title: Hospitalizations of nursing home residents with dementia in the last month of life: results from a nationwide survey.
abstract: BACKGROUND
  Hospitalizations of nursing home residents with dementia may not be uncommon. However, evidence from epidemiological studies outside the United States and knowledge about the circumstances of hospitalizations are lacking.
  
  
  OBJECTIVE
  To examine the proportion of nursing home residents with dementia hospitalized in the last month of life and factors associated with hospitalization.
  
  
  METHODS
  The design is stratified cluster sampling survey. Nurses retrospectively registered demographic and dementia-related information about deceased residents with dementia. This included information about hospitalizations, persons involved in hospitalization decisions and type and content of information transferred when hospitalized.
  
  
  METHODS
  Nursing home residents dying with dementia in Belgium (Flanders) in 2010.
  
  
  RESULTS
  In the final month of life, 19.5% of nursing home residents dying with dementia (N = 198) were hospitalized, including 4.6% admitted to an intensive care unit. For 12.2% of residents dying with dementia, a do-not-hospitalize advance directive was present, for 57.0%, a do-not-hospitalize general physician-order. Residents without a do-not-hospitalize general physician-order were more likely of being hospitalized (adjusted odds ratio: 3.4; 95% confidence interval: 1.3-8.7). None of the hospitalizations occurred at the request of the resident; 37% were at the request of relatives; curative or life-prolonging treatments were the most frequent reasons given. Information about the resident's nursing care or medical treatment was transferred in almost all hospitalizations, information about wishes and preferences for future care in 19%.
  
  
  CONCLUSIONS
  Hospitalization in Belgian nursing home residents with dementia in the last month of life was common. Documentation of do-not-hospitalize physician-orders in the resident's medical files may prevent hospitalizations.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium dirk.houttekier@vub.ac.be.
authors.forename: Dirk
authors.initials: D
authors.lastname: Houttekier
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.
authors.forename: An
authors.initials: A
authors.lastname: Vandervoort
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium Department of Family Medicine, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
authors.affiliation: EMGO Institute for Health and Care Research and Expertise Center for Palliative Care, Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jenny T
authors.initials: JT
authors.lastname: van der Steen
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Vander Stichele
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium EMGO Institute for Health and Care Research and Expertise Center for Palliative Care, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D016223:Advance Directives / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D003704:Dementia / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008017:Life Expectancy; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data*
keywords: Dementia; hospitalization; nursing homes