Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 12;11(8):e047086.
doi: 10.1136/bmjopen-2020-047086.

Hospitalisation in the last month of life and in-hospital death of nursing home residents: a cross-sectional analysis of six European countries

Elisabeth Honinx  1 , Ruth D Piers  2 , Bregje D Onwuteaka-Philipsen  3 , Sheila Payne  4 , Katarzyna Szczerbińska  5 , Giovanni Gambassi  6 , Marika Kylänen  7 , L Deliens  8 , Lieve Van den Block  9 , Tinne Smets  9 ; PACE collaborators
Collaborators, Affiliations

Hospitalisation in the last month of life and in-hospital death of nursing home residents: a cross-sectional analysis of six European countries

Elisabeth Honinx et al. BMJ Open. .

Abstract

Objectives: To examine the rate and characteristics of hospitalisation in the last month of life and place of death among nursing home residents and to identify related care processes, facility factors and residents' characteristics.

Setting: A cross-sectional study (2015) of deceased residents in 322 nursing homes in six European countries.

Participants: The nursing home manager (N=1634), physician (N=1132) and primary nurse (N=1384) completed questionnaires.

Outcome measures: Hospitalisation and place of death were analysed using generalised linear and logistic mixed models. Multivariate analyses were conducted to determine associated factors.

Results: Twelve to 26% of residents were hospitalised in the last month of life, up to 19% died in-hospital (p<0.001). Belgian residents were more likely to be hospitalised than those in Italy, the Netherlands and Poland. For those dying in-hospital, the main reason for admission was acute change in health status. Residents with a better functional status were more likely to be hospitalised or to die in-hospital. The likelihood of hospitalisation and in-hospital death increased if no conversation on preferred care with a relative was held. Not having an advance directive regarding hospitalisations increased the likelihood of hospitalisation.

Conclusions: Although participating countries vary in hospitalisation and in-hospital death rates, between 12% (Italy) and 26% (Belgium) of nursing home residents were hospitalised in the last month of life. Close monitoring of acute changes in health status and adequate equipment seem critical to avoiding unnecessary hospitalisations. Strategies to increase discussion of preferences need to be developed. Our findings can be used by policy-makers at governmental and nursing home level.

Keywords: adult palliative care; geriatric medicine; public health.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Numbers of questionnaires (distributed and returned) regarding residents per respondent in six countries.
See this image and copyright information in PMC

References

    1. Broad JB, Gott M, Kim H, et al. . Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health 2013;58:257–67. 10.1007/s00038-012-0394-5 - DOI - PubMed
    1. Honinx E, van Dop N, Smets T, et al. . Dying in long-term care facilities in Europe: the PACE epidemiological study of deceased residents in six countries. BMC Public Health 2019;19:1199. 10.1186/s12889-019-7532-4 - DOI - PMC - PubMed
    1. Ouslander JG, Lamb G, Perloe M, et al. . Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs: [see editorial comments by Drs. Jean F. Wyman and William R. Hazzard, pp 760-761]. J Am Geriatr Soc 2010;58:627–35. 10.1111/j.1532-5415.2010.02768.x - DOI - PubMed
    1. Houttekier D, Cohen J, Bilsen J, et al. . Place of death of older persons with dementia. A study in five European countries. J Am Geriatr Soc 2010;58:751–6. 10.1111/j.1532-5415.2010.02771.x - DOI - PubMed
    1. Verhofstede R, Smets T, Cohen J, et al. . Improving end-of-life care in acute geriatric hospital wards using the care programme for the last days of life: study protocol for a phase 3 cluster randomized controlled trial. BMC Geriatr 2015;15:13. 10.1186/s12877-015-0010-7 - DOI - PMC - PubMed

Publication types

LinkOut - more resources