Abstract
BackgroundDue to demographic ageing and increasing life expectancy, a growing demand for long-term nursing home care can be expected. Stays in nursing homes appear to be more socially determined than hospital stays. We therefore looked at the impact of socio-demographic and health care variables on the length of the last nursing home stay.MethodsNationwide individual data from nursing homes and hospitals in Switzerland were linked with census and mortality records. Gender-specific negative binomial regression models were used to analyze N = 35,739 individuals with an admission age of at least 65 years and deceased in 2007 or 2008 in a nursing home.ResultsPreceding death, men spent on average 790 days and women 1250 days in the respective nursing home. Adjusted for preceding hospitalizations, care level, cause of death and multimorbidity, a low educational level, living alone or being tenant as well as a low care level at the admission time increased the risk for longer terminal stays. Conversely, a high educational level, being homeowner, being married as well as a high care level at the admission time decreased the risk for longer stays.DiscussionThe length of the last nursing home stay before death was not only dependent on health-related factors alone, but also substantially depended on socio-demographic determinants such as educational level, homeownership or marital status. The support of elderly people at the admission time of a presumably following nursing home stay should be improved and better evaluated in order to reduce unnecessary and undesired long terminal nursing home stays.ConclusionsHealth policy should aim at diminishing the role of situational, non-health-related factors in order to empower people to spend the last years before death according to individual needs and preferences.
Highlights
Due to demographic ageing and increasing life expectancy, a growing demand for long-term nursing home care can be expected
Health policy should aim at diminishing the role of situational, non-health-related factors in order to empower people to spend the last years before death according to individual needs and preferences
The estimated incidence risk ratios (IRR) predicting the length of the last nursing home stay are presented in Table 2 for men and women separately
Summary
Due to demographic ageing and increasing life expectancy, a growing demand for long-term nursing home care can be expected. In many developed countries and ageing societies such as Switzerland or the US, staying in longterm facilities at the end of life has increased and nursing homes have been recognized as an important setting for end-of-life care [2, 3]. This trend from private home to nursing home as place of death is still ongoing and will further grow in the future [1, 2, 4]. Being male, having sufficient social (e.g., having a partner and/or adult children, daughters) or material resources (e.g., owning a home) may prevent an early entry and a long stay in a nursing home at the end of life [8, 9]
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