Abstract
BackgroundIt is well-known that the use of care services is most intensive in the last phase of life. However, so far only a few determinants of end-of-life care utilization are known. The aims of this study were to describe the utilization of acute and long-term care among older adults in their last year of life as compared to those not in their last year of life, and to examine which of a broad range of determinants can account for observed differences in care utilization.MethodsData were used from the Longitudinal Aging Study Amsterdam (LASA). In a random, age and sex stratified population-based cohort of 3107 persons aged 55 – 85 years at baseline and representative of the Netherlands, follow-up cycles took place at 3, 6 and 9 years. Those who died within one year directly after a cycle were defined as the "end-of-life group" (n = 262), and those who survived at least three years after a cycle were defined as the "survivors". Utilization of acute and long-term care services, including professional and informal care, were recorded at each cycle, as well as a broad range of health-related and psychosocial variables.ResultsThe end-of-life group used more care than the survivors. In the younger-old this difference was most pronounced for acute care, and in the older-old, for long-term care. Use of both acute and long-term home care in the last year of life was fully accounted for by health problems. Use of institutional care at the end of life was partly accounted for by health problems, but was not fully explained by the determinants included.ConclusionThis study shows that severity of health problems are decisive in the explanation of the increase in use of care services towards the end-of-life. This information is essential for an appropriate allocation of professional health care to the benefit of older persons themselves and their informal caregivers.
Highlights
It is well-known that the use of care services is most intensive in the last phase of life
We focused on all respondents who died within one year after a cycle, and those who were still alive three years after a cycle, to ensure a meaningful contrast between both groups, based on the acceleration of health care utilization in the last year of life
The majority of the end-of-life group had contacts with a medical specialist, and on average 20% were admitted to a hospital, 25% used professional home care, and 20% lived in a care institution
Summary
It is well-known that the use of care services is most intensive in the last phase of life. Care utilization in the last year of life of older adults is an important, but still relatively unexplored field. Research in this area has been conducted primarily from an economical and political point of view, focusing on its costs [1,2,3,4,5]. These studies have shown that at any age, the last year of life is more costly in terms of care utilization than any earlier year of life. This in turn will be of benefit for older people themselves and their informal caregivers, for whom the psychological, physical, social and financial impact of the last year of life may be tremendous [7]
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