Aaltonen Mari, Forma Leena, Pulkki Jutta, Raitanen Jani, Rissanen Pekka, Jylha Marja
Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, University of Tampere, Tampere, Finland.
The UKK Institute for Health Promotion Research, Tampere, Finland.
BMJ Open. 2017 Dec 1;7(11):e015130. doi: 10.1136/bmjopen-2016-015130.
The time of death is increasingly postponed to a very high age. How this change affects the use of care services at the population level is unknown. This study analyses the care profiles of older people during their last 2 years of life, and investigates how these profiles differ for the study years 1996-1998 and 2011-2013.
Retrospective cross-sectional nationwide data drawn from the Care Register for Health Care, the Care Register for Social Care and the Causes of Death Register. The data included the use of hospital and long-term care services during the last 2 years of life for all those who died in 1998 and in 2013 at the age of ≥70 years in Finland.
We constructed four care profiles using two criteria: (1) number of days in round-the-clock care (vs at home) in the last 2 years of life and (2) care transitions during the last 6 months of life (ie, end-of-life care transitions).
Between the study periods, the average age at death and the number of diagnoses increased. Most older people (1998: 64.3%, 2013: 59.3%) lived at home until their last months of life (profile 2) after which they moved into hospital or long-term care facilities. This profile became less common and the profiles with a high use of care services became more common (profiles 3 and 4 together in 1998: 25.0%, in 2013: 30.9%). People with dementia, women and the oldest old were over-represented in the latter profiles. In both study periods, fewer than one in ten stayed at home for the whole last 6 months (profile 1).
Postponement of death to a very old age may translate into more severe disability in the last months or years of life. Care systems must be prepared for longer periods of long-term care services needed at the end of life.
死亡时间越来越推迟到很高龄阶段。这种变化如何影响人群层面护理服务的使用尚不清楚。本研究分析了老年人生命最后2年的护理情况，并调查1996 - 1998年和2011 - 2013年这两个研究年份的护理情况有何不同。
从医疗保健护理登记册、社会护理护理登记册和死亡原因登记册中提取的全国性回顾性横断面数据。数据包括1998年和2013年在芬兰≥70岁死亡的所有人生命最后2年期间医院和长期护理服务的使用情况。
我们使用两个标准构建了四种护理情况：（1）生命最后2年全天候护理（与在家护理相比）的天数，以及（2）生命最后6个月期间的护理转换（即临终护理转换）。
在研究期间，平均死亡年龄和诊断数量增加。大多数老年人（1998年：64.3%，2013年：59.3%）在家生活直到生命的最后几个月（情况2），之后他们进入医院或长期护理机构。这种情况变得不那么常见，而高使用护理服务的情况变得更常见（1998年情况3和情况4合计：25.0%，2013年：30.9%）。痴呆患者、女性和最年长的老年人在后者情况中占比过高。在两个研究期间，在生命最后6个月全程都在家的人不到十分之一（情况1）。
将死亡推迟到非常高龄可能意味着在生命的最后几个月或几年出现更严重的残疾。护理系统必须为生命末期所需的更长时间的长期护理服务做好准备。
