Variation in the place of death among nursing home residents in France

• Published in: Age and ageing 2015-05, Vol.44 (3), p.415-421
• Main Authors: Morin, Lucas, Johnell, Kristina, Aubry, Régis
• Format: Article
• Language: English
• Subjects: Adjustment; Aged; Company business management; Cross-Sectional Studies; Death; Death & dying; Elderly; end-of-life care; France - epidemiology; Health aspects; Hospital Mortality; Humans; Institutionalization - statistics & numerical data; long-term care; Management; Medicin och hälsovetenskap; Models, Statistical; Nursing homes; Nursing Homes - statistics & numerical data; older people; Physicians; place of death; Practice; Probability; Retrospective Studies; Risk Factors; Terminal care; Terminal Care - statistics & numerical data
• ISSN: 0002-0729; 1468-2834; 1468-2834
• DOI: 10.1093/ageing/afu197

recent studies have reported that hospitals have become a common place of death for nursing home residents. This study aimed to (i) measure variations in the proportion of in-hospital deaths across regions after adjustment for facility-level characteristics and (ii) identify environmental risk factors that might explain these variations in France. a cross-sectional retrospective survey was conducted in 2013. coordinating physicians in 3,705 nursing homes in France. a regression model was used to construct risk-adjusted rates of in-hospital deaths considering the facilities' characteristics. At the regional level, the outcome was defined as the difference between the observed rate of in-hospital deaths and the expected risk-adjusted rate. Values exceeding zero indicated rates that exceeded the national predicted rate of in-hospital deaths and thus highlighted regions in which the risk-adjusted probability for nursing home residents to die in a hospital was greater than average. among 70,119 nursing home decedents, 25.4% (n = 17,789) died in hospitals. The characteristics of the facilities had a significant influence on the proportion of in-hospital deaths among the nursing home decedents. However, after adjustment for these facility-level risk factors, the proportion of nursing homes that reported worse-than-average outcomes showed significant variation (range 26.0-79.6%). At the regional level, both the rate of acute hospital beds and the rate of general practitioners were found to be strongly correlated with the probability of reporting worse-than-average outcomes (P < 0.001). our study demonstrates the existence of major differences across regions in France and highlights the need for targeted interventions regarding end-of-life care in nursing home facilities.