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Kelfve S, Wastesson JW, Meinow B. Length of the period with late life dependency: Does the age of onset make a difference? Eur J Ageing 2023; 20:30. [PMID: 37392319 DOI: 10.1007/s10433-023-00777-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/03/2023] Open
Abstract
There is a gap in knowledge about factors associated with the duration of late life dependency. In this study, we measured how the age at onset of late life dependency relates to the time spent with late life dependency. Using Swedish register data, we identified people 70 + who entered the period of late life dependency (measured by entering long-term care for help with PADLs) between June and December 2008. We followed this cohort (n = 17,515) for 7 years, or until death. We used Laplace regression models to estimate the median number of months with late life dependency by age group, gender, level of education and country of birth. We also calculated the crude percentiles (p10, p25, p50, p75 and p90) of month with late life dependency, by age group, gender and cohabitation status. Results show that the majority spent a rather long period with dependency, the median number of months were 40.0 (3.3 years) for women and 22.6 (1.9 year) for men. A higher age at entry was associated with a shorter duration of dependency, an association that was robust to adjustment for cohabiting at baseline, gender, education and country of birth. Our results suggest that older adults who postpone the start of dependency also compress the time with dependency, this lends support to the ambitions of public health initiatives and interventions targeting maintained independence in older adults.
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Affiliation(s)
- Susanne Kelfve
- Department of Culture and Society, Linköping University, Norrköping, Sweden.
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden.
| | - Jonas W Wastesson
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Bettina Meinow
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
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Colley A, Lin JA, Pierce L, Finlayson E, Sudore RL, Wick E. Missed Opportunities and Health Disparities for Advance Care Planning Before Elective Surgery in Older Adults. JAMA Surg 2022; 157:e223687. [PMID: 36001323 PMCID: PMC9403851 DOI: 10.1001/jamasurg.2022.3687] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/30/2022] [Indexed: 11/14/2022]
Abstract
Importance Advance care planning (ACP) prepares patients and caregivers for medical decision-making, yet it is underused in the perioperative surgical setting, particularly among older adults undergoing high-risk procedures who are at risk for postoperative complications. It is unknown what patient factors are associated with perioperative ACP documentation among older surgical patients. Objective To assess ACP documentation among high-risk patients 65 years and older undergoing elective surgery. Design, Setting, and Participants In this observational cohort study including 3671 patients 65 years and older undergoing elective surgery at a tertiary academic center in California, electronic health record data were linked to the National Surgical Quality Improvement Project outcomes data and the California statewide death registry. The study was conducted from January 1 to December 31, 2019. Data were analyzed from January to May 2022. Exposures Elective surgery requiring an inpatient admission. Main Outcomes and Measures ACP documentation, defined as a discussion regarding goals of care documented in an ACP note, an advance directive, or a physician order for life-sustaining treatment (POLST) form, within 90 days before elective surgery requiring inpatient admission. Multivariate regression was performed to identify factors associated with missing ACP. Results Among 3671 patients (median [IQR] age 72 [65-94] years; 1784 [48.6%] female; 401 [10.9%] Asian, 155 [4.2%] Black, 284 [7.7%] Latino/Latina, 2647 [72.1%] White, and 184 [5.0%] of other races or ethnicities, including American Indian or Alaska Native, Native Hawaiian or Pacific Islander, multiple races or ethnicities, other, and unknown or declined to respond, combined owing to small numbers), 539 (14.7%) had ACP documentation in the 90-day presurgery window. Of these 539, 448 (83.1%) had advance directives, and 60 (11.1%) had POLST forms. The 30-day and 1-year mortality were 0.7% (n = 27) and 6.6% (n = 244), respectively. Missing ACP was significantly associated with male sex (adjusted odds ratio [aOR], 1.39; 95% CI, 1.14-1.69) and having a non-English preferred language (aOR, 1.78; 95% CI, 1.18-2.79). Medicare insurance was significantly associated with having ACP (aOR for missing ACP, 0.63; 95% CI, 0.40-0.95). Conclusions and Relevance In this study, perioperative ACP was uncommon, particularly in men, individuals with a non-English preferred language, and those without Medicare insurance coverage. The perioperative setting may represent a missed opportunity for ACP for older surgical patients. When addressing ACP for surgical patients, particular attention should be paid to overcoming language-related disparities.
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Affiliation(s)
- Alexis Colley
- Department of Surgery, University of California, San Francisco
| | - Joseph A. Lin
- Department of Surgery, University of California, San Francisco
| | - Logan Pierce
- Department of Medicine, University of California, San Francisco
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco
| | - Rebecca L. Sudore
- Department of Medicine, Division of Geriatrics, University of California, San Francisco
| | - Elizabeth Wick
- Department of Surgery, University of California, San Francisco
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Wang M, Wang X, Cui W, Zhu G, Liang Y, Chen X, Jin T. The association between hemoglobin level and osteoporosis in a Chinese population with environmental lead and cadmium exposure. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2022; 44:1673-1682. [PMID: 34698982 DOI: 10.1007/s10653-021-01129-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/09/2021] [Indexed: 06/13/2023]
Abstract
Low hemoglobin (Hb) level or anemia is associated with osteoporosis and bone fracture. Cadmium (Cd) and lead (Pb) exposure are also risk factors of osteoporosis and anemia. However, the role of anemia in Cd/Pb related bone loss remains unclear. The aim of present study was to investigate the association between Hb level and bone loss in a population with environmental lead and cadmium exposure. One hundred and ninety-four women and 108 men with different levels of Cd/Pb exposure were included in our study. The Cd/Pb exposure was determined using graphite-furnace atomic absorption spectrometry. Forearm bone mineral density (BMD) was determined by peripheral dual-energy X-ray absortiometry. Hb concentration was determined using an automatic blood cellcounter. A logistic model was established to predict the risk of osteoporosis. The BMDs of women that had the highest quartile BCd and BPb were markedly lower than that with the lowest quartile (p < 0.05). The BMD and the prevalence of osteoporosis in men with anemia were lower and higher than that with normal Hb (p < 0.05), respectively. In men, age, BPb and anemia were independent risk factors for osteoporosis. The odds ratio (OR) of men with anemia was 11.28 (95%confidence interval (CI):1.94-65.54) and 19.56 (95%CI: 2.98-128.78) compared to those with normal Hb after adjusting for potential cofounders. No such association was found in women. The area under the curve was 0.88 (95%CI: 0.82-0.96) in predicting osteoporosis using the logistic model in men. Linear discriminant analysis also showed that 90.7% of osteoporosis was correctly classified. Our data show that anemia is associated with incident of osteoporosis in men but not in women that environmentally exposed to Pb and Cd.
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Affiliation(s)
- Miaomiao Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Xinru Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Wenjing Cui
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Guoying Zhu
- Institute of Radiation Medicine, Fudan University, 2094 Xietu road, Shanghai, 200032, China
| | - Yihuai Liang
- Department of Occupational Medicine, School of Public Health, Shanghai Medical College of Fudan University, 150 Dongan road, Shanghai, 200032, China
| | - Xiao Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
| | - Taiyi Jin
- Department of Occupational Medicine, School of Public Health, Shanghai Medical College of Fudan University, 150 Dongan road, Shanghai, 200032, China.
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Meinow B, Wastesson JW, Kåreholt I, Kelfve S. Long-Term Care Use During the Last 2 Years of Life in Sweden: Implications for Policy to Address Increased Population Aging. J Am Med Dir Assoc 2020; 21:799-805. [PMID: 32081681 DOI: 10.1016/j.jamda.2020.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/14/2019] [Accepted: 01/02/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To map out the total use of long-term care (LTC; ie, home care or institutional care) during the last 2 years of life and to investigate to what extent gender differences in LTC use were explained by cohabitation status and age at death. DESIGN The National Cause of Death Register was used to identify decedents. Use of LTC was based on the Social Services Register (SSR) and sociodemographic factors were provided by Statistics Sweden. SETTING AND PARTICIPANTS All persons living in Sweden who died in November 2015 aged ≥67 years (n = 5948). METHODS Zero inflated negative binomial regression was used to estimate the relative impact of age, gender, and cohabitation status on the use of LTC. RESULTS Women used LTC to a larger extent [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.92-2.50] and for a longer period [risk ratio (RR) 1.14, 95% CI 1.11-1.18] than men. When controlling for age at death and cohabitation status, gender differences in LTC attenuated (OR 1.47, 95% CI 1.28-1.72) and vanished in regard to the duration. In the controlled model, women used LTC for 15.6 months (95% CI 15.2-16.0) and men for 14.1 months (95% CI 13.7-14.5) out of 24 months. The length of stay in institutional care was 7.2 (95% CI 6.8-7.5) and 6.2 months (95% CI 5.8-6.6), respectively. CONCLUSIONS AND IMPLICATIONS A substantial part of women's greater use of LTC was due to their higher age at death and because they more often lived alone. Given that survival continues to increase, the association between older age at death and LTC use suggests that policy makers will have to deal with an increased pressure on the LTC sector. Yet, increased survival among men could imply that more women will have access to spousal caregivers, although very old couples may have limited capacity for extensive caregiving at the end of life.
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Affiliation(s)
- Bettina Meinow
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Jonas W Wastesson
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ingemar Kåreholt
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden; Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Susanne Kelfve
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden; Division Ageing and Social Change, Department of Social and Welfare studies, Linköping University, Linköping, Sweden
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Abstract
BACKGROUND Although most surgical outcomes research focuses on clinical end points and complications, older adult patients may value functional outcomes more. However, little is known about the risk of long-term functional disability after colorectal procedures. OBJECTIVE The purpose of this research was to understand the incidence and likelihood of functional decline after high-risk (ie, ≥1% inpatient mortality) colorectal operations both without and with complications. DESIGN This was a retrospective matched cohort study. SETTINGS The Health and Retirement Study, a nationally representative, longitudinal survey of adults >50 years of age, collects data on functional status, cognition, and demographics, among other topics. The survey was linked with Medicare claims and National Death Index data from 1992 to 2012. PATIENTS Patients ≥65 years of age who underwent elective high-risk colorectal surgery with functional status measured before and after surgery were included. These patients were matched 1:3 to survey respondents who did not undergo major surgery, based on propensity scores. MAIN OUTCOME MEASURES Functional decline, the primary outcome, was defined as an increase in the number of activities of daily living and instrumental activities of daily living requiring assistance before and after surgery. Using logistic regression, we examined whether surgery without or with complications was associated with functional decline. RESULTS We identified 289 patients who underwent high-risk colorectal surgery and 867 matched control subjects. Of the surgery patients, 90 (31%) experienced a complication. Compared with the control subjects, surgery patients experienced greater likelihood of functional decline (without complications: OR = 1.82 (95% CI, 1.22-2.71), and with complications: OR = 2.96 (95% CI, 1.70-5.14)). Increasing age also predicted greater odds of functional decline (OR = 2.09, per decade (95% CI, 1.57-2.80)). LIMITATIONS The functional measures were self-reported by survey participants. CONCLUSIONS High-risk colorectal surgery, without or with complications, is associated with increased likelihood of functional decline in older adults. Patient-centered decision-making should include discussion of expected functional outcomes and long-term disability. See Video Abstract at http://links.lww.com/DCR/B78. PÉRDIDA DE LA FUNCIONALIDAD A LARGO PLAZO LUEGO DE CIRUGÍA ELECTIVA COLORRECTAL DE ALTO RIESGO EN EL PACIENTE AÑOSO: Aunque en la mayoría de las investigaciones los resultados quirúrgicos se centran en los puntos finales clínicos y las complicaciones, actualmente se pueden valorar los resultados funcionales en el paciente añoso. Sin embargo, se sabe poco sobre el riesgo de la discapacidad funcional a largo plazo después de un procedimiento colorrectal.Comprender la incidencia y la probabilidad del deterioro funcional después de operaciones colorrectales de alto riesgo (es decir, ≥1% de mortalidad hospitalaria) con y sin complicaciones.Estudio de cohorte emparejado retrospectivo.El seguimiento longitudinal representativo a nivel nacional en adultos de >50 años y que recopila datos sobre su estado funcional, su estado cognitivo y su demografía, entre otros temas es el llamado "Estudio de Salud en jubilados." La encuesta se vinculó con los reclamos de Medicare y los datos del Índice Nacional de Defunciones entre 1992 y 2012.Aquellos de ≥65 años que se sometieron a cirugía colorrectal electiva de alto riesgo con un estado funcional medido antes y después de la cirugía. Estos pacientes se compararon 1: 3 con los encuestados que no se sometieron a cirugía mayor, según puntajes de propensión.La disminución functional como resultado primario, se definió como un aumento en el número de actividades de la vida diaria y actividades instrumentales de la vida diaria que requieren asistencia antes y después de la cirugía. Mediante la regresión logística, evaluamos si la cirugía sin complicaciones y/o con complicaciones se asoció con un deterioro funcional.Identificamos 289 pacientes que se sometieron a cirugía colorrectal de alto riesgo y 867 controles pareados. De los pacientes de cirugía, 90 (31%) experimentaron algun tipo de complicación. En comparación con los controles, los pacientes de cirugía experimentaron una mayor probabilidad de deterioro funcional (sin complicaciones: OR 1.82, IC 95% 1.22-2.71, y con complicaciones: OR 2.96, IC 95% 1.70-5.14). El aumento de la edad también predijo mayores probabilidades en el deterioro funcional (OR 2.09, por década, IC 95% 1.57-2.80).Las medidas funcionales fueron autoinformadas por los participantes de la encuesta.La cirugía colorrectal de alto riesgo, con o sin complicaciones, se asocia con una mayor probabilidad de deterioro funcional en adultos mayores. La toma de decisiones centradas en el paciente deben incluir la discusión de los resultados funcionales esperados y la discapacidad a largo plazo. Vea el resumen del video en http://links.lww.com/DCR/B78.
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Alwin J, Karlson BW, Husberg M, Carlsson P, Ekerstad N. Societal costs of informal care of community-dwelling frail elderly people. Scand J Public Health 2019; 49:433-440. [PMID: 31826709 DOI: 10.1177/1403494819844354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aims: The aims of this study are to describe informal care activities and to estimate the societal cost of informal care of community-dwelling frail elderly people in Sweden. Methods: This study was performed within the frame of the TREEE project that included 408 frail elderly patients. At index hospitalisation (baseline), primary informal caregivers of the patients were provided with a questionnaire on informal care during a period of three months. Questions concerning other (secondary) informal caregivers were also included. A rough estimate of the total cost of informal care of frail elderly people in Sweden was obtained by combining data from this study with published data and official statistics. Results: In total, 176 informal caregivers responded, and 89% had provided informal care. The informal caregivers (primary and secondary) provided care for an average of 245 hours over three months. Taking care of the home was the dominating activity. In total, the mean cost of informal care was estimated to approximately 18,000 SEK (€1878) over three months, corresponding to an annual cost of approximately 72,000 SEK (€7477) per frail elderly person. The total annual societal costs of informal care of community dwelling frail elderly people aged 75 years and older in Sweden was estimated to be approximately 11,000 million SEK (€1150 million). Conclusions: The care of frail elderly people provided by informal caregivers is extensive and represents a great economic value. Although our calculations are associated with uncertainty, the size indicates that supporting informal caregivers should be a priority for society.
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Affiliation(s)
- Jenny Alwin
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Sweden
| | - Björn W Karlson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Acute and Internal Medicine, NU (NÄL-Uddevalla) Hospital Group, Sweden
| | - Magnus Husberg
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Sweden
| | - Per Carlsson
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Sweden
| | - Niklas Ekerstad
- Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Sweden
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Wang H, Hai S, Liu Y, Liu Y, Dong B. Skeletal Muscle Mass as a Mortality Predictor among Nonagenarians and Centenarians: A Prospective Cohort Study. Sci Rep 2019; 9:2420. [PMID: 30787413 PMCID: PMC6382937 DOI: 10.1038/s41598-019-38893-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/04/2018] [Indexed: 02/05/2023] Open
Abstract
This study aimed to evaluate the association between skeletal muscle mass and long-term all-cause mortality among nonagenarians and centenarians in China. We used data from the Project of Longevity and Aging in Dujiangyan (PLAD). A total of 738 community-dwelling people aged ≥ 90 years (mean age of 93.5 ± 3.2 years) were analyzed in this study. The appendicular skeletal muscle mass (ASM) was estimated using a previously validated anthropometric equation. The information on the survival status was requested from the local government registries during the 4 year follow-up period following the baseline investigation. The mean muscle mass index (SMI) was 6.11 ± 0.53 kg/m2 in men and 4.00 ± 0.63 kg/m2 in women, respectively. Low muscle mass was associated with a higher risk of death (hazard ratio [HR] 1.54; (95% confidence interval [CI]:1.10–2.16) in women; however, no significant association was found in men. Disability in activities of daily living (ADL) (HR = 1.73; 95% CI: 1.13–2.63) in men and women and cognitive impairment (HR = 1.49; 95% CI: 1.05–2.13) in men were also associated with increased all-cause mortality. In conclusion, low muscle mass were predictors of long-term mortality in nonagenarian and centenarian women.
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Affiliation(s)
- Hui Wang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.,Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Shan Hai
- Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Yixin Liu
- Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ying Liu
- Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Birong Dong
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.
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Bloomer MJ, Botti M, Runacres F, Poon P, Barnfield J, Hutchinson AM. End-of-life care for older people in subacute care: A retrospective clinical audit. Collegian 2019. [DOI: 10.1016/j.colegn.2018.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Forma L, Aaltonen M, Pulkki J, Raitanen J, Rissanen P, Jylhä M. Long-term care is increasingly concentrated in the last years of life: a change from 2000 to 2011. Eur J Public Health 2018; 27:665-669. [PMID: 28339763 DOI: 10.1093/eurpub/ckw260] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The use of long-term care (LTC) is common in very old age and in the last years of life. It is not known how the use pattern is changing as death is being postponed to increasingly old age. The aim is to analyze the association between the use of LTC and approaching death among old people and the change in this association from 2000 to 2011. Methods The data were derived from national registers. The study population consists of 315 458 case-control pairs. Cases (decedents) were those who died between 2000 and 2011 at the age of 70 years or over in Finland. The matched controls (survivors) lived at least 2 years longer. Use of LTC was studied for the last 730 days for decedents and for the same calendar days for survivors. Conditional logistic regression analyses were performed to test the association of LTC use with decedent status and year. Results The difference in LTC use between decedents and survivors was smallest among the oldest (OR 9.91 among youngest, 4.96 among oldest). The difference widened from 2000 to 2011 (OR of interaction of LTC use and year increased): use increased or held steady among decedents, but decreased among survivors. Conclusions The use of LTC became increasingly concentrated in the last years of life during the study period. The use of LTC is also common among the oldest survivors. As more people live to very old age, the demand for LTC will increase.
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Affiliation(s)
- Leena Forma
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland.,Institute for Advanced Social Research, University of Tampere, Finland
| | - Mari Aaltonen
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland
| | - Jutta Pulkki
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland
| | - Jani Raitanen
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland.,UKK-Institute for Health Promotion Research, Tampere, Finland
| | - Pekka Rissanen
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland
| | - Marja Jylhä
- School of Health Sciences and Gerontology Research Center (GEREC), University of Tampere, Finland
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10
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Zapata C, Lum HD, Wistar E, Horton C, Sudore RL. Feasibility of a Video-Based Advance Care Planning Website to Facilitate Group Visits among Diverse Adults from a Safety-Net Health System. J Palliat Med 2018; 21:853-856. [PMID: 29461918 DOI: 10.1089/jpm.2017.0476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary care providers in safety-net settings often do not have time to discuss advance care planning (ACP). Group visits (GV) may be an efficient means to provide ACP education. OBJECTIVES To assess the feasibility and impact of a video-based website to facilitate GVs to engage diverse adults in ACP. DESIGN Feasibility pilot among patients who were ≥55 years of age from two primary care clinics in a Northern California safety-net setting. Participants attended two 90-minute GVs and viewed the five steps of the movie version of the PREPARE website ( www.prepareforyourcare.org ) concerning surrogates, values, and discussing wishes in video format. Two clinician facilitators were available to encourage participation. MEASUREMENTS We assessed pre-to-post ACP knowledge, whether participants designated a surrogate or completed an advance directive (AD), and acceptability of GVs and PREPARE materials. RESULTS We conducted two GVs with 22 participants. Mean age was 64 years (±7), 55% were women, 73% nonwhite, and 55% had limited literacy. Knowledge improved about surrogate designation (46% correct pre vs. 85% post, p = 0.01) and discussing decisions with others (59% vs. 90%, p = 0.01). Surrogate designation increased (48% vs. 85%, p = 0.01) and there was a trend toward AD completion (9% vs. 24%, p = 0.21). Participants rated the GVs and PREPARE materials a mean of 8 (±3.1) on a 10-point acceptability scale. CONCLUSIONS Using the PREPARE movie to facilitate ACP GVs for diverse adults in safety net, primary care settings is feasible and shows potential for increasing ACP engagement.
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Affiliation(s)
- Carly Zapata
- 1 Division of Hospital Medicine, Department of Medicine, University of California , San Francisco, California
| | - Hillary D Lum
- 2 VA Eastern Colorado Geriatric Research Education and Clinical Center (GRECC) , Denver, Colorado.,3 Division of Geriatric Medicine, Department of Medicine, University of Colorado , Aurora, Colorado
| | - Emily Wistar
- 4 Caleb G. Clark Potrero Hill Health Center , Department of Public Health, San Francisco, California.,5 Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California , San Francisco, California
| | - Claire Horton
- 5 Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California , San Francisco, California
| | - Rebecca L Sudore
- 6 Division of Geriatrics, Department of Medicine, University of California , San Francisco, California.,7 San Francisco Veterans Affairs Medical Center , San Francisco, California
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Abstract
Top themes of international research on disability in the past three decades are discussed: disability dynamics, buffers and barriers for disability, disability trends, and disability among very old persons. Each theme is highlighted by research examples. Turning to measurement, I discuss traditional measures of disability, new longer and shorter ones, and composites like disability-free life expectancy, noting their merits. Contemporary models of disability are presented, ranging from visual images to formal theories. The article ends on how scientists can facilitate movement of disability science into health care practice and policy.
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12
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Fleming J, Calloway R, Perrels A, Farquhar M, Barclay S, Brayne C. Dying comfortably in very old age with or without dementia in different care settings - a representative "older old" population study. BMC Geriatr 2017; 17:222. [PMID: 28978301 PMCID: PMC5628473 DOI: 10.1186/s12877-017-0605-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 09/01/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Comfort is frequently ranked important for a good death. Although rising numbers of people are dying in very old age, many with dementia, little is known about symptom control for "older old" people or whether care in different settings enables them to die comfortably. This study aims to examine, in a population-representative sample, associations between factors potentially related to reported comfort during very old people's final illness: physical and cognitive disability, place of care and transitions in their final illness, and place of death. METHODS Retrospective analyses linked three data sources for n = 180 deceased study participants (68% women) aged 79-107 in a representative population-based UK study, the Cambridge City over-75s Cohort (CC75C): i) prospective in-vivo dementia diagnoses and cognitive assessments, ii) certified place of death records, iii) data from interviews with relatives/close carers including symptoms and "How comfortable was he/she in his/her final illness?" RESULTS In the last year of life 83% were disabled in basic activities, 37% had moderate/severe dementia and 45% minimal/mild dementia or cognitive impairment. Regardless of dementia/cognitive status, three-quarters died following a final illness lasting a week or longer. 37%, 44%, 13% and 7% of the deceased were described as having been "very comfortable", "comfortable", "fairly comfortable" or "uncomfortable" respectively during their final illness, but reported symptoms were common: distress, pain, depression and delirium or confusion each affected 40-50%. For only 10% were no symptoms reported. There were ≥4-fold increased odds of dying comfortably associated with being in a care home during the final illness, dying in a care home, and with staying in place (dying at what death certificates record as "usual address"), whether home or care home, compared with hospital, but no significant association with disability or dementia/cognitive status, regardless of adjustment. CONCLUSIONS These findings are consistent with reports that care homes can provide care akin to hospice for the very old and support an approach of supporting residents to stay in their care home or own home if possible. Findings on reported high prevalence of multiple symptoms can inform policy and training to improve older old people's end-of-life care in all settings.
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Affiliation(s)
- Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
| | - Rowan Calloway
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- North East Thames Foundation School, London, UK
| | - Anouk Perrels
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Faculty of Medicine, Vrije Universiteit, Amsterdam, Netherlands
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Barclay
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
- Primary Care Unit, Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
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Forma L, Jylhä M, Pulkki J, Aaltonen M, Raitanen J, Rissanen P. Trends in the use and costs of round-the-clock long-term care in the last two years of life among old people between 2002 and 2013 in Finland. BMC Health Serv Res 2017; 17:668. [PMID: 28927415 PMCID: PMC5606077 DOI: 10.1186/s12913-017-2615-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The structure of long-term care (LTC) for old people has changed: care has been shifted from institutions to the community, and death is being postponed to increasingly old age. The aim of the study was to analyze how the use and costs of LTC in the last two years of life among old people changed between 2002 and 2013. METHODS Data were derived from national registers. The study population contains all those who died at the age of 70 years or older in 2002-2013 in Finland (N = 427,078). The costs were calculated using national unit cost information. Binary logistic regression and Cox proportional hazard models were used to study the association of year of death with use and costs of LTC. RESULTS The proportion of those who used LTC and the sum of days in LTC in the last two years of life increased between 2002 and 2013. The mean number of days in institutional LTC decreased, while that for sheltered housing increased. The costs of LTC per user decreased. CONCLUSIONS Use of LTC in the last two years of life increased, which was explained by the postponement of death to increasingly old age. Costs of LTC decreased as sheltered housing replaced institutional LTC. However, an accurate comparison of costs of different types of LTC is difficult, and the societal costs of sheltered housing are not well known.
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Affiliation(s)
- Leena Forma
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Marja Jylhä
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Jutta Pulkki
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Mari Aaltonen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
- Institute for Advanced Social Research, University of Tampere, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
- UKK-Institute for Health Promotion, Tampere, Finland
| | - Pekka Rissanen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
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Herr M, Arvieu JJ, Robine JM, Ankri J. Health, frailty and disability after ninety: Results of an observational study in France. Arch Gerontol Geriatr 2016; 66:166-75. [PMID: 27341649 DOI: 10.1016/j.archger.2016.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/09/2016] [Accepted: 06/04/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND In spite of their increasing demographic weight, health characteristics of the oldest old remain poorly described in epidemiological studies. OBJECTIVE To describe the health of people aged 70 years and over included in the SIPAF study, and to compare the prevalence of health indicators including successful aging, frailty, and disability between three age groups including the oldest old. METHODS The study population is composed of 2350 retired people recruited between 2008 and 2010, of whom 512 are aged 90 and over (21.8%). A comprehensive geriatric assessment was performed at home by trained nurses. The prevalence of health and functional indicators, as well as the distribution of people among successful ageing, frailty, and disability, were described by age group (70-79, 80-89, 90+) and sex. RESULTS Compared to their younger counterparts, people aged 90 years and over were more likely to experience functional limitations, sensory impairment, cognitive impairment, poor mood, and frailty. One third of the nonagenarians needed help in at least one basic activity of daily living and 25% met the frailty criteria. In contrast, the prevalence of most chronic diseases did not increase after ninety. Successful ageing concerned 9% of the oldest old. Women were less likely to experience successful ageing and more likely to be frail or dependent. CONCLUSION This study shows the diversity of health states in very old age and points out that one quarter of the people aged 90 and over said frail are likely to take advantage of preventive actions of disability.
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Affiliation(s)
- M Herr
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France; Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France; AP-HP, Hôpital Sainte Périne, Département de Santé Publique, Paris, France.
| | - J J Arvieu
- AG2R La Mondiale, Direction des Etudes, Prévoyance Individuelle et IARD, Paris, France
| | - J M Robine
- INSERM U988 et U1198, EPHE, Paris & Montpellier, France
| | - J Ankri
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France; Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France; AP-HP, Hôpital Sainte Périne, Département de Santé Publique, Paris, France
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Cho J, Smith ML, Ahn S, Kim K, Appiah B, Ory MG. Effects of an Evidence-Based Falls Risk-Reduction Program on Physical Activity and Falls Efficacy among Oldest-Old Adults. Front Public Health 2015; 2:182. [PMID: 25964911 PMCID: PMC4410414 DOI: 10.3389/fpubh.2014.00182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/23/2014] [Indexed: 11/26/2022] Open
Abstract
Purpose of the study The current study was designed to examine changes in falls efficacy and physical activities among oldest-old and young-old participants in a falls risk-reduction program called a matter of balance/volunteer lay leader model. Design and methods An oldest-old group (aged 85 years and older; n = 260) and a young-old group (aged between 65 and 84 years old; n = 1,139) in Texas with both baseline and post-intervention measures were included. Changes in Falls Efficacy Scale scores and weekly physical activity levels were examined from baseline to post-intervention. Repeated measures analysis of covariance were employed to assess program effects on falls efficacy. Results Results showed significant changes in falls efficacy from baseline to post-intervention, as well as a significant interaction effect between time (baseline and post-intervention) and physical activity on falls efficacy. Implications Findings from this study imply the effectiveness of evidence-based programs for increasing falls efficacy in oldest-old participants. Future implications for enhancing physical activities and reducing fear of falling for oldest-old adults are discussed.
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Affiliation(s)
- Jinmyoung Cho
- Center for Applied Health Research, Baylor Scott and White Health , Temple, TX , USA ; Department of Health Promotion and Community Health Science, Texas A&M Health Science Center, School of Public Health , College Station, TX , USA
| | - Matthew Lee Smith
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia , Athens, GA , USA
| | - SangNam Ahn
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis , Memphis, TN , USA
| | - Keonyeop Kim
- Department of Preventive Medicine, Graduate School of Public Health, Kyungpook National University , Daegu , South Korea
| | - Bernard Appiah
- Department of Public Health Studies, Texas A&M Health Science Center School of Public Health , College Station, TX , USA
| | - Marcia G Ory
- Department of Health Promotion and Community Health Science, Texas A&M Health Science Center, School of Public Health , College Station, TX , USA
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Evans CJ, Ho Y, Daveson BA, Hall S, Higginson IJ, Gao W. Place and cause of death in centenarians: a population-based observational study in England, 2001 to 2010. PLoS Med 2014; 11:e1001653. [PMID: 24892645 PMCID: PMC4043499 DOI: 10.1371/journal.pmed.1001653] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/17/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Centenarians are a rapidly growing demographic group worldwide, yet their health and social care needs are seldom considered. This study aims to examine trends in place of death and associations for centenarians in England over 10 years to consider policy implications of extreme longevity. METHODS AND FINDINGS This is a population-based observational study using death registration data linked with area-level indices of multiple deprivations for people aged ≥100 years who died 2001 to 2010 in England, compared with those dying at ages 80-99. We used linear regression to examine the time trends in number of deaths and place of death, and Poisson regression to evaluate factors associated with centenarians' place of death. The cohort totalled 35,867 people with a median age at death of 101 years (range: 100-115 years). Centenarian deaths increased 56% (95% CI 53.8%-57.4%) in 10 years. Most died in a care home with (26.7%, 95% CI 26.3%-27.2%) or without nursing (34.5%, 95% CI 34.0%-35.0%) or in hospital (27.2%, 95% CI 26.7%-27.6%). The proportion of deaths in nursing homes decreased over 10 years (-0.36% annually, 95% CI -0.63% to -0.09%, p = 0.014), while hospital deaths changed little (0.25% annually, 95% CI -0.06% to 0.57%, p = 0.09). Dying with frailty was common with "old age" stated in 75.6% of death certifications. Centenarians were more likely to die of pneumonia (e.g., 17.7% [95% CI 17.3%-18.1%] versus 6.0% [5.9%-6.0%] for those aged 80-84 years) and old age/frailty (28.1% [27.6%-28.5%] versus 0.9% [0.9%-0.9%] for those aged 80-84 years) and less likely to die of cancer (4.4% [4.2%-4.6%] versus 24.5% [24.6%-25.4%] for those aged 80-84 years) and ischemic heart disease (8.6% [8.3%-8.9%] versus 19.0% [18.9%-19.0%] for those aged 80-84 years) than were younger elderly patients. More care home beds available per 1,000 population were associated with fewer deaths in hospital (PR 0.98, 95% CI 0.98-0.99, p<0.001). CONCLUSIONS Centenarians are more likely to have causes of death certified as pneumonia and frailty and less likely to have causes of death of cancer or ischemic heart disease, compared with younger elderly patients. To reduce reliance on hospital care at the end of life requires recognition of centenarians' increased likelihood to "acute" decline, notably from pneumonia, and wider provision of anticipatory care to enable people to remain in their usual residence, and increasing care home bed capacity.
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Affiliation(s)
- Catherine J. Evans
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, United Kingdom
- Sussex Community NHS Trust, Brighton and Hove, United Kingdom
- * E-mail:
| | - Yuen Ho
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, United Kingdom
| | - Barbara A. Daveson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, United Kingdom
| | - Sue Hall
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, United Kingdom
| | - Irene J. Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, United Kingdom
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, United Kingdom
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The association of mavenism and pleasure with food involvement in older adults. Int J Behav Nutr Phys Act 2014; 11:60. [PMID: 24885765 PMCID: PMC4013542 DOI: 10.1186/1479-5868-11-60] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 04/22/2014] [Indexed: 11/23/2022] Open
Abstract
Background Food involvement is concerned with the involvement people have in the preparation and consumption of food. Little is known about older people’s food involvement or about the factors which may influence it. Therefore the main aim of this study was to examine food involvement and its associations among older Australians. Methods An Internet-based nationwide survey of 1,041 people aged 55 years and over (M = 66 years, SD 6.99) was conducted in 2012. Quota sampling was used to ensure that the age, gender and state of residence of the respondents were representative of the Australian population aged over 55 years. Bell and Marshall’s Food Involvement Scale was administered, along with questions pertaining to socio-demographic, social and hedonic factors. Results Overall predictor variables explained 45% (p = <0.0001) of variance in food involvement. Food mavenism and pleasure motivation for food were the factors most strongly associated with food involvement (β = .36; 95% CI .46, .61; p = < 0.0001 and β = .31; 95% CI .78, 1.08; p = < 0.0001, respectively). The predictive ability of demographic factors was reasonably poor. Conclusions Food mavenism and pleasure motivation are stronger predictors of Food Involvement than demographic factors. This suggests communication and health promotion opportunities among older people.
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Wilson AH, Kidd AC, Skinner J, Musonda P, Pai Y, Lunt CJ, Butchart C, Soiza RL, Potter JF, Myint PK. A simple 5-point scoring system, NaURSE (Na+, urea, respiratory rate and shock index in the elderly), predicts in-hospital mortality in oldest old. Age Ageing 2014; 43:352-7. [PMID: 24487652 DOI: 10.1093/ageing/afu002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND the mortality is high in acutely ill oldest old patients. Understanding the prognostic factors which influence mortality will help clinicians make appropriate management decisions. METHODS we analysed prospective mortality audit data (November 2008 to January 2009) to identify variables associated with in-patient mortality in oldest old. We selected those with P < 0.10 from univariate analysis and determined at which cut-point they served as the strongest predictor of mortality. Using these cut-off points, we constructed multivariate logistic regression models. A 5-point score was derived from cut-off points which were significantly associated with mortality tested in a smaller independent re-audit sample conducted in October 2011. RESULTS a total of 405 patients (mean 93.5 ± 2.7 years) were included in the study. The mean length of stay was 18.5 ± 42.4 days and 13.8% died as in-patients. Variables (cut-off values) found to be significantly associated with in-patient mortality were admission sodium (>145 mmol/l), urea (≥14 mmol/l), respiratory rate (>20/min) and shock index (>1.0): creating a 5-point score (NaURSE: NaURS in the Elderly). The crude mortality rates were 9.5, 19.9, 34.4, 66.7, and 100% for scores 0, 1, 2, 3 and 4, respectively. Using the cut-off point of ≥2, the NaURSE score has a specificity of 87% (83.1-90.3) and sensitivity of 39% (28.5-50.0), with an AUC value of 0.69 (0.63-0.76). An external independent validation study (n = 121) showed similar results. CONCLUSIONS the NaURSE score may be particularly useful in identifying oldest old who are likely to die in that admission to guide appropriate care.
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Affiliation(s)
- Alexander H Wilson
- Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, UK
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Perrels AJ, Fleming J, Zhao J, Barclay S, Farquhar M, Buiting HM, Brayne C. Place of death and end-of-life transitions experienced by very old people with differing cognitive status: retrospective analysis of a prospective population-based cohort aged 85 and over. Palliat Med 2014; 28:220-33. [PMID: 24317193 DOI: 10.1177/0269216313510341] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite fast-growing 'older old' populations, 'place of care' trajectories for very old people approaching death with or without dementia are poorly described and understood. AIM To explore end-of-life transitions of 'older old' people across the cognitive spectrum. DESIGN Population-based prospective cohort (United Kingdom) followed to death. SETTING/PARTICIPANTS Mortality records linked to 283 Cambridge City over-75s Cohort participants' cognitive assessments <1 year before dying aged ≥ 85 years. RESULTS Overall, 69% were community dwelling in the year before death; of those with severe cognitive impairment 39% were community dwelling. Only 6% subsequently changed their usual address. However, for 55% their usual address on death registration was not their place of death. Dying away from the 'usual address' was associated with cognition, overall fewer moving with increasing cognitive impairment - cognition intact 66%, mildly/moderately impaired 55% and severely impaired 42%, trend p = 0.003. This finding reflects transitions being far more common from the community than from institutions: 73% from the community and 28% from institutions did not die where last interviewed (p < 0.001). However, severely cognitively impaired people living in the community were the most likely group of all to move: 80% (68%-93%). Hospitals were the most common place of death except for the most cognitively impaired, who mostly died in care homes. CONCLUSION Most very old community-dwelling individuals, especially the severely cognitively impaired, died away from home. Findings also suggest that long-term care may play a role in avoidance of end-of-life hospital admissions. These results provide important information for planning end-of-life services for older people across the cognitive spectrum, with implications for policies aimed at supporting home deaths. MESH TERMS: Cognitive impairment, Dementia, Aged, 80 and over, Aged, frail elderly, Patient Transfer, Residential characteristics, Homes for the aged, Nursing Homes, Delivery of Health Care, Terminal care Other key phrases: Older old, Oldest old, Place of death, Place of care, End-of-life care.
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Affiliation(s)
- Anouk J Perrels
- 1Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
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20
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Kidd AC, Musonda P, Soiza RL, Butchart C, Lunt CJ, Pai Y, Hameed Y, Fox C, Potter JF, Myint PK. The relationship between total anticholinergic burden (ACB) and early in-patient hospital mortality and length of stay in the oldest old aged 90 years and over admitted with an acute illness. Arch Gerontol Geriatr 2014; 59:155-61. [PMID: 24582945 DOI: 10.1016/j.archger.2014.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/22/2014] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Abstract
The use of prescription drugs in older people is high and many commonly prescribed drugs have anticholinergic effects. We examined the relationship between ACB on mortality and in-patient length of stay in the oldest old hospitalised population. This was a retrospective analysis of prospective audit using hospital audit data from acute medical admissions in three hospitals in England and Scotland. Baseline use of possible or definite anticholinergics was determined according to the Anticholinergic Cognitive Burden Scale. The main outcome measures were decline in-hospital mortality, early in-hospital mortality at 3- and 7-days and in-patient length of stay. A total of 419 patients (including 65 patients with known dementia) were included [median age=92.9, inter-quartile range (IQR) 91.4-95.1 years]. 256 (61.1%) were taking anticholinergic medications. Younger age, greater number of pre-morbid conditions, ischemic heart disease, number of medications, higher urea and creatinine levels were significantly associated with higher total ACB burden on univariate regression analysis. There were no significant differences observed in terms of in-patient mortality, in-patient hospital mortality within 3- and 7-days and likelihood of prolonged length of hospital stay between ACB categories. Compared to those without cardiovascular disease, patients with cardiovascular disease showed similar outcome regardless of ACB load (either =0 or >0 ACB). We found no association between ACB and early (within 3- and 7-days) and in-patient mortality and hospital length of stay outcomes in this cohort of oldest old in the acute medical admission setting.
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Affiliation(s)
- Andrew C Kidd
- Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island; Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, Norfolk Island.
| | - Patrick Musonda
- Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island
| | - Roy L Soiza
- Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom; School of Medicine & Dentistry, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom
| | - Catherine Butchart
- Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom
| | - Claire J Lunt
- Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom
| | - Yogish Pai
- University Hospital of South Manchester, Manchester M23 9LT, United Kingdom
| | - Yasir Hameed
- Norfolk & Waveney Mental Health Care Trust, Norwich NR6 5BE, United Kingdom
| | - Chris Fox
- Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island
| | - John F Potter
- Norwich Medical School, Faculty of Medicine & Health Sciences, Chancellors Drive, University of East Anglia, Norwich NR4 7TJ, Norfolk Island; Academic Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, Norfolk Island
| | - Phyo Kyaw Myint
- Academic Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, United Kingdom; School of Medicine & Dentistry, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom.
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Abstract
IMPORTANCE Whereas many persons at advanced ages live independently and are free of disability, we know little about how likely older people are to be disabled in the basic activities of daily living that are necessary for independent living as they enter the last years of life. OBJECTIVE To determine national estimates of disability during the last 2 years of life. DESIGN Prospective cohort study. SETTING A nationally representative study of older adults in the United States. PARTICIPANTS Participants 50 years and older who died while enrolled in the Health and Retirement Study between 1995 and 2010. Each participant was interviewed once at a varying time point in the last 24 months of life. We used these interviews to calculate national estimates of the prevalence of disability across the 2 years prior to death. We modeled the prevalence of disability in the 2 years prior to death for groups defined by age at death and sex. MAIN OUTCOMES AND MEASURES Disability was defined as need for help with at least 1 of the following activities of daily living: dressing, bathing, eating, transferring, walking across the room, and using the toilet. RESULTS There were 8232 decedents (mean [SD] age at death, 79 [11] years; 52% women). The prevalence of disability increased from 28% (95% CI, 24%-31%) 2 years before death to 56% (95% CI, 52%-60%) in the last month of life. Those who died at the oldest ages were much more likely to have disability 2 years before death (ages 50-69 years, 14%; 70-79 years, 21%; 80-89 years, 32%; 90 years or more, 50%; P for trend, <.001). Disability was more common in women 2 years before death (32% [95% CI, 28%-36%]) than men (21% [95% CI, 18%-25%]; P < .001), even after adjustment for older age at death. CONCLUSIONS AND RELEVANCE Those who live to an older age are likely to be disabled, and thus in need of caregiving assistance, many months or years prior to death. Women have a substantially longer period of end-of-life disability than men.
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Affiliation(s)
- Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco2Veterans Affairs Medical Center, San Francisco, California
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Bai X, Chow N. Chinese Elders' Self-Image and Their Perceived Peer-Image: Possibility of Self-Enhancement Bias. Int J Aging Hum Dev 2013; 77:1-16. [PMID: 23986977 DOI: 10.2190/ag.77.1.a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Decades of research with Western participants has documented that there is a pervasive motivation for people to view themselves as better off than others while evidence for the existence of such self-enhancement bias (SEB) among East Asians varies considerably across studies. Considering the traditional culture of Confucius on modesty, the present study hypothesizes that there should be no significant SEB among Chinese elders. Structured face-to-face interviews were conducted with 445 older people in China-Wuhan, in which the revised Chinese version of Image of Aging Scale (IAS-C) was filled out. SEB was calculated by subtracting participants' ratings of “Peer-Image” (P) from their ratings of Self-Image (S). However, inconsistent with our hypothesis, a significant SEB was observed among the Chinese older participants and significant differences in the magnitude of SEB were discerned among older people in different characteristic groups. Possible explanations were further provided for the mismatch between Chinese values and the existence of SEB.
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Affiliation(s)
- Xue Bai
- The Hong Kong Polytechnic University
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Conway F, Magai C, Jones S, Fiori K, Gillespie M. A six-year follow-up study of social network changes among African-American, Caribbean, and U.S.-born Caucasian urban older adults. Int J Aging Hum Dev 2013; 76:1-27. [PMID: 23540157 DOI: 10.2190/ag.76.1.a] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study explores dynamic changes in network size and composition by examining patterns of older adults' social network change over time, that is: types of movements; the reason for the loss of network members; and the relation of movement and composition in concert. This study is a 6-year follow up of changes in the social networks of U.S.-Born Caucasian, African-American, and Caribbean older adults. One hundred and twenty-four community-dwelling older adults were interviewed during 2 data collection points over a 6-year period. Differences between Wave 1 and Wave 2 data were examined using paired sample t-tests confirmed with post-hoc tests and multivariate analyses. Results regarding types of movement showed that network changes were attributed to attrition--the "loss" of network members and a novel movement--the "addition" of network members not heretofore discussed. The results show an interaction between kinship status, ethnicity, and time--the attrition of non-kin members was underscored by ethnic differences. The type of network change was specific for type of network affiliation, such that children were more likely to be added to the networks of the young-old and kin were more likely to be lost in networks of the old-old. Older adults engage in social network interactions marked by compensatory processes beyond loss of network members such as social promotion and demotion. These social network processes are of emotional and functional significance for the older adult.
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Affiliation(s)
- Francine Conway
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City 11530-0701, New York, USA.
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Resnick B, Klinedinst J, Dorsey S, Holtzman L, Abuelhiga LS. Volunteer Behavior and Factors that Influence Volunteering Among Residents in Continuing Care Retirement Communities. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/02763893.2012.754820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Butchart C, Ismailoglu F, Myint PK, Musonda P, Lunt CJ, Pai Y, Soiza RL, Rayward-Smith V. Identification of possible determinants of inpatient mortality using Classification and Regression Tree (CART) analysis in hospitalized oldest old patients. Arch Gerontol Geriatr 2013; 56:188-91. [DOI: 10.1016/j.archger.2012.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 07/13/2012] [Accepted: 07/14/2012] [Indexed: 11/26/2022]
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Franke WD, Margrett JA, Heinz M, Martin P. Handgrip Strength, Positive Affect, and Perceived Health are Prospectively Associated with Fewer Functional Limitations among Centenarians. Int J Aging Hum Dev 2012; 75:351-63. [DOI: 10.2190/ag.75.4.d] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study assessed the association between perceived health, fatigue, positive and negative affect, handgrip strength, objectively measured physical activity, body mass index, and self-reported functional limitations, assessed 6 months later, among 11 centenarians (age = 102 ± 1). Activities of daily living, assessed 6 months prior to assessment of functional limitations, were also included in the model. Handgrip strength, positive affect, and self-rated current health were associated with higher functioning, expressed as either global, upper body, or lower body functioning (r > .60). Objectively measured physical activity was inversely related to the aforementioned measures of functioning. Thus, physical health as assessed by handgrip strength, but not by physical activity, is associated with better functioning in centenarians.
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King J, Yourman L, Ahalt C, Eng C, Knight SJ, Pérez-Stable EJ, Smith AK. Quality of life in late-life disability: "I don't feel bitter because I am in a wheelchair". J Am Geriatr Soc 2012; 60:569-76. [PMID: 22288767 DOI: 10.1111/j.1532-5415.2011.03844.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine perceived quality of life in a diverse population of elderly adults with late-life disability. DESIGN Qualitative cross-sectional study. SETTING Community-dwelling participants were recruited from San Francisco's On Lok Lifeways program, the first Program of All-inclusive Care for the Elderly. On Lok enrollees meet Medicaid criteria for nursing home placement. PARTICIPANTS Sixty-two elderly adults with a mean age of 78 and a mean 2.4 activity of daily living dependencies and 6.6 instrumental activity of daily living dependencies were interviewed. Respondents were 63% female, 24% white, 19% black, 18% Latino, 32% Chinese American, and 6% other race. MEASUREMENTS Elderly adults who scored higher than 17 points on the Mini-Mental State Examination were interviewed. Interviews were conducted in English, Spanish, and Cantonese. Respondents were asked to rate their overall quality of life on a 5-point scale. Open-ended questions explored positive and negative aspects of participants' daily experiences. Interviews were analyzed using modified grounded theory and digital coding software. RESULTS Eighty-seven percent of respondents rated their quality of life in the middle range of the quality-of-life spectrum (fair to very good). Themes were similar across ethnic groups. Most themes could be grouped into four domains that dependent elderly adults considered important to their quality of life: physical (e.g., pain), psychological (e.g., depression), spiritual or religious (e.g., religious coping), and social (e.g., life-space). Dignity and a sense of control were identified as themes that are the most closely tied to overall quality of life. CONCLUSION Factors that influence quality of life in late-life disability were similar across ethnic groups. As the number of elderly adults from diverse backgrounds with late life disability increases in the United States, interventions should be targeted to maximize daily sense of control and dignity.
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Affiliation(s)
- Jennifer King
- School of Medicine, University of California at San Francisco, San Francisco, California 94121, USA
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Jacobs JM, Maaravi Y, Cohen A, Bursztyn M, Ein-Mor E, Stessman J. Changing Profile of Health and Function from Age 70 to 85 Years. Gerontology 2012; 58:313-21. [DOI: 10.1159/000335238] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/21/2011] [Indexed: 12/12/2022] Open
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Pai Y, Butchart C, Lunt CJ, Musonda P, Gautham N, Soiza RL, Potter JF, Myint PK. Age, co-morbidity and poor mobility: no evidence of predicting in-patient death and acute hospital length of stay in the oldest old. QJM 2011; 104:671-9. [PMID: 21406460 DOI: 10.1093/qjmed/hcr028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The oldest old (aged over 90 years) are the fastest growing section of the UK population. Limited data exist regarding the effect of age, location, co-morbidity and physical performance status on outcome of acute illness in this age group. METHODS We performed a prospective study in people aged ≥ 90 years using hospital audit data in three hospitals in England and Scotland. We examined the characteristics of those admitted over three consecutive calendar months and calculated risk ratios of death and prolonged length of acute hospital stay (>7 days). RESULTS A total of 419 patients were included in this study (68% female, median age 93 years). There were similarities in presentation and diagnoses, but patients in Scotland (n = 164) were more likely to be admitted from sheltered housing or nursing homes than those in England (n = 255). Patients in England were significantly less likely to be able to mobilize < 10 m (41 vs. 34%, P < 0.001) but had lower prevalence of hypertension (40 vs. 55%, P = 0.02), ischaemic heart disease (30% vs. 45%, P = 0.02) and fewer prescribed medications (median 2 vs. 3, P < 0.001). Mortality was similar for the England and Scotland centres (P = 0.98). Previously recognized risk factors for death following hospital admission and length of stay e.g. older age, higher number of co-morbidities and poor mobility were not predictive in this study. CONCLUSION The 'oldest old' should not be considered as a homogenous group and findings from single-centre studies involving this age group may not be generalizable. We found no conclusive evidence that patient-related factors predict outcome in this age group in acute medical admission settings.
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Affiliation(s)
- Y Pai
- Department of Elderly Medicine, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston PR2 9HT, Lancashire, England, UK
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The last year of life in Europe: regional variations in functional status and sources of support. AGEING & SOCIETY 2010. [DOI: 10.1017/s0144686x10000280] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTThis article aims to provide an initial account of the life circumstances of older people in 11 continental European countries during the year prior to their deaths. It focuses on regional variations in functional limitations and sources of support. Using logistic regression we analyse data from 523 end-of-life interviews in 2006–07, collected for the Survey of Health, Ageing and Retirement in Europe (Wave 2) about the respondents who had died since the baseline data collection in 2004–05. The prevalence of functional limitations was found to be fairly consistent across Northern, Central and Southern Europe. Significant regional differences existed, however, with regard to the deceased respondents' main sources of support and the locations of their deaths. Northern Europeans were the least likely to receive help from their family only and the most likely to be supported by non-kin. They also exhibited the highest risk of dying in a nursing home. In Mediterranean countries, a pattern of exclusive family support and dying at home prevailed. The findings support the notion of a ‘mixed responsibility’ of families and welfare states as providers of support for older people in the last year of life.
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Fleming J, Zhao J, Farquhar M, Brayne C, Barclay S. Place of death for the 'oldest old': > or =85-year-olds in the CC75C population-based cohort. Br J Gen Pract 2010; 60:171-9. [PMID: 20353663 PMCID: PMC2845508 DOI: 10.3399/bjgp10x483959] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Deaths are rising fastest among the oldest old but data on their transitions in place of care at the end of life are scarce. AIM To examine the place of residence or care of > or =85 year-olds less than a year before death, and their place of death, and to map individual changes between the two. DESIGN OF STUDY Population-based cohort study. SETTING Cambridge City over-75s Cohort (CC75C) study, UK. METHOD Retrospective analysis of prospective data from males and females aged > or =85 years at death who died within a year of taking part in any CC75C survey (n = 320); death certificate linkage. RESULTS Only 7% changed their address in their last year of life, yet 52% died somewhere other than their usual address at the time of death. Over two-thirds were living in the community when interviewed <1 year before death, but less than one-third who had lived at home died there (less than one-fifth in sheltered housing). Care homes were the usual address of most people dying there (77% in residential homes, 87% in nursing homes) but 15% of deaths in acute hospital came from care homes. CONCLUSION More than half the study sample of individuals of advanced old age had a change in their place of residence or care in their last year of life. These findings add weight to calls for improved end-of-life care in all settings, regardless of age, to avoid unnecessary transfers. The study data provide a baseline that can help plan and monitor initiatives to promote choice in location of care at the end of life for the very old.
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Affiliation(s)
- Jane Fleming
- Institute of Public Health, University of Cambridge, Cambridge.
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