title: 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.
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.
  
  
  OBJECTIVE
  To explore end-of-life transitions of 'older old' people across the cognitive spectrum.
  
  
  METHODS
  Population-based prospective cohort (United Kingdom) followed to death.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: 1Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
authors: Anouk J
authors: AJ
authors: Perrels
authors: Jane
authors: J
authors: Fleming
authors: Jun
authors: J
authors: Zhao
authors: Stephen
authors: S
authors: Barclay
authors: Morag
authors: M
authors: Farquhar
authors: Hilde M
authors: HM
authors: Buiting
authors: Carol
authors: C
authors: Brayne
mesh_terms: D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000706:statistics & numerical data; D006113:United Kingdom
keywords: 80 and over; Cognitive impairment; aged; delivery of health care; dementia; frail elderly; homes for the aged; nursing homes; patient transfer; residential characteristics; terminal care