Table 3.
Factors associated with (1) hospitalisation of nursing home residents in last month of life and (2) in-hospital death
| Hospitalisation* | In-hospital death* | |||
| Exp(Coefficient)†; (95% CI) | P value for factor | Exp(Coefficient)†; (95% CI) | P value for factor | |
| Country, resident and nursing home characteristics (independent variables) | ||||
| Intercept‡ Country § |
8.02 (1.90 to 33.8) | 0.005 | 1.37 (0.19 to 9.82) | 0.75 |
| Belgium (reference) | Ref | Ref | Ref | |
| Finland | 0.51 (0.24 to 1.11) | 0.09 | 0.35 (0.11 to 1.23) | 0.08 |
| Italy | 0.36 (0.16 to 0.85) | 0.02 | 1.55 (0.50 to 4.81) | 0.45 |
| The Netherlands | 0.27 (0.12 to 0.62) | 0.002 | 0.33 (0.10 to 1.17) | 0.09 |
| Poland | 0.39 (0.16 to 0.97) | 0.04 | 1.33 (0.40 to 4.43) | 0.64 |
| Clinical characteristics | ||||
| Dementia at time of death¶ | 0.86 (0.55 to 1.37) | 0.53 | 0.78 (0.43 to 1.41) | 0.41 |
| Functional/cognitive status 1 month before death (BANS-S) ¶ | 0.90 (0.86 to 0.95) | <0.001 | 0.89 (0.84 to 0.95) | <0.001 |
| Nursing home stay characteristics | ||||
| Type of nursing home§ | ||||
| Type 1 (reference) | Ref | Ref | Ref | Ref |
| Type 2 | 0.91 (0.47 to 1.75) | 0.77 | 1.90 (0.73 to 4.94) | 0.19 |
| Nursing home size§ | 1.00 (0.99 to 1.00) | 0.23 | 0.99 (0.99 to 1.00) | 0.10 |
| Opioids available 24/7 for residents with PC needs§ | ||||
| Yes, for all residents | Ref | Ref | Ref | Ref |
| Yes, for most residents | 2.73 (1.25 to 5.95) | 0.01 | 1.85 (0.49 to 6.92) | 0.36 |
| Yes, for some residents | 1.84 (0.84 to 3.99) | 0.13 | 1.30 (0.44 to 3.86) | 0.64 |
| No, never | 1.01 (0.43 to 2.38) | 0.98 | 0.40 (0.10 to 1.55) | 0.18 |
| Care process characteristics | ||||
| Conversation between nurse and relative about preferred course of care was held¶ | 0.47 (0.31 to 0.72) | <0.001 | 0.54 (0.31 to 0.95) | 0.03 |
| Resident had a written advance directive with regard to ‘do not transfer to a hospital’¶ | 0.17 (0.06 to 0.50) | 0.001 | 0.40 (0.12 to 1.34) | 0.14 |
| Contact person for residents/relatives to ensure coordinated health and social care § | ||||
| Yes, for all residents | Ref | Ref | Ref | Ref |
| Yes, for most residents | 0.87 (0.29 to 2.62) | 0.80 | 0.73 (0.12 to 4.64) | 0.74 |
| Yes, for some residents | 0.43 (0.13 to 1.39) | 0.16 | 0.94 (0.22 to 4.00) | 0.93 |
| No, never | 1.24 (0.73 to 2.11) | 0.42 | 0.90 (0.40 to 2.00) | 0.74 |
| Physician’s level of expectation about death** | ||||
| Death was expected | Ref | Ref | Ref | Ref |
| Death was expected, yet sooner than anticipated | 1.18 (0.73 to 1.93) | 0.50 | 2.82 (1.48 to 5.39) | 0.002 |
| Death was neither expected nor unexpected | 1.04 (0.53 to 2.03) | 0.91 | 3.90 (1.78 to 8.55) | 0.001 |
| Death was unexpected | 0.45 (0.19 to 1.04) | 0.06 | 5.21 (2.22 to 12.23) | <0.001 |
We were able to include 790 residents for analysis of hospitalisation and 814 residents for analysis of in-hospital death in the complete-case multivariate analysis.
Due to low numbers of complete cases in England, we excluded data from England from the multivariate analyses. Therefore, also type 3 nursing homes were not included.
Data in bold indicate statistically significant p-values.
Multivariate logistic mixed-effect regression models reporting p value with hospitalisation in the last month of life and place of death as independent variables and nursing home as random factor, α<0.05.
*Hospitalisation ‘no’ and in-hospital death ‘no’ are reference categories.
†Exponentiation of the coefficient, which is an OR.
‡Expected mean value of the dependent variables (hospitalisation and in-hospital death) when all factors equal zero.
§Reported by administrator/manager of nursing home. For 44 out of 1384 residents, no questionnaire was returned by the nursing home administrator.
¶Reported by the nurse/care assistant most involved in care.
**Reported by the physician. For 397/1384 residents, no questionnaire was returned by physician.
BANS-S, Bedford Alzheimer Nursing Severity Scale; PC, palliative care.