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Variation in the place of death among nursing home residents in France
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). French National Observatory on End-of-Life Care, France.
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
Number of Authors: 3
2015 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 3, 415-421 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: recent studies have reported that hospitals have become a common place of death for nursing home residents. This study aimed to (i) measure variations in the proportion of in-hospital deaths across regions after adjustment for facility-level characteristics and (ii) identify environmental risk factors that might explain these variations in France. Design: a cross-sectional retrospective survey was conducted in 2013. Setting and participants: coordinating physicians in 3,705 nursing homes in France. Measurements: a regression model was used to construct risk-adjusted rates of in-hospital deaths considering the facilities' characteristics. At the regional level, the outcome was defined as the difference between the observed rate of in-hospital deaths and the expected risk-adjusted rate. Values exceeding zero indicated rates that exceeded the national predicted rate of in-hospital deaths and thus highlighted regions in which the risk-adjusted probability for nursing home residents to die in a hospital was greater than average. Results: among 70,119 nursing home decedents, 25.4% (n = 17,789) died in hospitals. The characteristics of the facilities had a significant influence on the proportion of in-hospital deaths among the nursing home decedents. However, after adjustment for these facility-level risk factors, the proportion of nursing homes that reported worse-than-average outcomes showed significant variation (range 26.0-79.6%). At the regional level, both the rate of acute hospital beds and the rate of general practitioners were found to be strongly correlated with the probability of reporting worse-than-average outcomes (P < 0.001). Conclusion: our study demonstrates the existence of major differences across regions in France and highlights the need for targeted interventions regarding end-of-life care in nursing home facilities.

Place, publisher, year, edition, pages
2015. Vol. 44, no 3, 415-421 p.
Keyword [en]
end-of-life care, place of death, nursing homes, long-term care, older people
National Category
Clinical Medicine
URN: urn:nbn:se:su:diva-119081DOI: 10.1093/ageing/afu197ISI: 000355623100013OAI: diva2:843398
Available from: 2015-07-28 Created: 2015-07-27 Last updated: 2015-07-28Bibliographically approved

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