Hospital Deaths Increased After Reforms Regardless of Dementia Status: An Interrupted Time-Series Analysis

ABS T R A C T Objectives: Dying in a hospital is highly stressful for older adults and families. Persons with dementia who are hospitalized are particularly vulnerable to negative outcomes. The objective of this study is to fill an evidence gap on whether the 2015 Dutch long-term care reforms were effective in increasing deaths at home while avoiding increases in hospital deaths for the total population aged >65 years and by de-mentia status. Design: We used annual cross-sectional, nationally representative data from 2012 to 2017. We performed an interrupted time-series analyses to evaluate changes in location of death after the implementation of the Dutch long-term reforms. Setting and Participants: Dutch population aged >65 years (N = 727,519) who died between 2012 and 2017 using data from Statistics Netherlands. Methods: The primary outcome was death in a long-term care facility (LTCF), home, hospital, or elsewhere. Results: After adjusting for seasonality and sex, we found significantly increased adjusted relative risk ratios (aRRRs) for the total older adult population having a death at home [aRRR 1.17, 95% confidence interval (CI) 1.12.-1.23] and hospital (1.09, 1.04-1.15) compared to deaths in an LTCF after the reforms. For persons with dementia (N = 81,373), hospital deaths increased (2.03, 1.37-3.01) compared with long-term care deaths after the implementation of the long-term care reforms; however, there was no change in the aRRR for death at home. For people without dementia (N = 646,146), we found increased aRRR for death at home (1.21, 1.16-1.28) and death at hospital (1.12, 1.07-1.19) vs LTCF deaths following the reforms. Conclusions and Implications: Hospital and home deaths increased for the total population. Hospital deaths increased for persons with dementia after the long-term care reforms despite evidence of negative outcomes associated with end-of-life hospitalizations. The Netherlands may have overlooked the merits of home care and LTCFs, particularly for people with dementia. (c) 2020 AMDA -The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Automated summary

This study found that after the Dutch long-term care reforms, there was an increase in deaths at home and in hospitals for the population aged >65 years, particularly for those with dementia. The results suggest that the Dutch long-term care system may have some shortcomings, especially for individuals with dementia.