Is the level of education associated with transitions between care settings in older adults near the end of life? A nationwide, retrospective cohort studyVise andre og tillknytning
2018 (engelsk)Inngår i: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 32, nr 2, s. 366-375Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]
Background: End-of-life transitions between care settings can be burdensome for older adults and their relatives. Aim: To analyze the association between the level of education of older adults and their likelihood to experience care transitions during the final months before death. Design: Nationwide, retrospective cohort study using register data. Setting/participants: Older adults (65 years) who died in Sweden in 2013 (n = 75,722). Place of death was the primary outcome. Institutionalization and multiple hospital admissions during the final months of life were defined as secondary outcomes. The decedents level of education (primary, secondary, or tertiary education) was considered as the main exposure. Multivariable analyses were stratified by living arrangement and adjusted for sex, age at time of death, illness trajectory, and number of chronic diseases. Results: Among community-dwellers, older adults with tertiary education were more likely to die in hospitals than those with primary education (55.6% vs 49.9%; odds ratio (OR) = 1.21, 95% confidence interval (CI) = 1.14-1.28), but less likely to be institutionalized during the final month before death (OR = 0.83, 95% CI = 0.76-0.91). Decedents with higher education had greater odds of remaining hospitalized continuously during their final 2 weeks of life (OR = 1.12, 95% CI = 1.02-1.22). Among older adults living in nursing homes, we found no association between the decedents level of education and their likelihood to be hospitalized or to die in hospitals. Conclusion: Compared with those who completed only primary education, individuals with higher educational attainment were more likely to live at home until the end of life, but also more likely to be hospitalized and die in hospitals.
sted, utgiver, år, opplag, sider
SAGE PUBLICATIONS LTD , 2018. Vol. 32, nr 2, s. 366-375
Emneord [en]
Education; social inequalities; elderly; end of life; place of death
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-145126DOI: 10.1177/0269216317726249ISI: 000423322000007PubMedID: 28952874OAI: oai:DiVA.org:liu-145126DiVA, id: diva2:1183666
Merknad
Funding Agencies|Swedish Council for Working Life and Social Research (FORTE); Swedish Research Council; Social Inequalities in Ageing (SIA) project; NordForsk
2018-02-192018-02-192025-02-21