Table 2.
Hospitalisation and place of death of nursing homes residents in six countries
| Belgium (n=291) | England (n=91) | Finland (n=269) | Italy (n=200) |
The netherlands (n=222) | Poland (n=311) | P value* | |
| Hospitalisation in the last month of life | |||||||
| Did the resident visit the emergency room in the last month of life (for less than 24 hours)?† | |||||||
| Yes (total) | 37 (13.3) | 17 (20.2) | 40 (15.4) | 31 (16.7) | 17 (7.9) | 25 (9.2) | <0.001 |
| Once | 35 (94.6) | 15 (88.2) | 28 (70) | 28 (90.3) | 12 (70.6) | 19 (76) | 0.02 |
| Twice or more | 2 (5.4) | 2 (11.8) | 12 (30) | 3 (9.7) | 5 (29.4) | 6 (24) | |
| Was the resident admitted to a hospital for more than 24 hours during the last month of life?† | |||||||
| Yes (total) | 72 (25.8) | 20 (23.3) | 58 (22.2) | 22 (11.6) | 34 (15.7) | 66 (25.1) | 0.001 |
| Once | 67 (93.1) | 18 (90) | 44 (75.9) | 17 (77.3) | 24 (70.6) | 44 (66.7) | <0.001 |
| Twice or more | 5 (6.9) | 2 (10) | 14 (24.1) | 5 (22.7) | 10 (29.4) | 22 (33.3) | |
| If admitted to hospital in last month of life, average length of stay in hospital in days† mean | 10.5 | 6.4 | 14.4 | 7 | 7 | 8.4 | 0.35 |
| If admitted to the hospital, was the resident admitted to an ICU in the last month of life?†‡ (yes) | 6 (75) | 0 (0) | 2 (28.6) | 2 (33.3) | 2 (12.5) | 4 (16.7) | 0.93 |
| Was the Hospital Palliative Care Team involved in the care of the resident in the hospital?† (yes) | 11 (14.5) | 10 (15.4) | 36 (15.1) | 6 (3.6) | 2 (3.8) | 29 (15.5) | 0.08 |
| Place of death | |||||||
| Place of death§¶ | |||||||
| Nursing home (%) | 226 (82.2) | 71 (81.6) | 224 (84.8) | 170 (86.7) | 176 (89.3) | 248 (80.0) | <0.001 |
| Hospital (%) | 48 (17.5) | 16 (8.6) | 24 (9.1) | 26 (13.3) | 12 (6.1) | 60 (19.4) | |
| If the resident died in hospital, what were the medical reasons for the last hospital admission?†** | |||||||
| A specific diagnosis was required for further decisions | 3 (7.5) | 0 (0) | 1 (2.4) | 0 (0) | 3 (17.6) | 7 (10.9) | |
| For specific treatment Sudden onset or | 5 (12.5) | 1 (7.7) | 9 (22) | 4 (18.2) | 3 (17.6) | 8 (12.5) | |
| Exacerbation symptoms or a life-threatening situation | 32 (80) | 12 (92.3) | 31 (75.6) | 18 (81.8) | 11 (64.7) | 49 (76.6) | |
| If the resident died in the hospital, at whose request did the last admission to the hospital take place?†** | |||||||
| Resident | 2 (4.5) | 1 (6.7) | 2 (4.2) | 0 (0) | 3 (18.8) | 2 (3.1) | 0.99 |
| Relatives | 3 (6.8) | 0 (0) | 6 (12.5) | 1 (6.3) | 0 (0) | 7 (10.8) | |
| Physician | 29 (65.9) | 6 (40) | 18 (37.5) | 4 (25) | 10 (62.5) | 25 (38.5) | |
| Nurses/carers NH | 10 (22.7) | 8 (53.3) | 22 (45.8) | 11 (68.8) | 3 (18.8) | 31 (47.7) | |
We only included residents for whom a questionnaire was filled in by a nurse (total n=1384). All variables are calculated at the level of the resident.
Data in bold indicate statistically significant p-values.
*Generalised linear and logistic mixed models reporting p value with country as a fixed effect and nursing home as a random effect in each model. Age, length of stay, place of death, dementia at time of death, diseases at time of death (cancer, cardiovascular, pulmonary and other diseases) and functional/cognitive status were also included as fixed effects to correct for differences in demographic, clinical and nursing home stay characteristics, α<0.05.
†Reported by the nurse/care assistant most involved in care.
‡Total number of answers to this question per country: 8 (Belgium), 2 (England), 7 (Finland), 6 (Italy), the Netherlands (16), Poland (24).
§Reported by administrator/manager of nursing home. For 44 out of 1384 residents, no questionnaire was returned by the nursing home administrator.
¶Other places not in table include: LTCF/hospice/Pall care unit/other.
**Multiple answers possible.
ICU, intensive care unit; NH, nursing home.