Comparison of end-of-life care for older people living at home and in residential homes: a mortality follow-back study among GPs in the Netherlands.
BACKGROUND
The proportion of older people is increasing, therefore their place of residence and place of care at the end of life are becoming increasingly important.


OBJECTIVE
To compare aspects of end-of-life care among older people in residential homes and home settings in the Netherlands.


METHODS
Nationwide representative mortality follow-back study among GPs in the Netherlands.


METHODS
The study included patients aged ≥65 years who died non-suddenly, whose longest place of residence in their last year of life was at home or in a residential home (n = 498). Differences were analysed using Pearson's χ(2) test, Mann-Whitney U tests, and multivariate logistic regression.


RESULTS
Controlling for the differences between the populations in home settings and residential homes, no differences were found in treatment goals, communication about end-of-life care, or use of specialised palliative care between the two settings. However, people living in a residential home were more likely to have received palliative care from a GP than people living at home (OR 2.84, 95% confidence interval [CI] = 1.41 to 5.07). In residential homes, people more often experienced no transfer between care settings (OR 2.76, 95% CI = 1.35 to 5.63) and no hospitalisations (OR 2.2, 95% CI = 1.04 to 4.67) in the last 3 months of life, and died in hospital less often (OR 0.78, 95% CI = 0.63 to 0.97) than those people living at home.


CONCLUSIONS
Despite similar treatment goals, care in residential homes seems more successful in avoiding transfers and hospitalisation at the end of life. Especially since older people are encouraged to stay at home longer, measures should be taken to ensure they are not at higher risk of transfers and hospitalisations in this setting.
End-of-Life Care Research Group, Vrije Universiteit Brussel ((VUB) and Ghent University, Brussels, Belgium.
Yolanda W H
YW
Penders
End-of-Life Care Research Group, Vrije Universiteit Brussel ((VUB) and Ghent University, Brussels, Belgium.
Lieve
L
Van den Block
NIVEL Primary Care Database - Sentinel Practices, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
Gé A
GA
Donker
End-of-Life Care Research Group, Vrije Universiteit Brussel ((VUB) and Ghent University, Brussels, Belgium.
Luc
L
Deliens
Bregje
B
Onwuteaka-Philipsen
D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D005500:Follow-Up Studies; D006299:Health Services for the Aged / Q000458:organization & administration / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data
end of life care; general practitioner; palliative care; residential facilities; terminal care