Where do the elderly die The impact of nursing home utilisation on the place of death. Observations from a mortality cohort study in FlandersReport as inadecuate

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BMC Public Health

, 6:178

First Online: 06 July 2006Received: 03 November 2005Accepted: 06 July 2006DOI: 10.1186-1471-2458-6-178

Cite this article as: Van Rensbergen, G., Nawrot, T.S., Van Hecke, E. et al. BMC Public Health 2006 6: 178. doi:10.1186-1471-2458-6-178


BackgroundMost of the research concerning place of death focuses on terminally ill patients cancer patients while the determinants of place of death of the elderly of the general population are not intensively studied. Studies showed the influence of gender, age, social-economical status and living arrangements on the place of death, but a facet not taken into account so far is the influence of the availability of nursing homes.

MethodsWe conducted a survey of deaths, between January 1999 and December 2000 in a small densely populated area in Belgium, with a high availability of nursing homes within 5 to 10 km of the place of residence of every elderly. We determined the incidence of total mortality of subjects >60 years from local official death registers that we consulted via the priest or the mortician of the local parish, to ask where the decedent had died and whether the deceased had lived in a nursing home. We compared the distribution of the places of death between parishes with a nursing home and with parishes without nursing home.

Results240 women and 217 men died during the two years study period. Only 22% died at home, while the majority 78% died in an institutional setting, either a hospital 50% or a nursing home 28%. Place of death was influenced by individual factors age and gender and the availability of a nursing home in the -own- parish. The chance of in-hospital death was 65% higher for men 95% Confidence Interval CI: 14 to 138%; p = 0.008 and decreased by 4% CI: -5.1% to -2.5%; p < 0.0001 for each year increase in age. Independent of gender and age, the chance of in-hospital death was 41% CI: -60% to -13%; p = 0.008 lower in locations with a nursing home.

ConclusionDemographic, but especially social-contextual factors determine where elderly will end their life. The majority of elderly in Flanders die in an institution. Age, gender and living situation are predictors of the place of death but the embedment of a nursing home in the local community seems to be a key predictor.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-6-178 contains supplementary material, which is available to authorized users.

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Author: Gilberte Van Rensbergen - Tim S Nawrot - Ettiene Van Hecke - Benoit Nemery

Source: https://link.springer.com/

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