Penning Margaret, Cloutier Denise S, Nuernberger Kim, Taylor Deanne
Department of Sociology.
Institute on Aging & Lifelong Health (IALH), and.
Innov Aging. 2017 Aug 30;1(1):igx011. doi: 10.1093/geroni/igx011. eCollection 2017 Mar 1.
Little is known regarding the care trajectories older adults experience at the end of life (EOL). We drew on a structural/institutional life course perspective to examine the trajectories evident among older adults transitioning through the Canadian formal long-term care system. The sequence of care transitions as well as the impact of social location, social and economic resources, and health-related factors on these trajectories were examined.
To identify EOL care trajectories, we used administrative data collected on older adults (aged 65+) who received publicly subsidized long-term care services (e.g., nursing home and home and community-based care) in one health region in British Columbia, Canada from January 1, 2008 through December 31, 2011 and who died by March 31, 2012 ( = 11,816). Multinomial logistic regression analyses assessed the impact of selected covariates on these trajectories.
The majority of those studied (65.4%) died outside of acute hospital settings. The most common trajectories involved transitions from home care to nursing home/residential care to non-hospital death (39.5%) and transitions from in-home care to hospital death (22.4%). These and other trajectories were shaped by social structural factors, access to social and economic resources, as well as health status and prior hospitalizations.
Despite calls for minimizing hospital-based deaths and maximizing home-based deaths, older LTC recipients often experience EOL care trajectories that end in death in a nursing home care setting. Our findings point to the value of a structural/institutional life course perspective in informing an understanding of who experiences this and other major EOL care trajectories. In doing so, they also provide direction for policy and practice designed to address inequalities and enhance the quality of EOL care.
关于老年人在生命末期（EOL）所经历的护理轨迹，我们知之甚少。我们运用结构/制度生命历程视角，来审视在加拿大正式长期护理系统中过渡的老年人所呈现出的轨迹。研究了护理过渡的顺序，以及社会位置、社会和经济资源以及健康相关因素对这些轨迹的影响。
为了确定生命末期护理轨迹，我们使用了对65岁及以上老年人收集的行政数据，这些老年人于2008年1月1日至2011年12月31日期间在加拿大不列颠哥伦比亚省的一个卫生区域接受了公共补贴的长期护理服务（如养老院以及居家和社区护理），并于2012年3月31日前去世（n = 11,816）。多项逻辑回归分析评估了选定协变量对这些轨迹的影响。
大多数研究对象（65.4%）在急症医院环境之外死亡。最常见的轨迹包括从居家护理过渡到养老院/寄宿护理再到非医院死亡（39.5%）以及从居家护理过渡到医院死亡（22.4%）。这些轨迹以及其他轨迹受到社会结构因素、社会和经济资源的可及性以及健康状况和既往住院情况的影响。
尽管呼吁尽量减少在医院死亡并尽量增加在家中死亡，但老年长期护理接受者的生命末期护理轨迹往往以在养老院护理环境中死亡告终。我们的研究结果指出了结构/制度生命历程视角在理解谁经历了这种及其他主要生命末期护理轨迹方面的价值。在此过程中，它们还为旨在解决不平等问题并提高生命末期护理质量的政策和实践提供了方向。
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