those who died between 2000 and 2011 at the age of 70 years or over in Finland. The matched controls (survivors) lived at least 2 years longer. Use of LTC was studied for the last 730 days for decedents and for the same calendar days for survivors. Conditional logistic regression analyses were performed to test the association of LTC use with decedent status and year. Results The difference in LTC use between decedents and survivors was smallest among the oldest (OR 9.91 among youngest, 4.96 among oldest). The difference widened from 2000 to 2011 (OR of interaction of LTC use and year increased): use increased or held steady among decedents, but decreased among survivors. Conclusions The use of LTC became increasingly concentrated in the last years of life during the study period. The use of LTC is also common among the oldest survivors. As more people live to very old age, the demand for LTC will increase.
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Affiliation(s)
- Leena Forma
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland.,Institute for Advanced Social Research, University of Tampere, Finland
| | - Mari Aaltonen
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland
| | - Jutta Pulkki
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland
| | - Jani Raitanen
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland.,UKK-Institute for Health Promotion Research, Tampere, Finland
| | - Pekka Rissanen
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland
| | - Marja Jylhä
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland
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Low LL, Yan S, Kwan YH, Tan CS, Thumboo J. Assessing the validity of a data driven segmentation approach: A 4 year longitudinal study of healthcare utilization and mortality. PLoS One 2018; 13:e0195243. [PMID: 29621280 PMCID: PMC5886524 DOI: 10.1371/journal.pone.0195243] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/19/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Segmentation of heterogeneous patient populations into parsimonious and relatively homogenous groups with similar healthcare needs can facilitate healthcare resource planning and development of effective integrated healthcare interventions for each segment. We aimed to apply a data-driven, healthcare utilization-based clustering analysis to segment a regional health system patient population and validate its discriminative ability on 4-year longitudinal healthcare utilization and mortality data. METHODS We extracted data from the Singapore Health Services Electronic Health Intelligence System, an electronic medical record database that included healthcare utilization (inpatient admissions, specialist outpatient clinic visits, emergency department visits, and primary care clinic visits), mortality, diseases, and demographics for all adult Singapore residents who resided in and had a healthcare encounter with our regional health system in 2012. Hierarchical clustering analysis (Ward's linkage) and K-means cluster analysis using age and healthcare utilization data in 2012 were applied to segment the selected population. These segments were compared using their demographics (other than age) and morbidities in 2012, and longitudinal healthcare utilization and mortality from 2013-2016. RESULTS Among 146,999 subjects, five distinct patient segments "Young, healthy"; "Middle age, healthy"; "Stable, chronic disease"; "Complicated chronic disease" and "Frequent admitters" were identified. Healthcare utilization patterns in 2012, morbidity patterns and demographics differed significantly across all segments. The "Frequent admitters" segment had the smallest number of patients (1.79% of the population) but consumed 69% of inpatient admissions, 77% of specialist outpatient visits, 54% of emergency department visits, and 23% of primary care clinic visits in 2012. 11.5% and 31.2% of this segment has end stage renal failure and malignancy respectively. The validity of cluster-analysis derived segments is supported by discriminative ability for longitudinal healthcare utilization and mortality from 2013-2016. Incident rate ratios for healthcare utilization and Cox hazards ratio for mortality increased as patient segments increased in complexity. Patients in the "Frequent admitters" segment accounted for a disproportionate healthcare utilization and 8.16 times higher mortality rate. CONCLUSION Our data-driven clustering analysis on a general patient population in Singapore identified five patient segments with distinct longitudinal healthcare utilization patterns and mortality risk to provide an evidence-based segmentation of a regional health system's healthcare needs.
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Affiliation(s)
- Lian Leng Low
- Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Singapore
- Family Medicine, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Shi Yan
- Duke–NUS Medical School, Singapore, Singapore
| | - Yu Heng Kwan
- Duke–NUS Medical School, Singapore, Singapore
- Singapore Heart Foundation, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Julian Thumboo
- Office of Insights and Analytics, SingHealth, Singapore, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
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Li F, Zhu B, He Z, Zhang X, Wang C, Wang L, Song P, Ding L, Jin C. Exploring the determinants that influence end-of-life hospital costs of the elderly in Shanghai, China. Biosci Trends 2018; 12:87-93. [PMID: 29553107 DOI: 10.5582/bst.2017.01244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to use data from the Information Center of the Shanghai Municipal Commission of Health and Family Planning (SMCHFP) to determine the factors affecting end-of-life hospital costs of patients. A total number of 43,806 decedents who died in medical facilities in 2015 were examined. These individuals, accounted for 34.85% of all deaths in 2015 in Shanghai. Descriptive analysis and multiple linear regression analysis were performed using STATA 13.0. Results indicated that 88.94% of the decedents who died in medical facilities were over age 60. Males accounted for 55.57% of decedents, and the insured were mostly covered by Urban Employee Basic Medical Insurance (UEBMI) (81.93%). Cancer and circulatory disease were the main causes of death, causing 34.53% and 26.19% of deaths. Hospital costs were higher for males (male vs. female: 9,013 USD vs. 7,844 USD), individuals insured by UEBMI (8,784 USD), and individuals with cancer (10,156USD). Twenty-nine-point-zero-three percent of admissions occurred in the month before death and accounted for 37.82% of costs. Multiple linear regression analysis indicated that hospital costs were correlated with gender, cause of death (cancer, circulatory disease, or respiratory disease), time-to-death, insurance schemes, level of medical facilities, and length of stay (LOS) (p < 0.05 for all). After controlling for other factors, age was not a significant factor (p > 0.05). A proximity-to-death (PTD) phenomenon was evident in Shanghai. This study suggested that the PTD should be considered when predicting medical cost. Primary medical care should be enhanced and gaps in insurance coverage should be reduced to improve the efficiency and equity of medical funding. More attention should be paid to the population with a heavier disease burden.
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Affiliation(s)
- Fen Li
- Shanghai Health Development Research Center
| | - Bifan Zhu
- Shanghai Health Development Research Center
| | - Zhimin He
- Xiangya School of Public Health, Central South University
| | | | | | - Linan Wang
- Shanghai Health Development Research Center
| | | | - Lingling Ding
- Xiangya School of Public Health, Central South University
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Aaltonen M, Forma L, Pulkki J, Raitanen J, Rissanen P, Jylha M. Changes in older people's care profiles during the last 2 years of life, 1996-1998 and 2011-2013: a retrospective nationwide study in Finland. BMJ Open 2017; 7:e015130. [PMID: 29196476 PMCID: PMC5719301 DOI: 10.1136/bmjopen-2016-015130] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The time of death is increasingly postponed to a very high age. How this change affects the use of care services at the population level is unknown. This study analyses the care profiles of older people during their last 2 years of life, and investigates how these profiles differ for the study years 1996-1998 and 2011-2013. DESIGN Retrospective cross-sectional nationwide data drawn from the Care Register for Health Care, the Care Register for Social Care and the Causes of Death Register. The data included the use of hospital and long-term care services during the last 2 years of life for all those who died in 1998 and in 2013 at the age of ≥70 years in Finland. METHODS We constructed four care profiles using two criteria: (1) number of days in round-the-clock care (vs at home) in the last 2 years of life and (2) care transitions during the last 6 months of life (ie, end-of-life care transitions). RESULTS Between the study periods, the average age at death and the number of diagnoses increased. Most older people (1998: 64.3%, 2013: 59.3%) lived at home until their last months of life (profile 2) after which they moved into hospital or long-term care facilities. This profile became less common and the profiles with a high use of care services became more common (profiles 3 and 4 together in 1998: 25.0%, in 2013: 30.9%). People with dementia, women and the oldest old were over-represented in the latter profiles. In both study periods, fewer than one in ten stayed at home for the whole last 6 months (profile 1). CONCLUSIONS Postponement of death to a very old age may translate into more severe disability in the last months or years of life. Care systems must be prepared for longer periods of long-term care services needed at the end of life.
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Affiliation(s)
- Mari Aaltonen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, University of Tampere, Tampere, Finland
| | - Leena Forma
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, University of Tampere, Tampere, Finland
| | - Jutta Pulkki
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, University of Tampere, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, University of Tampere, Tampere, Finland
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Pekka Rissanen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, University of Tampere, Tampere, Finland
| | - Marja Jylha
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, University of Tampere, Tampere, Finland
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Forma L, Jylhä M, Pulkki J, Aaltonen M, Raitanen J, Rissanen P. Trends in the use and costs of round-the-clock long-term care in the last two years of life among old people between 2002 and 2013 in Finland. BMC Health Serv Res 2017; 17:668. [PMID: 28927415 PMCID: PMC5606077 DOI: 10.1186/s12913-017-2615-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The structure of long-term care (LTC) for old people has changed: care has been shifted from institutions to the community, and death is being postponed to increasingly old age. The aim of the study was to analyze how the use and costs of LTC in the last two years of life among old people changed between 2002 and 2013. METHODS Data were derived from national registers. The study population contains all those who died at the age of 70 years or older in 2002-2013 in Finland (N = 427,078). The costs were calculated using national unit cost information. Binary logistic regression and Cox proportional hazard models were used to study the association of year of death with use and costs of LTC. RESULTS The proportion of those who used LTC and the sum of days in LTC in the last two years of life increased between 2002 and 2013. The mean number of days in institutional LTC decreased, while that for sheltered housing increased. The costs of LTC per user decreased. CONCLUSIONS Use of LTC in the last two years of life increased, which was explained by the postponement of death to increasingly old age. Costs of LTC decreased as sheltered housing replaced institutional LTC. However, an accurate comparison of costs of different types of LTC is difficult, and the societal costs of sheltered housing are not well known.
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Affiliation(s)
- Leena Forma
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Marja Jylhä
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Jutta Pulkki
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Mari Aaltonen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
- Institute for Advanced Social Research, University of Tampere, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
- UKK-Institute for Health Promotion, Tampere, Finland
| | - Pekka Rissanen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
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Yoon NH, Kim H, Kwon S. Long-Term Care Utilization among End-of-Life Older Adults in Korea: Characteristics and Associated Factors. HEALTH POLICY AND MANAGEMENT 2016. [DOI: 10.4332/kjhpa.2016.26.4.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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16
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Goldsbury DE, O'Connell DL, Girgis A, Wilkinson A, Phillips JL, Davidson PM, Ingham JM. Acute hospital-based services used by adults during the last year of life in New South Wales, Australia: a population-based retrospective cohort study. BMC Health Serv Res 2015; 15:537. [PMID: 26637373 PMCID: PMC4669596 DOI: 10.1186/s12913-015-1202-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 11/30/2015] [Indexed: 12/27/2022] Open
Abstract
Background There is limited information about health care utilisation at the end of life for people in Australia. We describe acute hospital-based services utilisation during the last year of life for all adults (aged 18+ years) who died in a 12-month period in Australia’s most populous state, New South Wales (NSW). Methods Linked administrative health data were analysed for all adults who died in NSW in 2007 (the most recent year for which cause of death information was available for linkage for this study). The data comprised linked death records (2007), hospital admissions and emergency department (ED) presentations (2006–2007) and cancer registrations (1994–2007). Measures of hospital-based service utilisation during the last year of life included: number and length of hospital episodes, ED presentations, admission to an intensive care unit (ICU), palliative-related admissions and place of death. Factors associated with these measures were examined using multivariable logistic regression. Results Of the 45,749 adult decedents, 82 % were admitted to hospital during their last year of life: 24 % had >3 care episodes (median 2); 35 % stayed a total of >30 days in hospital (median 17); 42 % were admitted to 2 or more different hospitals. Twelve percent of decedents spent time in an ICU with median 3 days. In the metropolitan area, 80 % of decedents presented to an ED and 18 % had >3 presentations. Overall 55 % died in a hospital or inpatient hospice. Although we could not quantify the extent and type of palliative care, 24 % had mention of “palliative care” in their records. The very elderly and those dying from diseases of the circulatory system or living in the least disadvantaged areas generally had lower hospital service use. Conclusions These population-wide health data collections give a highly informative description of NSWhospital-based end-of-life service utilisation. Use of hospital-based services during the last year of life was common, with substantial variation across sociodemographic groups, especially defined by age, cause of death and socioeconomic classification of the decedents’ place of residence. Further research is now needed to identify the contributors to these findings. Gaps in data collection were identified - particularly for palliative care and patient-reported outcomes. Addressing these gaps should facilitate improved monitoring and assessment of service use and care.
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Affiliation(s)
- David E Goldsbury
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia. .,Sydney School of Public Health, University of Sydney, Sydney, Australia. .,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
| | - Anne Wilkinson
- School of Nursing and Midwifery, Faculty of Health, Engineering and Science, Edith Cowan University, Perth, Western Australia, Australia.
| | - Jane L Phillips
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | | | - Jane M Ingham
- Sacred Heart Health Service, St Vincent's Health Network, Sydney, Australia. .,UNSW Australia, Faculty of Medicine, St Vincent's Hospital Clinical School, Sydney, Australia.
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17
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Rolden HJA, Rohling JHT, van Bodegom D, Westendorp RGJ. Seasonal Variation in Mortality, Medical Care Expenditure and Institutionalization in Older People: Evidence from a Dutch Cohort of Older Health Insurance Clients. PLoS One 2015; 10:e0143154. [PMID: 26571273 PMCID: PMC4646614 DOI: 10.1371/journal.pone.0143154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/30/2015] [Indexed: 11/19/2022] Open
Abstract
Background The mortality rates of older people changes with the seasons. However, it has not been properly investigated whether the seasons affect medical care expenditure (MCE) and institutionalization. Seasonal variation in MCE is plausible, as MCE rises exponentially before death. It is therefore important to investigate the impact of the seasons on MCE both mediated and unmediated by mortality. Methods Data on mortality, MCE and institutionalization from people aged 65 and older in a region in the Netherlands from July 2007 through 2010 were retrieved from a regional health care insurer and were linked with data from the Netherlands Institute for Social Research, and Statistics Netherlands (n = 61,495). The Seasonal and Trend decomposition using Loess (STL) method was used to divide mortality rates, MCE, and institutionalization rates into a long-term trend, seasonal variation, and remaining variation. For every season we calculated the 95% confidence interval compared to the long-term trend using Welch’s t-test. Results The mortality rates of older people differ significantly between the seasons, and are 21% higher in the winter compared to the summer. MCE rises with 13% from the summer to the winter; this seasonal difference is higher for the non-deceased than for the deceased group (14% vs. 6%). Seasonal variation in mortality is more pronounced in men and people in residential care. Seasonal variation in MCE is more pronounced in women. Institutionalization rates are significantly higher in the winter, but the other seasons show no significant impact. Conclusions Seasonal changes affect mortality and the level of MCE of older people; institutionalization rates peak in the winter. Seasonal variation in MCE exists independently from patterns in mortality. Seasonal variation in mortality is similar for both institutionalized and community-dwelling elderly. Policy-makers, epidemiologists and health economists are urged to acknowledge and include the impact of the seasons in future policy and research.
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Affiliation(s)
- Herbert Jan Albert Rolden
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | | | - David van Bodegom
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - Rudi Gerardus Johannes Westendorp
- Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
- University of Copenhagen, Copenhagen, Denmark
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18
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Complex health problems among the oldest old in Sweden: increased prevalence rates between 1992 and 2002 and stable rates thereafter. Eur J Ageing 2015; 12:285-297. [PMID: 28804361 DOI: 10.1007/s10433-015-0351-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Studies of health trends in older populations usually focus on single health indicators. We include multiple medical and functional indicators, which together indicate the broader impact of health problems experienced by individuals and the need for integrated care from several providers of medical and long-term care. The study identified severe problems in three health domains (diseases/symptoms, mobility, and cognition/communication) in three nationally representative samples of the Swedish population aged 77+ in 1992, 2002, and 2011 (n ≈ 1900; response rate >85 %). Institutionalized people and proxy interviews were included. People with severe problems in two or three domains were considered to have complex health problems. Results showed a significant increase of older adults with complex health problems from 19 % in 1992 to 26 % in 2002 and no change thereafter. Changes over time remained when controlling for age and sex. When stratified by education, complex health problems increased significantly for people with lower education between 1992 and 2002 and did not change significantly between 2002 and 2011. For higher-educated people, there was no significant change over time. Among the people with severe problems in the symptoms/disease domain, about half had no severe problems in the other domains. People with severe mobility problems, on the other hand, were more likely to also have severe problems in other domains. Even stable rates may imply an increasing number of very old people with complex health problems, resulting in a need for improved coordination between providers of medical care and social services.
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Variation in the costs of dying and the role of different health services, socio-demographic characteristics, and preceding health care expenses. Soc Sci Med 2014; 120:110-7. [PMID: 25238558 DOI: 10.1016/j.socscimed.2014.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 08/20/2014] [Accepted: 09/09/2014] [Indexed: 01/03/2023]
Abstract
The health care costs of population ageing are for an important part attributable to higher mortality rates in combination with high costs of dying. This paper answers three questions that remain unanswered regarding the costs of dying: (1) contributions of different health services to the costs of dying; (2) variation in the costs of dying; and (3) the influence of preceding health care expenses on the costs of dying. We retrieved data on 61,495 Dutch subjects aged 65 and older from July 2007 through 2010 from a regional health care insurer. We included all deceased subjects of whom health care expenses were known for 26 months prior to death (n=2833). Costs of dying were defined as health care expenses made in the last six months before death. Lorenz curves, generalized linear models and a two-part model were used for our analyses. (1) The average costs of dying are €25,919. Medical care contributes to 57% of this total, and long-term care 43%. The costs of dying mainly relate to hospital care (40%). (2) In the costs of dying, 75% is attributable to the costliest half of the population. For medical care, this distribution figure is 86%, and for long-term care 92%. Age and preceding expenses are significant determinants of this variation in the costs of dying. (3) Overall, higher preceding health care expenses are associated with higher costs of dying, indicating that the costs of dying are higher for those with a longer patient history. To summarize, there is not a large variation in the costs of dying, but there are large differences in the nature of these costs. Before death, the oldest old utilize more long-term care while their younger counterparts visit hospitals more often. To curb the health care costs of population ageing, a further understanding of the costs of dying is crucial.
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Care utilisation in the last years of life in Sweden: the effects of gender and marital status differ by type of care. Eur J Ageing 2014; 11:349-359. [PMID: 28804339 DOI: 10.1007/s10433-014-0320-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
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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21
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Eissens van der Laan MR, van Offenbeek MAG, Broekhuis H, Slaets JPJ. A person-centred segmentation study in elderly care: towards efficient demand-driven care. Soc Sci Med 2014; 113:68-76. [PMID: 24852657 DOI: 10.1016/j.socscimed.2014.05.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 03/31/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care. This paper describes a person-centred segmentation study of elderly, a large and increasing target group confronted with heterogeneous and often interrelated difficulties in their functioning. In twenty-five diverse healthcare and welfare organizations as well as elderly associations in the Netherlands, data were collected on the difficulties in biopsychosocial functioning experienced by 2019 older adults. Data were collected between March 2010 and January 2011 and sampling took place based on their (temporarily) living conditions. Factor Mixture Model was conducted to categorize the respondents into segments with relatively similar experienced difficulties concerning their functioning. First, the analyses show that older adults can be empirically categorized into five meaningful segments: feeling vital; difficulties with psychosocial coping; physical and mobility complaints; difficulties experienced in multiple domains; and feeling extremely frail. The categorization seems robust as it was replicated in two population-based samples in the Netherlands. The segmentation's usefulness is discussed and illustrated through an evaluation of the alignment between a segment's unfulfilled biopsychosocial needs and current healthcare utilization. The set of person-centred segmentation variables provides healthcare providers the option to perform a more comprehensive first triage step than only a disease-based one. The outcomes of this first step could guide a focused and, therefore, more efficient second triage step. On a local or regional level, this person-centred segmentation provides input information to policymakers and care providers for the demand-driven allocation of resources.
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Affiliation(s)
- M R Eissens van der Laan
- Department of Operations Management, Faculty of Economics and Business, University of Groningen, The Netherlands.
| | - M A G van Offenbeek
- Department of Innovation Management and Strategy, Faculty of Economics and Business, University of Groningen, The Netherlands
| | - H Broekhuis
- Department of Operations Management, Faculty of Economics and Business, University of Groningen, The Netherlands
| | - J P J Slaets
- Department of Internal Medicine-General (Geriatrics and Gerontology), Faculty of Medical Science, University of Groningen, The Netherlands
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22
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Kozakai R, von Bonsdorff M, Sipilä S, Rantanen T. Mobility limitation as a predictor of inpatient care in the last year of life among community-living older people. Aging Clin Exp Res 2013; 25:81-7. [PMID: 23740637 DOI: 10.1007/s40520-013-0013-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 01/23/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Need for inpatient care increases toward the end of life. We studied whether mobility limitation assessed approximately 5.8 years prior to death predicts the number of days in care during the last year of life. METHODS A population-based, prospective study with interviews conducted, on average, 5.8 years prior to death. Data on vital status and health care use were register-based. Participants consisted of 846 persons who had died between 1989 and 2004 at the age of 66-98 years. Participants were categorized as having mobility limitation if, at baseline, they reported difficulties in walking 2 km or climbing one flight of stairs. RESULTS Mean ± standard deviation of age at death for men was 81.6 ± 6.2 years and the median number of days in inpatient care in the last year of life was 38.5 days. For women, the corresponding figures were 84.1 ± 6.1 years and 66.0 days. Only 11% of men and 7% of women had no inpatient care in the last year of life. The adjusted incidence rate ratio for all-cause inpatient care in the last year of life was 1.53 (95% CI 1.09-2.16) among men with mobility limitation compared to those with intact mobility. Among women, mobility limitation did not increase the risk for all-cause inpatient care. CONCLUSION Mobility limitation (vs. intact mobility) at 5.8 years prior to death markedly increases the need of inpatient care in the last year of life among men.
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Affiliation(s)
- Rumi Kozakai
- Department of Sport Education, School of Lifelong Sport, Hokusho University, 23 Bunkyodai, Ebetsu, Hokkaido, 069-8511, Japan.
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Hanratty B, Holmes L, Lowson E, Grande G, Addington-Hall J, Payne S, Seymour J. Older adults' experiences of transitions between care settings at the end of life in England: a qualitative interview study. J Pain Symptom Manage 2012; 44:74-83. [PMID: 22658251 DOI: 10.1016/j.jpainsymman.2011.08.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 08/20/2011] [Accepted: 09/01/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Providing care that is shaped around the needs of patients, carers, and families is a challenge in the last months of life, as moves between home and institutions may be frequent. Despite this, there have been few studies of end-of-life transitions in the U.K. OBJECTIVES To explore older adults' experiences as they move between places of care at the end of life. METHODS In-depth qualitative interviews and thematic analysis of the data were performed. Thirty adults aged between 69 and 93 years took part. All were judged by their physicians to be in the last year of life, diagnosed with heart failure (13), lung cancer (14), and stroke (3). Sixteen participants were from the lowest socioeconomic groups. RESULTS Four themes were identified from the data relating to 1) the prioritization of institutional processes, 2) support across settings, 3) being heard, and 4) dignity. As they moved between different settings, much of the care received by older adults was characterized by inflexibility and a failure of professional carers to listen. Liaison between and within services was not always effective, and community support after a hospital admission was perceived to be, on occasions, absent, inappropriate, or excessive. CONCLUSION Qualitative study of transitions provides valuable insights into end-of-life care, even in countries where there are few financial barriers to services. This study has highlighted a need for continued attention to basic aspects of care and communication between professionals and with patients.
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Affiliation(s)
- Barbara Hanratty
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom.
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Forma L, Jylhä M, Aaltonen M, Raitanen J, Rissanen P. Municipal variation in health and social service use in the last 2 years of life among old people. Scand J Public Health 2011; 39:361-70. [DOI: 10.1177/1403494810396399] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: To describe and analyse municipal differences in health and social service use among old people in the last 2 years of life. Methods: The data were derived from national registers. All those who died in 2002 or 2003 at the age of ≥70 years were included except those who lived in very small municipalities. The services included were different types of hospitals, long-term care, and home care. The variation in service use was described by coefficients of variation (CV). To analyse local differences, three-level (individual, municipal, and regional) binary logistic and Poisson regression analyses were performed. Results: A total of 67,027 decedents from 315 municipalities in 20 hospital districts were included. There was considerable variation in service use between residents of different municipalities, especially in the types of hospital used. Of the individual-level variables age and use of other services were associated (p < 0.05) with use of all services. Of the municipal-level variables, indicators describing the service pattern in the municipality were associated with use of all services and average age of decedents with most of the services. The presence of a university hospital in the hospital district increased the probability of using university and general hospitals, but among the users increased days in university hospital and decreased days in general hospital. Conclusions: Considerable differences between municipalities exist, but these cannot be exhaustively explained. Behind the differences are probably factors which are difficult to describe and quantify, such as historical developments and political realities.
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Affiliation(s)
- Leena Forma
- School of Health Sciences, University of Tampere, Finland,
| | - Marja Jylhä
- School of Health Sciences, University of Tampere, Finland
| | - Mari Aaltonen
- School of Health Sciences, University of Tampere, Finland
| | - Jani Raitanen
- School of Health Sciences, University of Tampere, Finland
| | - Pekka Rissanen
- School of Health Sciences, University of Tampere, Finland
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Aaltonen M, Forma L, Rissanen P, Raitanen J, Jylhä M. Transitions in health and social service system at the end of life. Eur J Ageing 2010; 7:91-100. [PMID: 28798621 DOI: 10.1007/s10433-010-0155-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 04/25/2010] [Indexed: 10/19/2022] Open
Abstract
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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Affiliation(s)
- Mari Aaltonen
- Tampere School of Public Health, University of Tampere, FI-33014 Tampere, Finland
| | - Leena Forma
- Tampere School of Public Health, University of Tampere, FI-33014 Tampere, Finland
| | - Pekka Rissanen
- Tampere School of Public Health, University of Tampere, FI-33014 Tampere, Finland
| | - Jani Raitanen
- Tampere School of Public Health, University of Tampere, FI-33014 Tampere, Finland
| | - Marja Jylhä
- Tampere School of Public Health, University of Tampere, FI-33014 Tampere, Finland
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Pot AM, Portrait F, Visser G, Puts M, van Groenou MIB, Deeg DJH. Utilization of acute and long-term care in the last year of life: comparison with survivors in a population-based study. BMC Health Serv Res 2009; 9:139. [PMID: 19656358 PMCID: PMC2739193 DOI: 10.1186/1472-6963-9-139] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 08/05/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well-known that the use of care services is most intensive in the last phase of life. However, so far only a few determinants of end-of-life care utilization are known. The aims of this study were to describe the utilization of acute and long-term care among older adults in their last year of life as compared to those not in their last year of life, and to examine which of a broad range of determinants can account for observed differences in care utilization. METHODS Data were used from the Longitudinal Aging Study Amsterdam (LASA). In a random, age and sex stratified population-based cohort of 3107 persons aged 55 - 85 years at baseline and representative of the Netherlands, follow-up cycles took place at 3, 6 and 9 years. Those who died within one year directly after a cycle were defined as the "end-of-life group" (n = 262), and those who survived at least three years after a cycle were defined as the "survivors". Utilization of acute and long-term care services, including professional and informal care, were recorded at each cycle, as well as a broad range of health-related and psychosocial variables. RESULTS The end-of-life group used more care than the survivors. In the younger-old this difference was most pronounced for acute care, and in the older-old, for long-term care. Use of both acute and long-term home care in the last year of life was fully accounted for by health problems. Use of institutional care at the end of life was partly accounted for by health problems, but was not fully explained by the determinants included. CONCLUSION This study shows that severity of health problems are decisive in the explanation of the increase in use of care services towards the end-of-life. This information is essential for an appropriate allocation of professional health care to the benefit of older persons themselves and their informal caregivers.
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Affiliation(s)
- Anne Margriet Pot
- EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
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