Changes over a decade in end-of-life care and transfers during the last 3 months of life: a repeated survey among proxies of deceased older people.

BACKGROUND

In the ageing population, older people are living longer with chronic diseases. Especially in the last year of life, this can result in an increased need for (complex) end-of-life care.

AIM

To study potential changes in received end-of-life care and transfers by older people during the last 3 months of life between 2000 and 2010.

DESIGN

A repeated survey in 2000 and 2010.

PARTICIPANTS

Data were collected from a sample of proxies of deceased sample members of the Longitudinal Aging Study Amsterdam in 2000 (n = 270; response = 79%) and 2010 (n = 168; response = 59%).

RESULTS

Compared to 2000, in 2010, older people had a significantly lower functional ability 3 months before death. Over the 10-year period, people were significantly less likely to receive no care (12% vs 39%) and more likely to receive formal home care (45% vs 15%). Older people aged over 80 years, females, and those in the 2010 sample were more likely to receive formal home and institutional care (formal home care - age > 80 years, odds ratio: 3.7, male odds ratio: 0.74, 2010 - odds ratio: 6.9; institutional care - age > 80 years, odds ratio: 11.6, male odds ratio: 0.34, 2010 - odds ratio: 2.5) than informal or no care. Regardless of the study year, older people receiving informal home care were more likely to die in hospital (odds ratio: 2.3).

CONCLUSION

Two scenarios of care in the last 3 months of life seem to arise: staying at home as long as possible with a higher chance of hospital death or living in a residential or nursing home, reducing the chance of hospital death.