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Comparing circumstances of end-of-life care for older people living at home and in a residential home in the Netherlands via a mortality follow-back study.

Penders, Y.W.H., Block, L. van den, Donker, G.A., Onwuteaka-Philipsen, B. Comparing circumstances of end-of-life care for older people living at home and in a residential home in the Netherlands via a mortality follow-back study. European Journal of Palliative Care: 2015 . Abstract. 14th World Congress of the European Association for Palliative Care: Building Bridges. 8-10 mei 2015, Copenhagen.
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Background
Due to the growing proportion of older people, their place of residence and place of care at the end of life is becoming increasingly important.

Aim
To compare circumstances of end-of-life care and transitions between care settings in the last three months of life among older people in residential homes and home settings in the Netherlands.

Methods
Using a nationwide representative mortality follow-back study, we identified patients of 74 participating GP practices who died non-suddenly over the age of 65 in 2011 and 2012. Patients whose longest place of residence in the last year of life had been a home setting (own home or a relative’s home) or a residential home were included (n=498). Specialist nursing homes were excluded.

Results
Home settings and residential homes cater to different populations of older people: those in residential homes are older (87 versus 81), more likely to be female (63% versus 43%), more likely to have dementia (33% versus 13%) and less likely to have died of cancer (25% versus 54%). While there were no differences in treatment goals or communication about end-of-life care, those living in a residential home were more likely to have received palliative care from a GP than those living at home (58% versus 53%, odds ratio=2.8, 95% CI=1.4–5.1). Those living at home experienced transfers between care settings more often (odds ratio=2.8, 95% CI=1.4–5.6) as well as hospitalisation in the last three months of life (odds ratio=2.2, 95% CI=1.0–4.7), and were more likely to die in hospital (odds ratio=1.3, 95% CI=1.0–1.6) than those in a residential home.

Conclusion
Despite similar treatment goals, older people living at home are at risk of a lower quality of end of life and death than those living in a residential home. Measures should be taken to ensure that patients in different living situations receive appropriate end of-life care. Main funding source: EU Seventh Framework Programme (FP7/2007-2013, grant number
264697). (aut. ref.)
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