Bickel H
Psychiatrische Klinik der TU München.
Z Gerontol Geriatr. 1998 Jun;31(3):193-204. doi: 10.1007/s003910050034.
The aim of the present study was to describe the pattern of service use (hospitals, homes, ambulatory services) in the year before death. The results are based on administrative data for the elderly inhabitants of the city of Mannheim, who died during one year (n = 2507), as well as on a survey of the next of kin of a 40% random sample of the decedents (n = 958). Deaths occurred most frequently in hospitals (49.7%), followed by deaths outside of institutions (29.1%) and deaths in residential or nursing homes (21.2%). 79.6% of the deceased had been admitted to hospitals in the last year of their lives, 28.6% were cared for in homes, and almost 40% were receiving care from home-help services. 9.3% of the last year of life were spent on average in hospitals and 20.5% in residential or nursing homes. Utilization of care was influenced by age at death, family conditions, living arrangements, and level of dependency. Hospital and nursing care use showed an opposite pattern. With increasing age at death, the utilization of homes and ambulatory services rose steeply, whereas the probability of hospital treatment decreased with more advancing age. Obviously a substantial proportion of the resources of the care system is spent for care at the end of life. Future gains in life expectancy will probably have a greater impact on nursing care than on hospital care.
本研究的目的是描述死亡前一年的服务使用模式（医院、家庭、门诊服务）。研究结果基于曼海姆市老年居民的行政数据，这些居民在某一年死亡（n = 2507），同时也基于对40%随机抽取的死者近亲的调查（n = 958）。死亡最常发生在医院（49.7%），其次是机构外死亡（29.1%）和在养老院或疗养院死亡（21.2%）。79.6%的死者在生命的最后一年曾住院，28.6%在家中接受照料，近40%接受居家护理服务。生命的最后一年平均有9.3%的时间在医院度过，20.5%在养老院或疗养院度过。护理的利用受到死亡年龄、家庭状况、生活安排和依赖程度的影响。医院护理和机构护理的使用呈现相反的模式。随着死亡年龄的增加，家庭和门诊服务的利用率急剧上升，而随着年龄的增长，住院治疗的可能性下降。显然，护理系统的很大一部分资源用于临终护理。未来预期寿命的提高可能对机构护理的影响比对医院护理的影响更大。
