Abstract
BackgroundHospitalisation of patients with advanced dementia is generally regarded as less preferable compared to care at home or in a nursing home. For patients with other diagnoses, young age has been associated with better end-of-life care. However, studies comparing the quality of palliative care for persons with advanced dementia in hospitals and nursing homes are scarce. The aim of this study was to investigate whether quality of end-of-life care for patients with dementia depends on age, gender and place of death.MethodsThe Swedish Register of Palliative Care (SRPC) was used to identify patients who died from dementia in hospitals or nursing homes during a three-year period. The likelihood of death occurring at a hospital, based on age and gender differences, was calculated. Associations between 13 end-of-life care quality indicators collected from the SRPC and age, gender and place of care were examined in a logistic regression model.ResultsDeath at a hospital was associated with poorer quality of end-of-life care for 10 of the 13 measured outcomes when compared to death at a nursing home, and with better quality according to two of the outcomes. Death at a hospital was more common for men compared to women and for younger patients compared to older. Receiving fluids intravenously or via enteral tube in the last 24 h of life was strongly associated with death at a hospital. Women were more likely to have their oral health assessed and less likely to have pressure ulcers at death. Eight of 12 end-of-life care outcomes showed better results for the age group 65 to 84 years compared to those 85 years or older.ConclusionsDeath in hospitals was associated with poorer quality of end-of-life care compared to death in nursing homes. Our data support the importance of advance care planning and individual assessments in nursing homes to avoid referral to hospitals during end of life. Despite established recommendations to avoid hospitalisation if possible, there were strong associations between younger age, male gender and hospitalisation in the end of life. Further studies are needed to investigate the role of socioeconomic factors in end-of-life care for this patient group.
Highlights
Hospitalisation of patients with advanced dementia is generally regarded as less preferable compared to care at home or in a nursing home
The model showed no age or gender differences regarding the probability of receiving fluids (Table 4). In this national register study of 16,462 adults who died an expected death from dementia in hospitals or nursing homes we have shown that death at a hospital was associated with poorer quality of end-of-life care compared to death at a nursing home for all but three of the measured outcomes
This study demonstrates that a majority of patients with dementia were given end-of-life care in the nursing home, indicating that a majority of patients suffering from dementia can be managed in nursing homes during end of life
Summary
Hospitalisation of patients with advanced dementia is generally regarded as less preferable compared to care at home or in a nursing home. Studies comparing the quality of palliative care for persons with advanced dementia in hospitals and nursing homes are scarce. The white paper on dementia care from the European Association for Palliative Care concludes that “transfer to the hospital and the associated risks and benefits should be considered prudently in relation to the care goals and taking into account the stage of the dementia” [1]. Despite these recommendations, hospitalisation of patients with advanced dementia is common [2]. Febrile episodes, and eating problems are common for advanced dementia and are associated with high six-month mortality rates [6]
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