[The last year of life: a representative study of deceased patients. Living arrangement, place of death and utilization of health resources].

The aim of the present study was to describe the pattern of service use (hospitals, homes, ambulatory services) in the year before death. The results are based on administrative data for the elderly inhabitants of the city of Mannheim, who died during one year (n = 2507), as well as on a survey of the next of kin of a 40% random sample of the decedents (n = 958). Deaths occurred most frequently in hospitals (49.7%), followed by deaths outside of institutions (29.1%) and deaths in residential or nursing homes (21.2%). 79.6% of the deceased had been admitted to hospitals in the last year of their lives, 28.6% were cared for in homes, and almost 40% were receiving care from home-help services. 9.3% of the last year of life were spent on average in hospitals and 20.5% in residential or nursing homes. Utilization of care was influenced by age at death, family conditions, living arrangements, and level of dependency. Hospital and nursing care use showed an opposite pattern. With increasing age at death, the utilization of homes and ambulatory services rose steeply, whereas the probability of hospital treatment decreased with more advancing age. Obviously a substantial proportion of the resources of the care system is spent for care at the end of life. Future gains in life expectancy will probably have a greater impact on nursing care than on hospital care.