Hospitalizations at the end of life among long-term care residents

J Gerontol A Biol Sci Med Sci. 2009 Mar;64(3):395-402. doi: 10.1093/gerona/gln034. Epub 2009 Feb 4.


Background: Concerns have been raised over transfers into acute care hospitals at the end of life. The objective of this study was to examine (a) the extent of and (b) factors related to hospitalization in the last 180 days before death among long-term care (LTC) residents.

Methods: The study included all LTC residents from 60 facilities in the province of Manitoba, Canada, who died in 2003/04 (N = 2,379), with data derived from administrative health care records. Multilevel regression analyses were conducted to examine the relationship between resident and facility characteristics and the following: location of death (in hospital vs the LTC facility); whether individuals were hospitalized in the last 180 days before death; and number of hospital days in the last 180 days.

Results: Overall, 19.1% of LTC residents died in hospital; however, 40.7% were hospitalized at least once in the last 6 months before death. Several resident characteristics (age, trajectory group, and level of care) were related to the outcome measures. Living in a not-for-profit LTC facility decreased the odds of dying in hospital (adjusted odds ratio [OR] = 0.589; 95% confidence interval [CI] = 0.402-0.863) or being hospitalized (adjusted OR = 0.647; 95% CI = 0.452-0.926).

Conclusions: Hospitalization at the end of life is common among LTC residents, and the likelihood of hospital transfers is increased for residents who are younger, have organ failure, lower care level needs, as well as among those who live in for-profit facilities. Particular emphasis should, therefore, be placed on targeting these groups to determine the appropriateness of hospital admission and possible ways of reducing transfers.

Publication types

  • Comparative Study

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Homes for the Aged / statistics & numerical data*
  • Hospital Mortality / trends
  • Hospitalization / statistics & numerical data*
  • Humans
  • Long-Term Care / statistics & numerical data*
  • Long-Term Care / trends
  • Male
  • Manitoba
  • Multivariate Analysis
  • Nursing Homes*
  • Odds Ratio
  • Patient Transfer / statistics & numerical data
  • Probability
  • Risk Factors
  • Sex Factors
  • Terminal Care / methods*