Susanne Kelfve1,2, Jonas Wastesson2, Stefan Fors2,3, Kristina Johnell2, Lucas Morin2. 1. 1 Division Ageing and Social Change, Department of Social and Welfare Studies, Linköping University, Linköping, Sweden. 2. 2 Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden. 3. 3 Centre for Health Equity Studies, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Abstract
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.
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.
Entities:
Keywords:
Education; elderly; end of life; place of death; social inequalities
Authors: Joanna M Davies; Katherine E Sleeman; Javiera Leniz; Rebecca Wilson; Irene J Higginson; Julia Verne; Matthew Maddocks; Fliss E M Murtagh Journal: PLoS Med Date: 2019-04-23 Impact factor: 11.069
Authors: Joanna M Davies; Matthew Maddocks; Kia-Chong Chua; Panayotes Demakakos; Katherine E Sleeman; Fliss E M Murtagh Journal: Lancet Public Health Date: 2021-02-08