Social determinants of duration of last nursing home stay at the end of life in Switzerland: a retrospective cohort study

Abstract

BackgroundDue to demographic ageing and increasing life expectancy, a growing demand for long-term nursing home care can be expected. Stays in nursing homes appear to be more socially determined than hospital stays. We therefore looked at the impact of socio-demographic and health care variables on the length of the last nursing home stay.MethodsNationwide individual data from nursing homes and hospitals in Switzerland were linked with census and mortality records. Gender-specific negative binomial regression models were used to analyze N = 35,739 individuals with an admission age of at least 65 years and deceased in 2007 or 2008 in a nursing home.ResultsPreceding death, men spent on average 790 days and women 1250 days in the respective nursing home. Adjusted for preceding hospitalizations, care level, cause of death and multimorbidity, a low educational level, living alone or being tenant as well as a low care level at the admission time increased the risk for longer terminal stays. Conversely, a high educational level, being homeowner, being married as well as a high care level at the admission time decreased the risk for longer stays.DiscussionThe length of the last nursing home stay before death was not only dependent on health-related factors alone, but also substantially depended on socio-demographic determinants such as educational level, homeownership or marital status. The support of elderly people at the admission time of a presumably following nursing home stay should be improved and better evaluated in order to reduce unnecessary and undesired long terminal nursing home stays.ConclusionsHealth policy should aim at diminishing the role of situational, non-health-related factors in order to empower people to spend the last years before death according to individual needs and preferences.

Health Care Utilisation and Transitions between Health Care Settings in the Last 6 Months of Life in Switzerland

“…Therefore, no statement on the quality of care can be made on the basis of the present study findings [ 35 ]. Further factors presumably influencing the health care utilisation and transitions (like living arrangement) [ 36 ] could not be taken into account as we were lacking this information. Due to the lack of clinical diagnosis chronic conditions were based on medical expenditures (PCGs).…”

Length of stay in long-term care facilities: a comparison of residents in six European countries. Results of the PACE cross-sectional study

“…Previous reviews of studies containing community-based samples of older adults have identified numerous factors predictive of future LTCF admission, with older adults with dementia more likely to be admitted to an LTCF than those without 7 8. Postadmission, the factors associated with shorter and longer length of stay in an LTCF have also been explored9–14; a systematic review of these factors identified shorter lengths of stay associated with older age, being male, having a cancer diagnosis, shortness of breath, receipt of oxygen therapy and residence in an LTCF providing nursing care 15. In particular, the review found stronger evidence for the association of poor physical functioning and shorter lengths of stay, compared with cognitive functioning.…”

Long-Term Care Residents’ Geriatric Syndromes at Admission and Disablement Over Time: An Observational Cohort Study

“…In our study, the median frequency and intervals between RAI-MDS assessments indicate that the vast majority of those who survived were followed for the full 2 years. LTCH residents’ length of stay varies across countries and sociodemographic characteristics (32,33); in the United States, the mean length of stay is 1.1 years (33), compared to 2 to 3 years in Canada, England, and Switzerland (32,34,35). Findings from the present study are more generalizable that past research for care planning among newly admitted LTCH residents in populations where the majority of LTCH residents live 2 years or more after admission.…”