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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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Effects of municipality factors on care transitions.

https://arctichealth.org/en/permalink/ahliterature114573
Source
Scand J Public Health. 2013 Aug;41(6):604-15
Publication Type
Article
Date
Aug-2013
Author
Mari Aaltonen
Leena Forma
Pekka Rissanen
Jani Raitanen
Marja Jylhä
Author Affiliation
Gerontology Research Center and School of Health Sciences, University of Tampere, Tampere, Finland. mari.s.aaltonen@uta.fi
Source
Scand J Public Health. 2013 Aug;41(6):604-15
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cities
Continuity of Patient Care - statistics & numerical data
Female
Finland
Health Facilities - utilization
Home Care Services - utilization
Humans
Male
Registries
Residence Characteristics - statistics & numerical data
Socioeconomic Factors
Time Factors
Abstract
To analyse whether transitions between care settings differ between municipalities in the last 2 years of life among older people in Finland.
Data were derived from Finnish national registers, and include all those who died in 2002 and 2003 at the age of 70 or older except those living in very small municipalities (n=67,027). Data include admissions and discharges from health and social care facilities (university hospitals, general hospitals, health centres, residential care facilities) and time spent outside care facilities for 730 days prior to death. Three-level negative binomial regression analyses were performed to study the effect of municipal factors on (1) the total number of all care transitions, (2) the number of transitions between home and different care facilities, and (3) transitions between different care facilities.
The municipality of residence had only a minor effect on the total number of care transitions, but greater variation between municipalities was found when different types of care transition were examined separately. Largest differences were found in care transitions involving specialised care. Age structure, urbanity, and economic situation of the municipality had an impact on several different care transitions.
The total number of care transitions in 2 final years of life was approximately similar irrespective of the municipality of residence, but the findings imply differences in transitioning specialised care. Potentially, this may suggest inequality between the municipalities, but more detailed studies are needed to confirm the factors underlying these differences.
PubMed ID
23604036 View in PubMed
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The impact of dementia on care transitions during the last two years of life.

https://arctichealth.org/en/permalink/ahliterature129596
Source
Age Ageing. 2012 Jan;41(1):52-7
Publication Type
Article
Date
Jan-2012
Author
Mari Aaltonen
Pekka Rissanen
Leena Forma
Jani Raitanen
Marja Jylhä
Author Affiliation
School of Health Sciences, University of Tampere, Tampere FIN-33014, Finland. mari.s.aaltonen@uta.fi
Source
Age Ageing. 2012 Jan;41(1):52-7
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Continuity of Patient Care
Dementia - epidemiology - therapy
Female
Finland - epidemiology
Humans
Male
Residential Facilities - statistics & numerical data
Abstract
Dementia is one of the main challenges to our health and social care. This study compares the number and timing of transitions between care settings in the last 2 years of life among older people with and without dementia.
Data were derived from Finnish national registers, and include all those who died in 2002 and 2003 at the age of 70 or older (n = 70,366). Negative binomial regression analyses were used to analyse the impact of dementia on number of transitions among people with and without dementia and to adjust the number for age, gender and other diagnoses.
In the group that lived at home 2 years before death people with a dementia diagnosis had 32% more care transitions than people without dementia, while the group that was in residential care facility 2 years before death people with dementia had 12% fewer moves than those without dementia The average number of transition was highest in last 3 months of life. People with dementia had their last move more often between care facilities and hospitals offering basic health care than people without dementia.
Dementia has a significant impact on the number and type of transitions. As the number of people with dementia increases, the quality and equity of care of these patients in their last years constitute a special challenge.
PubMed ID
22089082 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
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