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Utilization of acute and long-term care in the last year of life: comparison with survivors in a population-based study
Authors
A Ramirez
Anne Margriet Pot
+52 more
ATF Beekman
BWJH Penninx
DB Mukamel
DJH Deeg
DM Kriegsman
DM Kriegsman
DMW Kriegsman
Dorly JH Deeg
E Jakobsson
FD Wolinsky
France Portrait
G Sundström
G Van Rensbergen
Geraldine Visser
GP Westert
H Bickel
H Ramroth
J Henderson
JD Lubitz
JLA Van Sonsbeek
JM Guralnik
JR McWhinnie
JW Twisk
K Larsson
KJ Brameld
KS Lyons
L Forma
L Grabbe
LF Cherkas
LP Fried
LS Radloff
M Klinkenberg
MA Sager
Marjolein I Broese van Groenou
Martine Puts
MF Folstein
MR Gillick
MTE Puts
N Serup-Hansen
PH Wood
PM Van Bilsen
R Andersen
S Ahmad
S Weitzen
SA Reijneveld
SL Zeger
SW Geerlings
T Dixon
T Scharf
T Stooker
TN Tombaugh
VH Menec
Publication date
1 January 2009
Publisher
BioMed Central
Doi
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on
PubMed
Abstract
Background. It is well-known that the use of care services is most intensive in the last phase of life. However, so far only a few determinants of end-of-life care utilization are known. The aims of this study were to describe the utilization of acute and long-term care among older adults in their last year of life as compared to those not in their last year of life, and to examine which of a broad range of determinants can account for observed differences in care utilization. Methods. Data were used from the Longitudinal Aging Study Amsterdam (LASA). In a random, age and sex stratified population-based cohort of 3107 persons aged 55 ? 85 years at baseline and representative of the Netherlands, follow-up cycles took place at 3, 6 and 9 years. Those who died within one year directly after a cycle were defined as the "end-of-life group" (n = 262), and those who survived at least three years after a cycle were defined as the "survivors". Utilization of acute and long-term care services, including professional and informal care, were recorded at each cycle, as well as a broad range of health-related and psychosocial variables. Results. The end-of-life group used more care than the survivors. In the younger-old this difference was most pronounced for acute care, and in the older-old, for long-term care. Use of both acute and long-term home care in the last year of life was fully accounted for by health problems. Use of institutional care at the end of life was partly accounted for by health problems, but was not fully explained by the determinants included. Conclusion. This study shows that severity of health problems are decisive in the explanation of the increase in use of care services towards the end-of-life. This information is essential for an appropriate allocation of professional health care to the benefit of older persons themselves and their informal caregivers. © 2009 Pot et al; licensee BioMed Central Ltd
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