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Is the level of education associated with transitions between care settings in older adults near the end of life? A nationwide, retrospective cohort study
Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden; Stockholm Univ, Sweden.
Karolinska Inst, Sweden; Stockholm Univ, Sweden.
Karolinska Inst, Sweden; Stockholm Univ, Sweden; Karolinska Inst, Sweden.
Karolinska Inst, Sweden; Stockholm Univ, Sweden.
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2018 (English)In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 32, no 2, p. 366-375Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD , 2018. Vol. 32, no 2, p. 366-375
Keywords [en]
Education; social inequalities; elderly; end of life; place of death
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-145126DOI: 10.1177/0269216317726249ISI: 000423322000007PubMedID: 28952874OAI: oai:DiVA.org:liu-145126DiVA, id: diva2:1183666
Note

Funding Agencies|Swedish Council for Working Life and Social Research (FORTE); Swedish Research Council; Social Inequalities in Ageing (SIA) project; NordForsk

Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-02-19

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Kelfve, Susanne
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Division Ageing and Social ChangeFaculty of Arts and Sciences
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Palliative Medicine: A Multiprofessional Journal
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