Hospitalizations and emergency department visits trends among elderly individuals in proximity to death: a retrospective population-based study

AbstractAcute healthcare services are extremely important, particularly during the COVID-19 pandemic, as healthcare demand has rapidly intensified, and resources have become insufficient. Studies on specific prepandemic hospitalization and emergency department visit (EDV) trends in proximity to death are limited. We examined time-trend specificities based on sex, age, and cause of death in the last 2 years of life. Datasets containing all hospitalizations and EDVs of elderly residents in Friuli-Venezia Giulia, Italy (N = 411,812), who died between 2002 and 2014 at ≥ 65 years, have been collected. We performed subgroup change-point analysis of monthly trends in the 2 years preceding death according to sex, age at death (65–74, 75–84, 85–94, and ≥ 95 years), and main cause of death (cancer, cardiovascular, or respiratory disease). The proportion of decedents (N = 142,834) accessing acute healthcare services increased exponentially in proximity to death (hospitalizations = 4.7, EDVs = 3.9 months before death). This was inversely related to age, with changes among the youngest and eldest decedents at 6.6 and 3.5 months for hospitalizations and at 4.6 and 3.3 months for EDVs, respectively. Healthcare use among cancer patients intensified earlier in life (hospitalizations = 6.8, EDVs = 5.8 months before death). Decedents from respiratory diseases were most likely to access hospital-based services during the last month of life. No sex-based differences were found. The greater use of acute healthcare services among younger decedents and cancer patients suggests that policies potentiating primary care support targeting these at-risk groups may reduce pressure on hospital-based services.

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An Analysis of Emergency Department Visits and the Survival Rate for Colorectal Cancer Patients: A Nationwide Population-based Study

Internal Medicine ◽

10.2169/internalmedicine.7629-16 ◽

2017 ◽

Vol 56 (16) ◽

pp. 2125-2132 ◽

Cited By ~ 2

Author(s):

Pei-Ling Tang ◽

Hong-Tai Chang ◽

Chin-Chang Cheng ◽

Hung-Chih Chen ◽

Shyh-Ming Kuo ◽

...

Keyword(s):

Colorectal Cancer ◽

Emergency Department ◽

Survival Rate ◽

Cancer Patients ◽

Population Based ◽

Emergency Department Visits ◽

Population Based Study ◽

Colorectal Cancer Patients

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Do Patient-Reported Symptoms Predict Emergency Department Visits in Cancer Patients? A Population-Based Analysis

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2012.10.010 ◽

2013 ◽

Vol 61 (4) ◽

pp. 427-437.e5 ◽

Cited By ~ 51

Author(s):

Lisa Barbera ◽

Clare Atzema ◽

Rinku Sutradhar ◽

Hsien Seow ◽

Doris Howell ◽

...

Keyword(s):

Emergency Department ◽

Cancer Patients ◽

Population Based ◽

Emergency Department Visits ◽

Patient Reported

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Do patient-reported symptoms predict for emergency department visits? A population-based analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.6039 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 6039-6039

Author(s):

Lisa Catherine Barbera ◽

Clare Atzema ◽

Rinku Sutradhar ◽

Hsien Seow ◽

Doris Howell ◽

...

Keyword(s):

Emergency Department ◽

Cancer Patients ◽

Symptom Assessment ◽

Well Being ◽

Population Based ◽

Emergency Department Visits ◽

Assessment System ◽

Patient Reported ◽

Symptom Scores ◽

Ed Visits

6039 Background: Since 2007 in Ontario, Canada, the Edmonton Symptom Assessment System (ESAS) has been routinely used to assess symptoms in cancer patients in both ambulatory and home-care settings. The purpose of this study was to determine the relationship between individual patient symptoms, and their severity, with the likelihood of an emergency department (ED) visit. Methods: The cohort includes all cancer patients in Ontario who completed an ESAS assessment between January 2007 and March 2009. We linked multiple provincial health databases to describe the cohort and determine if an ED visit occurred within 7 days of the patient’s first ESAS. Multivariate logistic regression was used to determine the association between symptom scores (absent: score 0; mild: 1-3; moderate: 4-7; severe: 8-10) and the likelihood of an ED visit. Results: The cohort included 45,118 unique patients whose first assessment contributes to the study. 3.8% (n=1732) had an ED visit. The patients with ED visits were more likely to be men, to have lung or gastro-intestinal cancer, to have had recent radio or chemotherapy, and to have a shorter survival. The proportion of patients with ED visits increased from 2% to 10-12% as individual symptom scores increased from 0 to 10. Anxiety and depression were not associated with ED visits in the model, regardless of severity. Pain, nausea, drowsiness, appetite and shortness of breath with moderate or severe scores were associated with ED visits. Tiredness and wellbeing were the only symptoms to show a significant association for mild, moderate and severe scores. A well being score of 7-10 (reference score=0) had the highest odds ratio of 1.8 (95% CI 1.4-2.3). Conclusions: Worsening symptoms clearly contribute to ED visits. While specific symptoms like pain are obvious targets for management in the outpatient setting, constitutional symptoms like wellbeing or fatigue are associated with even higher odds. Though difficult to manage, such symptoms also warrant detailed assessment in order to optimize patient outcomes.

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Preferred and actual place of death in haematological malignancies: a report from the UK haematological malignancy research network

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-002097 ◽

2020 ◽

pp. bmjspcare-2019-002097

Author(s):

Rebecca Sheridan ◽

Eve Roman ◽

Alex G Smith ◽

Andrew Turner ◽

Anne C Garry ◽

...

Keyword(s):

Cause Of Death ◽

Haematological Malignancy ◽

Care Home ◽

Healthcare Services ◽

Population Based ◽

Place Of Death ◽

Research Network ◽

Hospital Death ◽

The Uk ◽

Proximity To Death

ObjectivesHospital death is comparatively common in people with haematological cancers, but little is known about patient preferences. This study investigated actual and preferred place of death, concurrence between these and characteristics of preferred place discussions.MethodsSet within a population-based haematological malignancy patient cohort, adults (≥18 years) diagnosed 2004–2012 who died 2011–2012 were included (n=963). Data were obtained via routine linkages (date, place and cause of death) and abstraction of hospital records (diagnosis, demographics, preferred place discussions). Logistic regression investigated associations between patient and clinical factors and place of death, and factors associated with the likelihood of having a preferred place discussion.ResultsOf 892 patients (92.6%) alive 2 weeks after diagnosis, 58.0% subsequently died in hospital (home, 20.0%; care home, 11.9%; hospice, 10.2%). A preferred place discussion was documented for 453 patients (50.8%). Discussions were more likely in women (p=0.003), those referred to specialist palliative care (p<0.001), and where cause of death was haematological cancer (p<0.001); and less likely in those living in deprived areas (p=0.005). Patients with a discussion were significantly (p<0.05) less likely to die in hospital. Last recorded preferences were: home (40.6%), hospice (18.1%), hospital (17.7%) and care home (14.1%); two-thirds died in their final preferred place. Multiple discussions occurred for 58.3% of the 453, with preferences varying by proximity to death and participants in the discussion.ConclusionChallenges remain in ensuring that patients are supported to have meaningful end-of-life discussions, with healthcare services that are able to respond to changing decisions over time.

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