Skip header and navigation

Refine By

2 records – page 1 of 1.

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
Less detail

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
Cites: Palliat Med. 2010 Mar;24(2):166-74 PMID 20007818
Cites: Am J Public Health. 1991 Apr;81(4):443-7 PMID 2003621
Cites: N Engl J Med. 2011 Sep 29;365(13):1212-21 PMID 21991894
Cites: J Am Geriatr Soc. 2013 Sep;61(9):1443-8 PMID 23926902
Cites: Alzheimer Dis Assoc Disord. 2004 Apr-Jun;18(2):83-9 PMID 15249852
Cites: J Am Geriatr Soc. 2002 Jun;50(6):1108-12 PMID 12110073
Cites: Lancet. 2013 Apr 13;381(9874):1312-22 PMID 23541057
Cites: Lancet. 2009 Oct 3;374(9696):1196-208 PMID 19801098
Cites: JAMA. 2004 Dec 8;292(22):2765-70 PMID 15585737
Cites: Lancet. 2015 Feb 7;385(9967):563-75 PMID 25468158
Cites: Age Ageing. 2012 Jan;41(1):52-7 PMID 22089082
Cites: Lancet. 2015 Jun 6;385(9984):2255-63 PMID 25771249
Cites: J Gerontol A Biol Sci Med Sci. 2007 May;62(5):531-6 PMID 17522358
Cites: Health Soc Care Community. 2016 Sep;24(5):631-8 PMID 25944315
Cites: J Gerontol A Biol Sci Med Sci. 2011 Dec;66(12):1328-35 PMID 21891791
Cites: JAMA Intern Med. 2013 Sep 9;173(16):1506-13 PMID 23836120
Cites: Health Econ. 2015 Mar;24 Suppl 1:18-31 PMID 25760580
Cites: Gerontologist. 2007;47 Spec No 3:118-24 PMID 18162574
Cites: J Am Geriatr Soc. 2005 Aug;53(8):1396-401 PMID 16078968
Cites: J Epidemiol Community Health. 2012 Dec;66(12):1152-8 PMID 22544922
Cites: Eur J Public Health. 2009 Jun;19(3):313-8 PMID 19286838
Cites: Scand J Public Health. 2012 Aug;40(6):505-15 PMID 22899561
Cites: JAMA. 2003 May 14;289(18):2387-92 PMID 12746362
Cites: J Am Med Dir Assoc. 2014 Sep;15(9):643-8 PMID 24913211
Cites: Eur J Public Health. 2008 Feb;18(1):77-84 PMID 17566001
Cites: BMC Health Serv Res. 2009 Aug 05;9:139 PMID 19656358
Cites: Dementia (London). 2014 Jan;13(1):5-22 PMID 24381036
Cites: Am J Public Health. 1992 Aug;82(8):1093-8 PMID 1386195
Cites: J Gerontol A Biol Sci Med Sci. 2009 Mar;64(3):395-402 PMID 19196640
PubMed ID
29196476 View in PubMed
Less detail