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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.

ABSTRACT: OBJECTIVES: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. DESIGN: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. METHODS: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). RESULTS: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). CONCLUSIONS: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.

SUBMITTER: Aaltonen M

PROVIDER: S-EPMC5719301 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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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.

Aaltonen Mari M Forma Leena L Pulkki Jutta J Raitanen Jani J Rissanen Pekka P Jylha Marja M

BMJ open 20171201 11

<h4>Objectives</h4>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.<h4>Design</h4>Retrospective cross-sectional nationwide data drawn from the Care Register for Health Care, the Care Register for Social Care and the Causes ...[more]

PMID: 29196476

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Project description:ObjectivesTo study the interplay between several indicators of social disadvantage and hospitalisations due to ambulatory care-sensitive conditions (ACSC) in 2011─2013. To evaluate whether the accumulation of preceding social disadvantage in one point of time or prolongation of social disadvantage had an effect on hospitalisations due to ACSCs. Four common indicators of disadvantage are examined: living alone, low level of education, poverty and unemployment.DesignA population-based register study.SettingNationwide individual-level register data on hospitalisations due to ACSCs for the years 2011-2013 and preceding data on social and socioeconomic factors for the years 2006─2010.ParticipantsFinnish residents aged 45 or older on 1 January 2011.Outcome measureHospitalisations due to ACSCs in 2011-2013. The effect of accumulation of preceding disadvantage in one point of time and its prolongation on ACSCs was studied using modified Poisson regression.ResultsPeople with preceding cumulative social disadvantage were more likely to be hospitalised due to ACSCs. The most hazardous combination was simultaneously living alone, low level of education and poverty among the middle-aged individuals (aged 45-64 years) and the elderly (over 64 years). Risk ratio (RR) of being hospitalised due to ACSC was 3.16 (95% CI 3.03-3.29) among middle-aged men and 3.54 (3.36-3.73) among middle-aged women compared with individuals without any of these risk factors when controlling for age and residential area. For the elderly, the RR was 1.61 (1.57-1.66) among men and 1.69 (1.64-1.74) among women.ConclusionsTo improve social equity in healthcare, it is important to recognise not only patients with cumulative disadvantage but also-as this study shows-patients with particular combinations of disadvantage who may be more susceptible. The identification of these vulnerable patient groups is also necessary to reduce the use of more expensive treatment in specialised healthcare.

Dataset Information

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.

Publications

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.

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