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Predictors of Place of Death for Seniors in Ontario: A Population-Based Cohort Analysis*

Published online by Cambridge University Press:  31 March 2010

Sanober S. Motiwala ,
Ruth Croxford ,
Denise N. Guerriere  and
Peter C. Coyte
Sanober S. Motiwala
Affiliation:
Department of Health Policy, Management and Evaluation, University of Toronto
Ruth Croxford
Affiliation:
Clinical Epidemiology Unit, Sunnybrook and Women's College Health Sciences Centre, Toronto
Denise N. Guerriere
Affiliation:
Department of Health Policy, Management and Evaluation, University of Toronto
Peter C. Coyte*
Affiliation:
Department of Health Policy, Management and Evaluation, University of Toronto Institute for Clinical Evaluative Sciences, Toronto, Ontario
*
Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être addressées à : Dr. Peter C. Coyte, Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 1P8. ([email protected])
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Abstract

Place of death was determined for all 58,689 seniors (age ≥ 66 years) in Ontario who died during fiscal year 2001/2002. The relationship of place of death to medical and socio-demographic characteristics was examined using a multinomial logit model. Half (49.2%) of these individuals died in hospital, 30.5 per cent died in a long-term care facility, 9.6 per cent died at home while receiving home care, and 10.7 per cent died at home without home care. Co-morbidities were the strongest predictors of place of death (p < 0.0001). A cancer diagnosis increased the chances of death at home while receiving home care; seniors with dementia were most likely to die in LTC facilities; and those with major acute conditions were most likely to die in hospitals. Higher socio-economic status was associated with greater probability of dying at home but contributed little to the model. Appropriate planning and resource allocation may help move place of death from hospitals to nursing homes or the community, in accordance with individual preferences.

Résumé

Nous avons déterminé le lieu du décès de la totalité des 58689 personnes âgées (âge ≥ 66 ans) en Ontario qui étaient décédées pendant l'exercice 2001-2002. La relation entre le lieu du décès et les caractéristiques médicales et sociodémographiques a été examinée à l'aide d'un modèle logit multinomial. La moitié (49,2%) de ces personnes étaient mortes à l'hôpital, 30,5% dans un établissement de soins de longue durée, 9,6% à la maison tout en recevant des soins à domicile et 10,7% à la maison alors qu'ils ne recevaient pas de soins à domicile. La comorbidité était le plus fort prédicteur du lieu de décès (p < 0,0001). Les personnes atteintes de cancer mourraient probablement à la maison tout en recevant des soins à domicile ; les personnes âgées souffrant de démence allaient probablement mourir dans un établissement de soins prolongés ; celles se trouvant en phase aiguë allaient probablement mourir à l'hôpital. Les personnes dont le statut socio-économique était plus élevé avaient plus de chances de mourir à la maison, mais cet élément a peu contribué au modèle. Une planification et une attribution des ressources appropriées peuvent aider à déplacer le lieu de décès des hôpitaux vers les maisons de soins infirmiers ou vers les services communautaires, selon les préférences de chacun.

Keywords

agingplace of deathhomehospitalsocio-economic statusco-morbiditiesvieillissementlieu de décèsmaisonhôpitalstatut socio-économiquecomorbidité
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 25 , Issue 4 , Winter/Hiver 2006 , pp. 363 - 371
Copyright
Copyright © Canadian Association on Gerontology 2006

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Footnotes

*

The authors thank Drs. Whitney Berta, Rhonda Cockerill, and Joan Tranmer for comments on earlier versions of this paper. Sanober Motiwala was partially funded by a CHSRF/CIHR Health Services Research Training Award. ICES is funded by the Ontario Ministry of Health and Long-Term Care.

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