• Javiera Leniz, Irene J Higginson, Robert Stewart, and Katherine E Sleeman.
• King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, UK.
• Age Ageing. 2019 Sep 1; 48 (5): 672-679.

Backgroundtransitions between care settings near the end-of-life for people with dementia can be distressing, lead to physical and cognitive deterioration, and may be avoidable.Objectiveto investigate determinants of end-of-life hospital transitions, and association with healthcare use, among people with dementia.Designretrospective cohort study.Settingelectronic records from a mental health provider in London, linked to national mortality and hospital data.Subjectspeople with dementia who died in 2007-2016.Methodsend-of-life hospital transitions were defined as: multiple admissions in the last 90 days (early), or any admission in the last three days of life (late). Determinants were assessed using logistic regression.Resultsof 8,880 people, 1,421 (16.0%) had at least one end-of-life transition: 505 (5.7%) had early, 788 (8.9%) late, and 128 (1.5%) both types. Early transitions were associated with male gender (OR 1.33, 95% CI 1.11-1.59), age (>90 vs <75 years OR 0.69, 95% CI 0.49-0.97), physical illness (OR 1.52, 95% CI 1.20-1.94), depressed mood (OR 1.49, 95% CI 1.17-1.90), and deprivation (most vs least affluent quintile OR 0.58, 95% CI 0.37-0.90). Care home residence was associated with fewer early (OR 0.63, 95% CI 0.53 to 0.76) and late (OR 0.80, 95% CI 0.65 to 0.97) transitions. Early transitions were associated with more hospital admissions throughout the last year of life compared to those with late and no transitions (mean 4.56, 1.89, 1.60; P < 0.001).Conclusionsin contrast to late transitions, early transitions are associated with higher healthcare use and characteristics that are predictable, indicating potential for prevention.© The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society.

21 keywords...

hide…