Factors associated with hospital deaths in the oldest old: a cross-sectional study

Abstract

Aims/objectives: to study associations between the likelihood of hospital death with patient demographics, cause of death and co-morbidities for people aged ≥85 at death who have been previously admitted (within 12 months of death) to hospital.

Methods: a cross-sectional study, using death registration data and hospital episode statistics, for 671,178 England residents who had been admitted to hospital during the 12 months before death and were aged 85 or over at death during 2008-12. The outcome variable was the likelihood of dying in hospital. Covariates included gender, age, social deprivation, care home residence, cause of death and co-morbidity. Potential associations were explored by multivariable regression analysis.

Results: sixty-two per cent of the sample died in hospital. The likelihood of dying in hospital varies significantly with age, cause of death, deprivation, number of emergency hospital and co-morbidities. People aged over 90 at the time of death are less likely to die in hospital than those aged 85-89 [odds ratio (OR) for aged 90-94, 0.99; 95% confidence interval (CI) 0.98-1.00, OR for aged 95 and over, 0.91; 95% CI: 0.89-0.92]. People who are care home residents at the time of death are significantly less likely to die in hospital (OR 0.34; 95% CI: 0.34-0.35). Having a mention of dementia on the death certificate was significantly associated with a reduction in the likelihood of dying in hospital (OR 0.32; 95% CI: 0.31-0.32).

Conclusions: the likelihood of an older person dying in hospital is significantly associated with a number of socio-demographic factors, such as age and level of deprivation. Care home residence is significantly associated with a reduction in likelihood of hospital death.

Keywords: aged 85 or over; hospitals; location of death; older people; terminal care.