title: Dying in hospital with dementia and pneumonia: a nationwide study using death certificate data.
abstract: BACKGROUND
  For people with dementia dying from pneumonia, hospitalization at the end of life may be of little benefit and result in unfavourable outcomes such as hospital death.
  
  
  OBJECTIVE
  The aim of this study is to estimate the incidence of and factors associated with hospital death in people with dementia dying from pneumonia.
  
  
  METHODS
  We used death certificate data of all deaths in Belgium in 2008 (n = 101,685) to examine characteristics of deaths of people with dementia dying from pneumonia. Information about the urbanization level of the place of residence and the availability of hospital beds, residential (without continuous skilled nursing) and skilled nursing beds in long-term care settings was linked through the zip code of the place of residence.
  
  
  RESULTS
  Of people with dementia dying from pneumonia (n = 1,420), 47.2% died in hospital. Of those living in long-term care settings, 25.6% died in hospital. For people living in their own home, hospital death was more likely for those who were single (adjusted odds ratio (AOR) 2.83, 95% CI 1.30-6.16) and living in strongly urbanized areas (AOR 2.48, 95% CI 1.47-4.18). For those living in long-term care settings, hospital death was more likely in regions with higher availability of residential beds (without continuous skilled nursing) in long-term care settings (AOR per unit 1.02, 95% CI 1.01-1.03).
  
  
  CONCLUSIONS
  Almost half of all those with dementia dying from pneumonia and a quarter of those living in long-term care settings died in a hospital. These results suggest shortcomings in the Belgian healthcare system in preventing potentially avoidable terminal hospitalizations in a vulnerable population.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Houttekier
authors.forename: Thijs
authors.initials: T
authors.lastname: Reyniers
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Nele
authors.initials: N
authors.lastname: Van Den Noortgate
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D003644:Death Certificates; D003704:Dementia / Q000150:complications* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011014:Pneumonia / Q000150:complications* / Q000401:mortality*; D012307:Risk Factors; D019037:Urban Health Services