• Rose Miranda, Tinne Smets, Robrecht De Schreye, Kristof Faes, Nele Van Den Noortgate, Joachim Cohen, and Lieve Van den Block.
• End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
• Palliat Med. 2021 Oct 1; 35 (9): 1701-1712.

BackgroundWhile palliative home care is advocated for people with dementia, evidence of its effectiveness is lacking.AimTo evaluate the effects of palliative home care on quality and costs of end-of-life care for older people with dementia.DesignDecedent cohort study using linked nationwide administrative databases and propensity score matching.Setting/ParticipantsAll home-dwelling older people who died with dementia between 2010 and 2015 in Belgium (N = 23,670).ExposureReceiving palliative home care support for the first time between 360 and 15 days before death.ResultsFive thousand six hundred and thirty-seven (23.8%) received palliative home care support in the last 2 years of life, of whom 2918 received it for the first time between 360 and 15 days before death. Two thousand eight hundred and thirty-nine people who received support were matched to 2839 people who received usual care. After matching, those using palliative home care support, in the last 14 days of life, had lower risk of hospital admission (17.5% vs 50.5%; relative risk (RR) = 0.21), undergoing diagnostic testing (17.0% vs 53.6%; RR = 0.20) and receiving inappropriate medications, but were more likely to die at home (75.7% vs 32.6%; RR = 6.45) and to have primary care professional contacts (mean 11.7 vs mean 5.2), compared with those who did not. Further, they had lower mean total costs of care in the last 30 days of life (incremental cost:-€2129).ConclusionsPalliative home care use by home-dwelling older people with dementia is associated with improved quality and reduced costs of end-of-life care. Access remains low and should be increased.

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