Article Text

Unplanned hospitalisations in older people: illness trajectories in the last year of life
  1. Máté Szilcz1,
  2. Jonas W Wastesson1,2,
  3. Kristina Johnell1 and
  4. Lucas Morin1,3
  1. 1 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  2. 2 Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden
  3. 3 Inserm CIC 1431, University Hospital of Besançon, Besançon, France
  1. Correspondence to Máté Szilcz, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 171 77, Sweden; mate.szilcz{at}ki.se

Abstract

Objective Unplanned hospitalisations can be burdensome for older people who approach the end of life. Hospitalisations disrupt the continuity of care and often run against patients’ preference for comfort and palliative goals of care. This study aimed to describe the patterns of unplanned hospitalisations across illness trajectories in the last year of life.

Methods Longitudinal, retrospective cohort study of decedents, including all older adults (≥65 years) who died in Sweden in 2015. We used nationwide data from the National Cause of Death Register linked at the individual level with several other administrative and healthcare registers. Illness trajectories were defined based on multiple-cause-of-death data to approximate functional decline near the end of life. Incidence rate ratios (IRR) for unplanned hospitalisations were modelled with zero-inflated Poisson regressions.

Results In a total of 77 315 older decedents (53% women, median age 85.2 years), the overall incidence rate of unplanned hospitalisations during the last year of life was 175 per 100 patient-years. The adjusted IRR for unplanned hospitalisation was 1.20 (95%CI 1.18 to 1.21) times higher than average among decedents who followed a trajectory of cancer. Conversely, decedents who followed the trajectory of prolonged dwindling had a lower-than-average risk of unplanned hospitalisation (IRR 0.66, 95% CI 0.65 to 0.68). However, these differences between illness trajectories only became evident during the last 3 months of life.

Conclusion Our study highlights that, during the last 3 months of life, unplanned hospitalisations are increasingly frequent. Policies aiming to reduce burdensome care transitions should consider the underlying illness trajectories.

  • hospital care
  • end of life care
  • terminal care

Data availability statement

Data may be obtained from a third party and are not publicly available. Clinical data cannot be made publicly available because of privacy issues. However, additional results and aggregated findings are available in the supplementary files or on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Clinical data cannot be made publicly available because of privacy issues. However, additional results and aggregated findings are available in the supplementary files or on reasonable request.

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Footnotes

  • Contributors LM and MS conceived and designed the study. MS performed the statistical analysis, interpreted the data, drafted and critically revised the manuscript. LM, JWW and KJ interpreted the data and critically revised the manuscript. KJ obtained funding, provided supervision, interpreted the data and critically revised the manuscript. LM is the guarantor of the study and data integrity. All authors gave approval for the final version of the manuscript and agree to be accountable for all aspects of the work.

  • Funding This work was supported by funding from the Swedish Research Council for Health, Working Life and Welfare (FORTE) and KID-funding. The sponsor had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.