Variation in the place of death among nursing home residents in France
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Titre | Variation in the place of death among nursing home residents in France |
Type de publication | Journal Article |
Year of Publication | 2015 |
Auteurs | Morin L, Johnell K, Aubry R |
Journal | AGE AND AGEING |
Volume | 44 |
Pagination | 415-421 |
Date Published | MAY |
Type of Article | Article |
ISSN | 0002-0729 |
Mots-clés | End-of-life care, Long-term care, nursing homes, older people, place of death |
Résumé | Objectives: recent studies have reported that hospitals have become a common place of death for nursing home residents. This study aimed to (i) measure variations in the proportion of in-hospital deaths across regions after adjustment for facility-level characteristics and (ii) identify environmental risk factors that might explain these variations in France. Design: a cross-sectional retrospective survey was conducted in 2013. Setting and participants: coordinating physicians in 3,705 nursing homes in France. Measurements: a regression model was used to construct risk-adjusted rates of in-hospital deaths considering the facilities' characteristics. At the regional level, the outcome was defined as the difference between the observed rate of in-hospital deaths and the expected risk-adjusted rate. Values exceeding zero indicated rates that exceeded the national predicted rate of in-hospital deaths and thus highlighted regions in which the risk-adjusted probability for nursing home residents to die in a hospital was greater than average. Results: among 70,119 nursing home decedents, 25.4% (n = 17,789) died in hospitals. The characteristics of the facilities had a significant influence on the proportion of in-hospital deaths among the nursing home decedents. However, after adjustment for these facility-level risk factors, the proportion of nursing homes that reported worse-than-average outcomes showed significant variation (range 26.0-79.6%). At the regional level, both the rate of acute hospital beds and the rate of general practitioners were found to be strongly correlated with the probability of reporting worse-than-average outcomes (P < 0.001). Conclusion: our study demonstrates the existence of major differences across regions in France and highlights the need for targeted interventions regarding end-of-life care in nursing home facilities. |
DOI | 10.1093/ageing/afu197 |