Kjell Asplund1, Staffan Lundström2,3, Birgitta Stegmayr1. 1. 1Department of Public Health and Clinical Medicine, Umeå University, Sweden. 2. Stockholms Sjukhem Foundation, Karolinska Institutet, Stockholm, Sweden. 3. Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden.
Abstract
INTRODUCTION: In the scientific literature, there is very limited empirical information on end-of-life issues after stroke in the scientific literature. The present nationwide study describes the circumstances surrounding deaths that occur within a year after a stroke. PATIENTS AND METHODS: Datasets from three nationwide Swedish registers (on stroke, palliative care and cause of death) were linked. Basic information was available for 42,502 unselected cases of death that occurred within a year after a stroke and more detailed information was available for 16,408 deaths. Odds ratios for characteristics of end-of-life care were calculated by logistic regression. RESULTS: In the late phase after stroke (three months to one year), 46% of patients died in a nursing home, whereas 37% of patients died in a hospital after readmission and 10% of patients died at home. Eleven per cent of deaths were reported as being unexpected. A next of kin was present at 49% of deaths. The frequency of unattended deaths (neither next of kin nor staff were present at the time of death) ranged from 5% at home with specialised home care to 25% in hospitals. DISCUSSION: This is, by far, the largest study published on end-of-life issues after stroke. Major differences between countries in healthcare, community services, family structure and culture may limit direct transfer of the present results to other settings. CONCLUSION: There is considerable discordance between presumed 'good death' late after stroke (dying at home surrounded by family members) and the actual circumstances at the end of life.
INTRODUCTION: In the scientific literature, there is very limited empirical information on end-of-life issues after stroke in the scientific literature. The present nationwide study describes the circumstances surrounding deaths that occur within a year after a stroke. PATIENTS AND METHODS: Datasets from three nationwide Swedish registers (on stroke, palliative care and cause of death) were linked. Basic information was available for 42,502 unselected cases of death that occurred within a year after a stroke and more detailed information was available for 16,408 deaths. Odds ratios for characteristics of end-of-life care were calculated by logistic regression. RESULTS: In the late phase after stroke (three months to one year), 46% of patients died in a nursing home, whereas 37% of patients died in a hospital after readmission and 10% of patients died at home. Eleven per cent of deaths were reported as being unexpected. A next of kin was present at 49% of deaths. The frequency of unattended deaths (neither next of kin nor staff were present at the time of death) ranged from 5% at home with specialised home care to 25% in hospitals. DISCUSSION: This is, by far, the largest study published on end-of-life issues after stroke. Major differences between countries in healthcare, community services, family structure and culture may limit direct transfer of the present results to other settings. CONCLUSION: There is considerable discordance between presumed 'good death' late after stroke (dying at home surrounded by family members) and the actual circumstances at the end of life.
Entities:
Keywords:
Stroke; death; end of life; next of kin; nursing homes; terminal care
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