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Burdensome transitions at the end of life among long-term care residents with dementia.

https://arctichealth.org/en/permalink/ahliterature262778
Source
J Am Med Dir Assoc. 2014 Sep;15(9):643-8
Publication Type
Article
Date
Sep-2014
Author
Mari Aaltonen
Jani Raitanen
Leena Forma
Jutta Pulkki
Pekka Rissanen
Marja Jylhä
Source
J Am Med Dir Assoc. 2014 Sep;15(9):643-8
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Continuity of Patient Care
Dementia - mortality
Female
Finland - epidemiology
Hospitalization - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Long-Term Care
Male
Patient Transfer - statistics & numerical data
Registries
Retrospective Studies
Terminal Care - statistics & numerical data
Abstract
The purpose of the study was to examine the frequency of burdensome care transitions at the end of life, the difference between different types of residential care facilities, and the changes occurring between 2002 and 2008.
A nationwide, register-based retrospective study.
Residential care facilities offering long-term care, including traditional nursing homes, sheltered housing with 24-hour assistance, and long-term care facilities specialized in care for people with dementia.
All people in Finland who died at the age of 70 or older, had dementia, and were in residential care during their last months of life.
Three types of potentially burdensome care transition: (1) any transition to another care facility in the last 3 days of life; (2) a lack of continuity with respect to a residential care facility before and after hospitalization in the last 90 days of life; (3) multiple hospitalizations (more than 2) in the last 90 days of life. The 3 types were studied separately and as a whole.
One-tenth (9.5%) had burdensome care transitions. Multiple hospitalizations in the last 90 days were the most frequent, followed by any transitions in the last 3 days of life. The frequency varied between residents who lived in different baseline care facilities being higher in sheltered housing and long-term specialist care for people with dementia than in traditional nursing homes. During the study years, the number of transitions fluctuated but showed a slight decrease since 2005.
The ongoing change in long-term care from institutional care to housing services causes major challenges to the continuity of end-of-life care. To guarantee good quality during the last days of life for people with dementia, the underlying reasons behind transitions at the end of life should be investigated more thoroughly.
PubMed ID
24913211 View in PubMed
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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.

https://arctichealth.org/en/permalink/ahliterature293459
Source
BMJ Open. 2017 Dec 01; 7(11):e015130
Publication Type
Journal Article
Date
Dec-01-2017
Author
Mari Aaltonen
Leena Forma
Jutta Pulkki
Jani Raitanen
Pekka Rissanen
Marja Jylha
Author Affiliation
Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, University of Tampere, Tampere, Finland.
Source
BMJ Open. 2017 Dec 01; 7(11):e015130
Date
Dec-01-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Cross-Sectional Studies
Dementia - epidemiology
Female
Finland - epidemiology
Home Care Services - statistics & numerical data
Homes for the Aged
Hospitalization - statistics & numerical data
Humans
Long-Term Care - statistics & numerical data
Male
Nursing Homes - statistics & numerical data
Patient Transfer - statistics & numerical data
Registries
Retrospective Studies
Terminal Care - statistics & numerical data
Time Factors
Abstract
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.
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.
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).
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).
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.
Notes
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PubMed ID
29196476 View in PubMed
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Long-term care is increasingly concentrated in the last years of life: a change from 2000 to 2011.

https://arctichealth.org/en/permalink/ahliterature292269
Source
Eur J Public Health. 2017 08 01; 27(4):665-669
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
08-01-2017
Author
Leena Forma
Mari Aaltonen
Jutta Pulkki
Jani Raitanen
Pekka Rissanen
Marja Jylhä
Author Affiliation
School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland.
Source
Eur J Public Health. 2017 08 01; 27(4):665-669
Date
08-01-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Age Factors
Aged
Aged, 80 and over
Case-Control Studies
Female
Finland - epidemiology
Humans
Logistic Models
Long-Term Care - statistics & numerical data
Male
Registries
Terminal Care - statistics & numerical data
Abstract
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.
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.
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.
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.
PubMed ID
28339763 View in PubMed
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Long-term care use among old people in their last 2 years of life: variations across Finland.

https://arctichealth.org/en/permalink/ahliterature291240
Source
Health Soc Care Community. 2016 07; 24(4):439-49
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
07-2016
Author
Jutta Pulkki
Marja Jylhä
Leena Forma
Mari Aaltonen
Jani Raitanen
Pekka Rissanen
Author Affiliation
Gerontology Research Center, School of Health Sciences, University of Tampere, Tampere, Finland.
Source
Health Soc Care Community. 2016 07; 24(4):439-49
Date
07-2016
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Finland
Health facilities
Home Care Services
Hospitalization
Humans
Long-Term Care
Abstract
Variations across Finland in the use of six different long-term care (LTC) services among old people in their last 2 years of life, and the effects of characteristics of municipalities on the variations were studied. We studied variations in the use of residential home, sheltered housing, regular home care and inpatient care in health centre wards by using national registers. We studied how the use of LTC was associated with characteristics of the individuals and in particular characteristics of the municipalities in which they lived. Analyses were conducted with multilevel binary logistic regression. Data included all individuals (34,753) who died in the year 2008 at the age of 70 or over. Of those, 58.3% used some kind of LTC during their last 2 years of life. We found considerable variations between municipalities in the use of different kinds of LTC. A portion of the variation was explained by municipality characteristics. The size and location of the municipality had the strongest association with the use of different kinds of LTC. The economic status of the municipality and morbidity at the population level were poorly associated with LTC use, whereas old-age dependency showed no association. When individual-level characteristics were added to the models, these associations did not alter. Results indicated that the delivery system characteristics had an important effect on the use of LTC services. The considerable variation in LTC services also poses questions with respect to equity in access and to quality of LTC across the country.
PubMed ID
25809383 View in PubMed
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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.

https://arctichealth.org/en/permalink/ahliterature291563
Source
BMC Health Serv Res. 2017 Sep 19; 17(1):668
Publication Type
Journal Article
Date
Sep-19-2017
Author
Leena Forma
Marja Jylhä
Jutta Pulkki
Mari Aaltonen
Jani Raitanen
Pekka Rissanen
Author Affiliation
Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014, Tampere, Finland. leena.forma@uta.fi.
Source
BMC Health Serv Res. 2017 Sep 19; 17(1):668
Date
Sep-19-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Cause of Death
Continuity of Patient Care
Female
Finland - epidemiology
Government Programs
Health Facilities - economics - trends - utilization
Health Services Research
Health Services for the Aged - economics - trends - utilization
Humans
Life Expectancy - trends
Long-Term Care - economics - trends - utilization
Male
Registries
Abstract
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.
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.
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.
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.
Notes
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PubMed ID
28927415 View in PubMed
Less detail