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Ten-year trends in end-of-life hospitalizations of nursing home residents in Germany, 2006–2015

  • Falk Hoffmann
    Correspondence
    Corresponding author at: Carl von Ossietzky University Oldenburg, Department of Health Services Research, Ammerländer Heerstr. 140, D- 26129, Oldenburg, Germany.
    Affiliations
    Carl von Ossietzky University Oldenburg, Department of Health Services Research, Oldenburg, Germany
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  • Katharina Allers
    Affiliations
    Carl von Ossietzky University Oldenburg, Department of Health Services Research, Oldenburg, Germany
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      Highlights

      • End-of-life hospitalizations of nursing home residents are common in Germany.
      • We found a small decrease over recent years in the proportion of in-hospital deaths.
      • No significant differences in hospitalization rates during the last 7, 14 and 30 days of life over a 10-year period were seen.
      • The length of terminal hospitalizations decreased over time.
      • More studies should examine longitudinal trends.

      Abstract

      Objectives

      We investigated trends in end-of-life hospitalizations among nursing home residents (NHR) over 10 years and looked at differences between age groups and sexes as well as the length of terminal hospital stays.

      Study design

      Retrospective cohort study based on health insurance claims data of the AOK Bremen/Bremerhaven. All NHR aged 65 years or more who died between 2006 and 2015 were included.

      Main outcome measures

      We assessed the proportions of decedents who were in hospital on the day of death and during the last 3, 7, 14 and 30 days of life, stratified by two-year periods. Multiple logistic regressions were conducted to study changes over time, adjusting for covariates.

      Results

      A total of 10,781 decedents were included (mean age 86.1 years, 72.1 % females). Overall, 29.2 % died in hospital, with a slight decrease from 30.3 % in 2006–2007 to 28.3 % in 2014–2015 (OR 0.86; 95 % CI 0.75–0.98). Of the 3150 terminal hospitalizations, 35.5 % lasted up to 3 days and the mean length of stay decreased from 9.0 (2006–2007) to 7.5 days (2014–2015). When looking at the last 7, 14 and 30 days of life, no changes over time were found. Male sex and younger age were associated with a higher chance of end-of-life hospitalization in almost all analyses.

      Conclusions

      End-of-life hospitalizations of NHR are common in Germany. There has been a small decrease during recent years in the proportion of in-hospital deaths, but not of hospitalizations during the last 7, 14 and 30 days of life. This might be explained by shorter durations of hospital stays.

      Keywords

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      References

        • Allers K.
        • Hoffmann F.
        Mortality and hospitalization at the end of life in newly admitted nursing home residents with and without dementia.
        Soc. Psychiatry Psychiatr. Epidemiol. 2018; 53: 833-839https://doi.org/10.1007/s00127-018-1523-0
        • Menec V.H.
        • Nowicki S.
        • Blandford A.
        • Veselyuk D.
        Hospitalizations at the end of life among long-term care residents.
        J. Gerontol. A Biol. Sci. Med. Sci. 2009; 64: 395-402https://doi.org/10.1093/gerona/gln034
        • Allers K.
        • Hoffmann F.
        • Schnakenberg R.
        Hospitalizations of nursing home residents at the end of life: a systematic review.
        Palliat. Med. 2019; 33: 1282-1298https://doi.org/10.1177/0269216319866648
        • Pedone C.
        • Ercolani S.
        • Catani M.
        • Maggio D.
        • Ruggiero C.
        • Quartesan R.
        • Senin U.
        • Mecocci P.
        • Cherubini A.
        Elderly patients with cognitive impairment have a high risk for functional decline during hospitalization: the GIFA Study.
        J. Gerontol. A Biol. Sci. Med. Sci. 2005; 60: 1576-1580
        • Dwyer R.
        • Gabbe B.
        • Stoelwinder J.U.
        • Lowthian J.
        A systematic review of outcomes following emergency transfer to hospital for residents of aged care facilities.
        Age Ageing. 2014; 43: 759-766https://doi.org/10.1093/ageing/afu117
        • Cardona-Morrell M.
        • Kim J.C.H.
        • Brabrand M.
        • Gallego-Luxan B.
        • Hillman K.
        What is inappropriate hospital use for elderly people near the end of life? A systematic review.
        Eur. J. Intern. Med. 2017; 42: 39-50https://doi.org/10.1016/j.ejim.2017.04.014
        • Hess S.
        • Stiel S.
        • Hofmann S.
        • Klein C.
        • Lindena G.
        • Ostgathe C.
        Trends in specialized palliative care for non-cancer patients in Germany —data from the National Hospice and Palliative Care Evaluation (HOPE).
        Eur. J. Intern. Med. 2014; 25: 187-192https://doi.org/10.1016/j.ejim.2013.11.012
        • Resnick H.E.
        • Schuur J.D.
        • Heineman J.
        • Stone R.
        • Weissman J.S.
        Advance directives in nursing home residents aged ≥65 years: united States 2004.
        Am. J. Hosp. Palliat. Med. 2009; 25: 476-482https://doi.org/10.1177/1049909108322295
        • Temkin-Greener H.
        • Zheng N.T.
        • Xing J.
        • Mukamel D.B.
        Site of death among nursing home residents in the United States: changing patterns, 2003–2007.
        J. Am. Med. Dir. Assoc. 2013; 14: 741-748https://doi.org/10.1016/j.jamda.2013.03.009
        • Teno J.M.
        • Gozalo P.
        • Mitchell S.L.
        • Bynum J.P.W.
        • Dosa D.
        • Mor V.
        Terminal hospitalizations of nursing home residents: does facility increasing the rate of do not resuscitate orders reduce them?.
        J. Pain Symptom Manage. 2011; 41: 1040-1047https://doi.org/10.1016/j.jpainsymman.2010.07.014
        • Li Q.
        • Zheng N.T.
        • Temkin-Greener H.
        Quality of end-of-Life care of long-term nursing home residents with and without dementia.
        J. Am. Geriatr. Soc. 2013; 61: 1066-1073https://doi.org/10.1111/jgs.12330
        • Cai S.
        • Miller S.C.
        • Gozalo P.L.
        Nursing home–hospice collaboration and end-of-life hospitalizations among dying nursing home residents.
        J. Am. Med. Dir. Assoc. 2018; 19: 439-443https://doi.org/10.1016/j.jamda.2017.10.020
        • Ramroth H.
        • Specht-Leible N.
        • König H.-H.
        • Brenner H.
        Hospitalizations during the last months of life of nursing home residents: a retrospective cohort study from Germany.
        BMC Health Serv. Res. 2006; 6: 70https://doi.org/10.1186/1472-6963-6-70
        • Luque Ramos A.
        • Hoffmann F.
        Differences in chronic back pain and joint disorders among health insurance funds: results of a cross-sectional study based on the data of the Socioeconomic Panel from 2013.
        Z. Rheumatol. 2017; 76: 238-244https://doi.org/10.1007/s00393-016-0178-z
        • Hoffmann F.
        • Icks A.
        Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann Health-Care Monitor.
        Gesundheitswesen. 2012; 74: 291-297https://doi.org/10.1055/s-0031-1275711
        • Morin L.
        • Johnell K.
        • Aubry R.
        Variation in the place of death among nursing home residents in France.
        Age Ageing. 2015; 44: 415-421https://doi.org/10.1093/ageing/afu197
        • Hoffmann F.
        • van den Bussche H.
        • Wiese B.
        • Glaeske G.
        • Kaduszkiewicz H.
        Diagnoses indicating pain and analgesic drug prescription in patients with dementia: a comparison to age- and sex-matched controls.
        BMC Geriatr. 2014; 14: 20https://doi.org/10.1186/1471-2318-14-20
        • Hoffmann F.
        • Allers K.
        Variations over time in the effects of age and sex on hospitalization rates before and after admission to a nursing home: a German cohort study.
        Maturitas. 2017; 102: 50-55https://doi.org/10.1016/j.maturitas.2017.04.017
        • Busse R.
        • Blümel M.
        Germany: health system review.
        Health Syst. Transit. 2014; 16: 1-296
        • Pedone C.
        • Ercolani S.
        • Catani M.
        • Maggio D.
        • Ruggiero C.
        • Quartesan R.
        • Senin U.
        • Mecocci P.
        • Cherubini A.
        GIFA Study Group, Elderly patients with cognitive impairment have a high risk for functional decline during hospitalization: the GIFA Study.
        J. Gerontol. A Biol. Sci. Med. Sci. 2005; 60 (accessed April 7, 2019): 1576-1580
        • Trahan L.M.
        • Spiers J.A.
        • Cummings G.G.
        Decisions to transfer nursing home residents to emergency departments: a scoping review of contributing factors and staff perspectives.
        J. Am. Med. Dir. Assoc. 2016; 17: 994-1005https://doi.org/10.1016/j.jamda.2016.05.012
        • Nakashima T.
        • Young Y.
        • Hsu W.-H.
        Are Hospital/ED transfers less likely among nursing home residents with do-not-Hospitalize orders?.
        J. Am. Med. Dir. Assoc. 2017; 18: 438-441https://doi.org/10.1016/j.jamda.2016.12.004
        • Kirsebom M.
        • Hedström M.
        • Pöder U.
        • Wadensten B.
        Transfer of nursing home residents to emergency departments: organizational differences between nursing homes with high vs. Low transfer rates.
        Nurs. Open. 2017; 4: 41-48https://doi.org/10.1002/nop2.68
        • Martin R.S.
        • Hayes B.
        • Gregorevic K.
        • Lim W.K.
        The effects of advance care planning interventions on nursing home residents: a systematic review.
        J. Am. Med. Dir. Assoc. 2016; 17: 284-293https://doi.org/10.1016/j.jamda.2015.12.017
        • Sommer S.
        • Marckmann G.
        • Pentzek M.
        • Wegscheider K.
        • Abholz H.-H.
        • in der Schmitten J.
        Advance directives in nursing homes: prevalence, validity, significance, and nursing staff adherence.
        Dtsch. Ärzteblatt Int. 2012; 109: 577-583https://doi.org/10.3238/arztebl.2012.0577
        • Pfister D.
        • Markett S.
        • Müller M.
        • Müller S.
        • Grützner F.
        • Rolke R.
        • Kern M.
        • Schmidt-Wolf G.
        • Radbruch L.
        German nursing home professionals’ knowledge and specific self-efficacy related to palliative care.
        J. Palliat. Med. 2013; 16: 794-798https://doi.org/10.1089/jpm.2012.0586
        • van Oorschot B.
        • Mücke K.
        • Cirak A.
        • Henking T.
        • Neuderth S.
        Gewünschter Sterbeort, Patientenverfügungen und Versorgungswünsche am Lebensende: erste Ergebnisse einer Befragung von Pflegeheimbewohnern.
        Z. Gerontol. Geriatr. 2018; https://doi.org/10.1007/s00391-018-1432-6
        • Hoffmann F.
        • Allers K.
        Age and sex differences in hospitalisation of nursing home residents: a systematic review.
        BMJ Open. 2016; 6: e011912https://doi.org/10.1136/bmjopen-2016-011912
        • Stall N.M.
        • Fischer H.D.
        • Fung K.
        • Giannakeas V.
        • Bronskill S.E.
        • Austin P.C.
        • Matlow J.N.
        • Quinn K.L.
        • Mitchell S.L.
        • Bell C.M.
        • Rochon P.A.
        Sex-specific differences in end-of-life burdensome interventions and antibiotic therapy in nursing home residents with advanced dementia.
        JAMA Netw. Open. 2019; 2: e199557https://doi.org/10.1001/jamanetworkopen.2019.9557
        • Menec V.H.
        • Nowicki S.
        • Blandford A.
        • Veselyuk D.
        Hospitalizations at the end of life among long-term care residents.
        J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2009; 64A: 395-402https://doi.org/10.1093/gerona/gln034
        • McGregor M.J.
        • Tate R.B.
        • Ronald L.A.
        • McGrail K.M.
        Variation in Site of death among nursing home residents in British Columbia, Canada.
        J. Palliat. Med. 2007; 10: 1128-1136https://doi.org/10.1089/jpm.2007.0018
        • Zheng N.T.
        • Mukamel D.B.
        • Caprio T.
        • Cai S.
        • Temkin-Greener H.
        Racial disparities in in-hospital death and hospice use among nursing home residents at the end of life.
        Med. Care. 2011; 49: 992-998https://doi.org/10.1097/MLR.0b013e318236384e
        • Ong A.C.L.
        • Sabanathan K.
        • Potter J.F.
        • Myint P.K.
        High mortality of older patients admitted to hospital from care homes and insight into potential interventions to reduce hospital admissions from care homes: The Norfolk experience.
        Arch. Gerontol. Geriatr. 2011; 53: 316-319https://doi.org/10.1016/j.archger.2010.12.004
        • Gozalo P.
        • Teno J.M.
        • Mitchell S.L.
        • Skinner J.
        • Bynum J.
        • Tyler D.
        • Mor V.
        End-of-life transitions among nursing home residents with cognitive issues.
        N. Engl. J. Med. 2011; 365: 1212-1221https://doi.org/10.1056/NEJMsa1100347
        • Allers K.
        • Fassmer A.M.
        • Spreckelsen O.
        • Hoffmann F.
        End-of-life care of nursing home residents: A survey among general practitioners in northwestern Germany.
        Geriatr. Gerontol. Int. 2019; https://doi.org/10.1111/ggi.13809
        • Hoffmann F.
        • Schmiemann G.
        Influence of age and sex on hospitalization of nursing home residents: A cross-sectional study from Germany.
        BMC Health Serv. Res. 2017; 17: 55https://doi.org/10.1186/s12913-017-2008-7