Determinants of aggregate length of hospital stay in the last year of life in Switzerland.

BACKGROUND: In contrast to individual preferences, most people in developed countries die in health care institutions, with a considerable impact on health care resource use and costs. However, evidence about determinants of aggregate length of hospital stay in the last year preceding death is scant. METHODS: Nationwide individual patient data from Swiss hospital discharge statistics were linked with census and mortality records from the Swiss National Cohort. We explored determinants of aggregate length of hospital stay in the last year of life in N = 35,598 inpatients ≥65 years who deceased in 2007 or 2008. RESULTS: The average aggregate length of hospital stay in the last year of life was substantially longer in the German speaking region compared to the French (IRR 1.36 [95 % CI 1.32-1.40]) and Italian (IRR 1.22 [95 % CI 1.16-1.29]) speaking region of the country. Increasing age, female sex, multimorbidity, being divorced, foreign nationality, and high educational level prolonged, whereas home ownership shortened the aggregate length of hospital stay. Individuals with complementary private health insurance plans had longer stays than those with compulsory health insurance plans (IRR 1.04 [95 % CI 1.01-1.07]). CONCLUSIONS: The aggregate length of hospital stay during the last year of life was substantially determined by regional and socio-demographic characteristics, and only partially explained by differential health conditions. Therefore, more detailed studies need to evaluate, whether these differences are based on patients' health care needs and preferences, or whether they are supply-driven.

Social determinants of duration of last nursing home stay at the end of life in Switzerland: a retrospective cohort study.

BACKGROUND: Due to demographic ageing and increasing life expectancy, a growing demand for long-term nursing home care can be expected. Stays in nursing homes appear to be more socially determined than hospital stays. We therefore looked at the impact of socio-demographic and health care variables on the length of the last nursing home stay. METHODS: Nationwide individual data from nursing homes and hospitals in Switzerland were linked with census and mortality records. Gender-specific negative binomial regression models were used to analyze N = 35,739 individuals with an admission age of at least 65 years and deceased in 2007 or 2008 in a nursing home. RESULTS: Preceding death, men spent on average 790 days and women 1250 days in the respective nursing home. Adjusted for preceding hospitalizations, care level, cause of death and multimorbidity, a low educational level, living alone or being tenant as well as a low care level at the admission time increased the risk for longer terminal stays. Conversely, a high educational level, being homeowner, being married as well as a high care level at the admission time decreased the risk for longer stays. DISCUSSION: The length of the last nursing home stay before death was not only dependent on health-related factors alone, but also substantially depended on socio-demographic determinants such as educational level, homeownership or marital status. The support of elderly people at the admission time of a presumably following nursing home stay should be improved and better evaluated in order to reduce unnecessary and undesired long terminal nursing home stays. CONCLUSIONS: Health policy should aim at diminishing the role of situational, non-health-related factors in order to empower people to spend the last years before death according to individual needs and preferences.

Moving to and dying in a nursing home depends not only on health - an analysis of socio-demographic determinants of place of death in Switzerland.

BACKGROUND: In developed countries generally about 7 out of 10 deaths occur in institutions such as acute care hospitals or nursing homes. However, less is known about the influence of non-medical determinants of place of death. This study examines the influence of socio-demographic and regional factors on place of death in Switzerland. DATA AND METHODS: We linked individual data from hospitals and nursing homes with census and mortality records of the Swiss general population. We differentiated between those who died in a hospital after a length of stay ≤2 days or ≥3 days, those who died in nursing homes, and those who died at home. In gender-specific multinomial logistic regression models we analysed N = 85,129 individuals, born before 1942 (i.e., ≥65 years old) and deceased in 2007 or 2008. RESULTS: Almost 70% of all men and 80% of all women died in a hospital or nursing home. Regional density of nursing home beds, being single, divorced or widowed, or living in a single-person household were predictive of death in an institution, especially among women. Conversely, homeownership, high educational level and having children were associated with dying at home. CONCLUSION: Place of death substantially depends on socio-demographic determinants such as household characteristics and living conditions as well as on regional factors. Individuals with a lower socio-economic position, living alone or having no children are more prone to die in a nursing home. Health policy should empower these vulnerable groups to choose their place of death in accordance to needs and wishes.