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

Background: In the ageing population, older people are living longer with chronic diseases. Especially in the last year of life, this can result in an increased need for (complex) end-of-life care.

Aim: To study potential changes in received end-of-life care and transfers by older people during the last 3 months of life between 2000 and 2010.

Design: A repeated survey in 2000 and 2010.

Participants: Data were collected from a sample of proxies of deceased sample members of the Longitudinal Aging Study Amsterdam in 2000 (n = 270; response = 79%) and 2010 (n = 168; response = 59%).

Results: Compared to 2000, in 2010, older people had a significantly lower functional ability 3 months before death. Over the 10-year period, people were significantly less likely to receive no care (12% vs 39%) and more likely to receive formal home care (45% vs 15%). Older people aged over 80 years, females, and those in the 2010 sample were more likely to receive formal home and institutional care (formal home care - age > 80 years, odds ratio: 3.7, male odds ratio: 0.74, 2010 - odds ratio: 6.9; institutional care - age > 80 years, odds ratio: 11.6, male odds ratio: 0.34, 2010 - odds ratio: 2.5) than informal or no care. Regardless of the study year, older people receiving informal home care were more likely to die in hospital (odds ratio: 2.3).

Conclusion: Two scenarios of care in the last 3 months of life seem to arise: staying at home as long as possible with a higher chance of hospital death or living in a residential or nursing home, reducing the chance of hospital death.