End of life hospitalisations differ for older Australian women according to death trajectory: a longitudinal data linkage study.
Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. Despite the apparent high use of hospitals at the end of life, limited evidence currently exists regarding reasons for hospitalisation. Understanding complex end of life care needs is required for future health care planning as the global population ages. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use.



Survey data from 1,205 decedents from the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health were matched with the state-based hospital records and the National Death Index. Hospital patterns based on COD were graphically summarised and multivariate logistic regression models examined the impact of short-term predictors of length of stay (LOS).



85 % of women had at least one admission in the last year of life; and 8 % had their first observed admission during this time. Reasons for hospitalisation, timing of admissions and LOS differed by COD. Women who died of cancer, diabetes and 'other' causes were admitted earlier than women who died of organ failure, dementia and influenza. Women who died of organ failure overall spent the longest time in hospital, and women with cancer had the highest median LOS. Longer LOS was associated with previous short- and medium-term- hospitalisations and type of hospital separation.



Reducing acute care admissions and LOS at the end of life is complex and requires a shift in perceptions and treatment regarding end of life care and chronic disease management.
Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. Melissa.Harris@newcastle.edu.au.
Melissa L
ML
Harris
Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Xenia
X
Dolja-Gore
Centre for Research on Ageing, Health and Wellbeing, College of Medicine, Biology and Environment, Australian National University, Mills Road, Acton, ACT, Australia.|ARC Centre of Excellence in Population Ageing Research, Sydney, NSW, 2033, Australia.
Hal
H
Kendig
Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.|ARC Centre of Excellence in Population Ageing Research, Sydney, NSW, 2033, Australia.
Julie E
JE
Byles
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002908:Chronic Disease; D003422:Critical Care / Q000706:statistics & numerical data; D003704:Dementia / Q000401:mortality / Q000628:therapy; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007251:Influenza, Human / Q000401:mortality / Q000628:therapy; D016247:Information Storage and Retrieval; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D013727:Terminal Care / Q000706:statistics & numerical data*
Admissions; Chronic disease; End of life; Hospital; Old age; Women