Associations between home deaths and end-of-life nursing care trajectories for community-dwelling people: a population-based registry study.
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Continuity of Patient Care
/ statistics & numerical data
Female
Home Care Services
/ statistics & numerical data
Home Nursing
/ methods
Hospice Care
/ methods
Hospitals
/ statistics & numerical data
Humans
Independent Living
Infant
Infant, Newborn
Logistic Models
Longitudinal Studies
Male
Middle Aged
Norway
Nursing Care
/ methods
Palliative Care
/ methods
Registries
Research Design
Retrospective Studies
Skilled Nursing Facilities
/ statistics & numerical data
Terminal Care
/ methods
Young Adult
Epidemiology
Home care
Primary care
Terminal care
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
15 Oct 2019
15 Oct 2019
Historique:
received:
01
03
2019
accepted:
16
09
2019
entrez:
17
10
2019
pubmed:
17
10
2019
medline:
14
1
2020
Statut:
epublish
Résumé
Few studies have estimated planned home deaths compared to actual place of death in a general population or the longitudinal course of home nursing services and associations with place of death. We aimed to investigate trajectories of nursing services, potentially planned home deaths regardless of place of death; and associations of place of death with potentially planned home deaths and nursing service trajectories, by analyzing data from the last 90 days of life. A retrospective longitudinal study with data from the Norwegian Cause of Death Registry and National registry for statistics on municipal healthcare services included all community-dwelling people who died in Norway 2012-2013 (n = 53,396). We used a group-based trajectory model to identify joint trajectories of home nursing (hours per week) and probability of a skilled nursing facility (SNF) stay, each of the 13 weeks leading up to death. An algorithm estimated potentially planned home deaths. We used a multinomial logistic regression model to estimate associations of place of death with potentially planned home deaths, trajectories of home nursing and short-term SNF. We identified four home nursing service trajectories: no (46.5%), accelerating (7.6%), decreasing (22.1%), and high (23.5%) home nursing; and four trajectories of the probability of a SNF stay: low (69.0%), intermediate (6.7%), escalating (15.9%), and increasing (8.4%) SNF. An estimated 24.0% of all deaths were potentially planned home deaths, of which a third occurred at home. Only high home nursing was associated with increased likelihood of a home death (adjusted relative risk ratio (aRRR) 1.29; CI 1.21-1.38). Following any trajectory with elevated probability of a SNF stay reduced the likelihood of a home death. We estimated few potentially planned home deaths. Trajectories of home nursing hours and probability of SNF stays indicated possible effective palliative home nursing for some, but also missed opportunities of staying at home longer at the end-of-life. Continuity of care seems to be an important factor in palliative home care and home death.
Sections du résumé
BACKGROUND
BACKGROUND
Few studies have estimated planned home deaths compared to actual place of death in a general population or the longitudinal course of home nursing services and associations with place of death. We aimed to investigate trajectories of nursing services, potentially planned home deaths regardless of place of death; and associations of place of death with potentially planned home deaths and nursing service trajectories, by analyzing data from the last 90 days of life.
METHODS
METHODS
A retrospective longitudinal study with data from the Norwegian Cause of Death Registry and National registry for statistics on municipal healthcare services included all community-dwelling people who died in Norway 2012-2013 (n = 53,396). We used a group-based trajectory model to identify joint trajectories of home nursing (hours per week) and probability of a skilled nursing facility (SNF) stay, each of the 13 weeks leading up to death. An algorithm estimated potentially planned home deaths. We used a multinomial logistic regression model to estimate associations of place of death with potentially planned home deaths, trajectories of home nursing and short-term SNF.
RESULTS
RESULTS
We identified four home nursing service trajectories: no (46.5%), accelerating (7.6%), decreasing (22.1%), and high (23.5%) home nursing; and four trajectories of the probability of a SNF stay: low (69.0%), intermediate (6.7%), escalating (15.9%), and increasing (8.4%) SNF. An estimated 24.0% of all deaths were potentially planned home deaths, of which a third occurred at home. Only high home nursing was associated with increased likelihood of a home death (adjusted relative risk ratio (aRRR) 1.29; CI 1.21-1.38). Following any trajectory with elevated probability of a SNF stay reduced the likelihood of a home death.
CONCLUSIONS
CONCLUSIONS
We estimated few potentially planned home deaths. Trajectories of home nursing hours and probability of SNF stays indicated possible effective palliative home nursing for some, but also missed opportunities of staying at home longer at the end-of-life. Continuity of care seems to be an important factor in palliative home care and home death.
Identifiants
pubmed: 31615500
doi: 10.1186/s12913-019-4536-9
pii: 10.1186/s12913-019-4536-9
pmc: PMC6794846
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
698Subventions
Organisme : NIA NIH HHS
ID : P30 AG021342
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG047891
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG047891-01A1; P30AG021342-14S1
Pays : United States
Organisme : the Yale Claude D. Pepper Older Americans Independence Center
ID : P30AG021342
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