Abstract
BackgroundHospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. Despite the apparent high use of hospitals at the end of life, limited evidence currently exists regarding reasons for hospitalisation. Understanding complex end of life care needs is required for future health care planning as the global population ages. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use.MethodsSurvey data from 1,205 decedents from the 1921–1926 cohort of the Australian Longitudinal Study on Women’s Health were matched with the state-based hospital records and the National Death Index. Hospital patterns based on COD were graphically summarised and multivariate logistic regression models examined the impact of short-term predictors of length of stay (LOS).Results85 % of women had at least one admission in the last year of life; and 8 % had their first observed admission during this time. Reasons for hospitalisation, timing of admissions and LOS differed by COD. Women who died of cancer, diabetes and ‘other’ causes were admitted earlier than women who died of organ failure, dementia and influenza. Women who died of organ failure overall spent the longest time in hospital, and women with cancer had the highest median LOS. Longer LOS was associated with previous short- and medium-term- hospitalisations and type of hospital separation.ConclusionsReducing acute care admissions and LOS at the end of life is complex and requires a shift in perceptions and treatment regarding end of life care and chronic disease management.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1729-3) contains supplementary material, which is available to authorized users.
Highlights
Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users
This study aims to fill this gap by describing patterns of hospitalisation in the last year of life according to cause of death (COD) for older Australian women using data collected over a 12 year period
COD profile Among the 1,205 women who died during the observation period, 30.5 % (n = 382) of deaths were attributed to cancer, 21.7 % (n = 270) to organ failure, 13.1 % (n = 138) to dementia/Alzheimer’s disease, 7.0 % (n = 81) to diabetes and 3.7 % (n = 51) to influenza/pneumonia
Summary
Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use. In Australia, the proportion of adults aged over 65 has risen by Hospitalisations have been identified as a prime contributor to healthcare expenditure, with older adults often identified as high hospital users [4, 5]. Menec et al [10] found that 37 % of hospital use was concentrated into the last month prior to death, while an Australian study found a marked increase in admissions in the last 108 days for cancer-related deaths and 83 days for non-cancer related deaths [11]
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