Use of healthcare services at the end of life in decedents compared to their surviving counterparts: A case-control study among adults born before 1946 in Friuli Venezia Giulia

Abstract

BackgroundThere is a heterogeneous literature on healthcare utilization patterns at the end of life. The objective of this study is to examine the impact of closeness to death on the utilization of acute hospital-based healthcare services and some primary healthcare services and compare differences in gender, age groups and major causes of death disease specific mortality.MethodsA matched case-control study, nested in a cohort of 411,812 subjects, linked to administrative databases was conducted. All subjects were residents in the Friuli Venezia Giulia Region (Italy), born before 1946, alive in January 2000 and were followed up to December 2014. Overall, 158,571 decedents/cases were matched by gender and year of birth to one control, alive at least one year after their matched case’s death (index-date). Hospital admissions, emergency department visits, drug prescriptions, specialist visits and laboratory tests that occurred 365 days before death/index-date, have been evaluated. Odds Ratios (ORs) for healthcare utilization were estimated through conditional regression models, further adjusted for Charlson Comorbidity Index and stratified by gender, age groups and major causes of death.ResultsDecedents were significantly more likely of having at least one hospital admission (OR 7.0, 6.9–7.1), emergency department visit (OR 5.2, 5.1–5.3), drug prescription (OR 2.8, 2.7–2.9), specialist visit (OR 1.4, 1.4–1.4) and laboratory test (OR 2.7, 2.6–2.7) than their matched surviving counterparts. The ORs were generally lower in the oldest age group (95+) than in the youngest (55–74). Healthcare utilization did not vary by sex, but was higher in subjects who died of cancer.ConclusionCloseness to death appeared to be strongly associated with healthcare utilization in adult/elderly subjects. The risk seems to be greater among younger age groups than older ones, especially for acute based services. Reducing acute healthcare at the EOL represents an important issue to improve the quality of life in proximity to death.

Hospitalizations and emergency department visits trends among elderly individuals in proximity to death: a retrospective population-based study

“…This retrospective approach serves to describe patterns of healthcare service use in proximity to death and provided insights for healthcare policy-makers on the expected need for hospital-based healthcare services in a specific population. Previous literature has suggested that closeness to death may be the main driver of change in the intensity of acute healthcare service utilization 1 , 5 , 14 . The period considered for the end of life varies in the literature, ranging from days to years before death 7 , 15 – 18 and mainly depending on the specific conditions considered (i.e., studies on cancer patients generally require a longer time frame) 19 – 22 .…”

“…In the present study, we observed an overall higher use among men, but highly comparable trends among men and women, as confirmed by similar change points. Several studies have shown that older age is associated with lower use of acute healthcare services at the end of life 1 , 5 , 6 , 23 , 24 . This finding can be linked to a high proportion of institutionalized individuals who are regularly provided with basic assistance, potentially reducing the need to access hospital-based services, if not in close proximity to death, as suggested by the change point.…”

“…Hospital care and emergency department visits (EDVs) are fundamental services of any healthcare system. At the same time, hospital admissions and EDVs impact public health in terms of both individual quality of life and healthcare costs 2 – 4 , and their utilization intensifies significantly at the end of life 1 , 5 – 7 . Previous literature indicates that approximately 84% of people who die were hospitalized the year before death, with variations depending on age and sex 1 , 8 , and 70% accessed an emergency department in their last 12 months of life 7 .…”

Were the hospital bed reductions proposed by English Clinical Commissioning Groups (CCGs) in the sustainability and transformation plans (STPs) achievable? Insights from a new model to compare international bed numbers

“…The key observation regarding bed numbers is that both admissions and bed occupancy increase dramatically as a person nears the end of life, irrespective of the age at death 16–26 . This is called the time‐to‐death (TTD) or nearness‐to‐death (NTD) effect.…”

Comparisons between protocols and publications of case-control studies: analysis of potential causes of non-reproducibility and recommendations for enhancing the quality of personalization in healthcare

“…CCS is one of the most important methodologies in health and medical sciences, and has been widely used in exploration of etiology, comparison of diagnostic approaches, evaluation of clinical treatments, and other healthcare investigations [15][16][17]. To resolve the co-morbidities and complex clinical situations worldwide, new scientific findings of CCSs are required for the development of predictive, preventive, and personalized medicine (PPPM)-related approaches [18,19].…”