Pam Kaspers, PhD candidate at the EMGO Institute on Health and Care Research – VU Medical Center Amsterdam, Netherlands, explains the background to a longer article that has been selected as ‘Editor’s choice’ in the June edition of Palliative Medicine.
The article presented here is part of my thesis entitled ‘End-of-life care and preferences for (non)treatment decisions of older people during their last three months of life.’ On 4 September 2013 I will defend this thesis at the VU University Amsterdam.
By the end of the 1980s, Dutch ministry officials recognised that the ageing of the population would shape the need for health care in the Dutch population in the near future.1 Therefore, these officials became increasingly interested in the changes in independent functioning with ageing and ageing-related determinants of health care use, and wanted empirical evidence to monitor and develop policies for older people, who were in need of extra care and support.1
In 1991, the Dutch Ministry of Health, Welfare and Sports initiated The Longitudinal Aging Study Amsterdam (LASA, VU Medical Center Amsterdam) to determine predictors and consequences of changes in functioning with ageing.2 In addition to data on changes in functioning over time provided by the long-term follow-up of the same people, the longitudinal design of LASA provides the possibility to study period and cohort differences in similar age groups at different points in time.1 In my present study, as published in the June 2013 issue of Palliative Medicine, the subject of cohort differences is approached by examining the potential changes in received end-of-life care and transfers between different places of residence, by older people during their last three months of life between 2000-2010. Therefore, we replicated a LASA study of ten years ago,3 which was published by Palliative Medicine in 2003, in order to monitor changes in care over ten years.
The results of this article are important as they show that in ten years time there was a decrease in functional ability of older people, no change in the number of home deaths and an increase in the utilisation of home care. In the light of the increase in disability, making optimal use of home care seems crucial when people do want to stay at home. Regardless of the period studied, two scenarios of care in the last three months of life seem to prevail in the Netherlands: staying at home as long as possible with a higher chance of dying in hospital, or being admitted to a residential or nursing home with a reduced chance of dying in hospital. The healthcare professionals could take this into account when discussing with patients in the light of advance care planning: older people might prefer staying at home, accepting the higher chance of dying in hospital, or they might prefer timely transfer to a residential or nursing home which may avoid hospital death. In addition, further improvement of palliative home care could decrease undesirable hospitalisation at the end of life.
1. Huisman, M, Poppelaars, J, Van Der Horst, HAM, Beekman, AT, Brug, J, Van Tilburg, TG, Deeg, DJH. Cohort profile: The Longitudinal Aging Study Amsterdam. International Journal of Epidemiology, 2011; 40 (4): 868–876.
2. Longitudinal Aging Study Amsterdam (LASA). Amsterdam: May 2013, last update of the website at April 23, 2013.
3. Klinkenberg, M, Smit, JH, Deeg, DJ, Willems, DL, Onwuteaka-Philipsen, BD, van der Wal, G. Proxy reporting in after-death interviews: the use of proxy respondents in retrospective assessment of chronic diseases and symptom burden in the terminal phase of life. Palliative Medicine, 2003; 17 (2):191-201.
To find out more…
This post relates to a longer article, ‘Changes over a decade in end-of-life care and transfers during the last 3 months of life: A repeated survey among proxies of deceased older people’ by Pam J Kaspers, H Roeline W Pasman, Bregje D Onwuteaka-Philipsen and Dorly JH Deeg. Palliative Medicine, 2013 June; 27 (6): 544-552. First published on 17 September 2012, Doi:10.1177/0269216312457212.
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