A Population-Based Study of Care at the End of Life Among People With HIV in Ontario From 2010 to 2013

Kendall, Claire; Chalifoux, Mathieu; Dujovny, Manuel; Reinhard, Robert J.; Robinson, Gregory; Bacon, Jean; Rourke, Sean B.; Rosenes, Ron; Tanuseputro, Peter

doi:10.1097/qai.0000000000001268

Cited by 5 publications

(2 citation statements)

References 40 publications

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“…However, end‐of‐life data were poorly reported, with information available for only 57% of deaths. Where known, two‐thirds of expected deaths had a palliative care discussion and, consistent with previous studies , a high proportion of both expected and unexpected deaths occurred in hospital. Palliative care is effective in improving patient‐reported outcomes , although access among people with living HIV may be limited .…”

Section: Discussionsupporting

confidence: 82%

Cause of death among HIV patients in London in 2016

et al. 2019

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Objectives Since 2013, the London HIV Mortality Review Group has conducted annual reviews of deaths among people with HIV to reduce avoidable mortality. Methods All London HIV care Trusts reported data on 2016 patient deaths in 2017. Deaths were submitted using a modified Causes of Death in HIV reporting form and categorized by a specialist HIV pathologist and two HIV clinicians. Results There were 206 deaths reported; 77% were among men. Median age at death was 56 years. Cause was established for 82% of deaths, with non‐AIDS‐related malignancies and AIDS‐defining illnesses being the most common causes reported. Risk factors in the year before death included: tobacco smoking (37%), excessive alcohol consumption (19%), non‐injecting drug use (10%), injecting drug use (7%) and opioid substitution therapy (6%). Thirty‐nine per cent of patients had a history of depression, 33% chronic hypertension, 27% dyslipidaemia, 17% coinfection with hepatitis B virus and/or hepatitis C virus and 14% diabetes mellitus. At the time of death, 81% of patients were on antiretroviral therapy (ART), 61% had a CD4 count < 350 cells/μL, and 24% had a viral load ≥ 200 HIV‐1 RNA copies/mL. Thirty‐six per cent of deaths were unexpected; 61% of expected deaths were in hospital. Two‐thirds of expected deaths had a prior end‐of‐life care discussion documented. Conclusions In 2016, most deaths were attributable to non‐AIDS‐related conditions and the majority of patients were on ART and virally suppressed. However, several potentially preventable deaths were identified and underlying risk factors were common. As London HIV patients are not representative of people with HIV in the UK, a national mortality review is warranted.

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Section: Discussionsupporting

confidence: 82%

Cause of death among HIV patients in London in 2016

et al. 2019

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“…Much of the existing literature uses retrospective methods to examine outcomes of interest, such as health care use, among decedents at various periods before death. 10,[30][31][32] While data used in this study are historic, our approach distinguishes this study from others by first estimating the risk of death -and classifying individuals accordingly -before examining individuals' prospective health care use. In doing so, we gain insights into how we may be able to prospectively identify the health care people will need to increase palliative care for people requiring this type of service.…”

Section: Discussionmentioning

confidence: 99%

Estimated mortality risk and use of palliative care services among home care clients during the last 6 months of life: a retrospective cohort study

Murmann,

Manuel,

Tanuseputro

et al. 2024

CMAJ

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Background: In Canada, only 15% of patients requiring palliative care receive such services in the year before death. We describe health care utilization patterns among home care users in their last 6 months of life to inform care planning for older people with varying mortality risks and evolving care needs as they decline. Methods: Using population health administrative data from Ontario, we performed a retrospective cohort study involving home care clients aged 50 years and older who received at least 1 interRAI (Resident Assessment Instrument) Home Care assessment between April 2018 and September 2019. We report the proportion of clients who used acute care, long-term care, and palliative home care services within 6 months of their assessment, stratified by their predicted 6-month mortality risk using a prognostic tool called the Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool (RESPECT) and vital status. Results: The cohort included 247 377 adults, 11.9% of whom died within 6 months of an assessment. Among decedents, 50.6% of those with a RESPECT-estimated median survival of fewer than 3 months received at least 1 nonphysician palliative home care visit before death. This proportion declined to 38.7% and 29.5% among decedents with an estimated median survival between 3 and 6 months and between 6 and 12 months, respectively. Interpretation: Many older adults in Ontario do not receive any palliative home care before death. Prognostic tools such as RESPECT may improve recognition of reduced life expectancies and palliative care needs of individuals in their final years of life.

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