Hospitalisation in the last month of life and in-hospital death of nursing home residents: a cross-sectional analysis of six European countries.
adult palliative care
geriatric medicine
public health
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
12 08 2021
12 08 2021
Historique:
entrez:
13
8
2021
pubmed:
14
8
2021
medline:
17
8
2021
Statut:
epublish
Résumé
To examine the rate and characteristics of hospitalisation in the last month of life and place of death among nursing home residents and to identify related care processes, facility factors and residents' characteristics. A cross-sectional study (2015) of deceased residents in 322 nursing homes in six European countries. The nursing home manager (N=1634), physician (N=1132) and primary nurse (N=1384) completed questionnaires. Hospitalisation and place of death were analysed using generalised linear and logistic mixed models. Multivariate analyses were conducted to determine associated factors. Twelve to 26% of residents were hospitalised in the last month of life, up to 19% died in-hospital (p<0.001). Belgian residents were more likely to be hospitalised than those in Italy, the Netherlands and Poland. For those dying in-hospital, the main reason for admission was acute change in health status. Residents with a better functional status were more likely to be hospitalised or to die in-hospital. The likelihood of hospitalisation and in-hospital death increased if no conversation on preferred care with a relative was held. Not having an advance directive regarding hospitalisations increased the likelihood of hospitalisation. Although participating countries vary in hospitalisation and in-hospital death rates, between 12% (Italy) and 26% (Belgium) of nursing home residents were hospitalised in the last month of life. Close monitoring of acute changes in health status and adequate equipment seem critical to avoiding unnecessary hospitalisations. Strategies to increase discussion of preferences need to be developed. Our findings can be used by policy-makers at governmental and nursing home level.
Identifiants
pubmed: 34385245
pii: bmjopen-2020-047086
doi: 10.1136/bmjopen-2020-047086
pmc: PMC8362714
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e047086Investigateurs
Yuliana Gatsolaeva
(Y)
Rose Miranda
(R)
Lara Pivodic
(L)
Marc Tanghe
(M)
Hein van Hout
(HV)
Roeline Hrw Pasman
(RH)
Mariska Oosterveld-Vlug
(M)
Ruth Piers
(R)
Anne B Wichmann
(AB)
Yvonne Engels
(Y)
Myrra Vernooij-Dassen
(M)
Jo Hockley
(J)
Sheila Payne
(S)
Suvi Leppäaho
(S)
Ilona Barańska
(I)
Sophie Pautex
(S)
Catherine Bassal
(C)
Federica Mammarella
(F)
Martina Mercuri
(M)
Paola Rossi
(P)
Ivan Segat
(I)
Agata Stodolska
(A)
Eddy Adang
(E)
Paula Andreasen
(P)
Outi Kuitunen-Kaija
(O)
Danni Collingridge Moore
(DC)
Agnieszka Pac
(A)
Violetta Kijowska
(V)
Maud Ten Koppel
(MT)
Jenny T van der Steen
(JTV)
Emilie Morgan de Paula
(EM)
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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