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Age Ageing. 2019 May 1;48(3):433-439. doi: 10.1093/ageing/afz015.

Understanding the factors associated with patients with dementia achieving their preferred place of death: a retrospective cohort study.

Author information

1
Oxford University Hospital NHS Foundation Trust, UK.
2
The Royal Marsden NHS Foundation Trust, UK.
3
Institute of Global Health Innovation, Imperial College London, UK.
4
Kings College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, UK.

Abstract

BACKGROUND:

dying in one's preferred place is a quality marker for end-of-life care. Little is known about preferred place of death, or the factors associated with achieving this, for people with dementia.

AIMS:

to understand preferences for place of death among people with dementia; to identify factors associated with achieving these preferences.

POPULATION:

adults with a diagnosis of dementia who died between December 2015 and March 2017 and who were registered on Coordinate My Care, an Electronic Palliative Care Coordination System.

DESIGN:

retrospective cohort study.

ANALYSIS:

multivariable logistic regression investigated factors associated with achieving preferred place of death.

RESULTS:

we identified 1,047 people who died with dementia; information on preferred and actual place of death was available for 803. Preferred place of death was most commonly care home (58.8%, n = 472) or home (39.0%, n = 313). Overall 83.7% (n = 672) died in their preferred place. Dying in the preferred place was more likely for those most functionally impaired (OR 1.82 95% CI 1.06-3.13), and with a ceiling of treatment of 'symptomatic relief only' (OR 2.65, 95% CI 1.37-5.14). It was less likely for people with a primary diagnosis of cancer (OR 0.52, 95% CI 0.28-0.97), those who were 'for' cardio-pulmonary resuscitation (OR 0.32, 95% CI 0.16-0.62) and those whose record was created longer before death (51-250 days (ref <50 days) OR 0.60, 95% CI 0.38-0.94).

CONCLUSIONS:

most people with dementia want to die in a care home or at home. Achieving this is more likely where goals of treatment are symptomatic relief only, indicating the importance of advance care planning.

KEYWORDS:

Electronic Palliative Care Co-ordination Systems (EPaCCS); dementia; end of life care; older people; palliative; preferred place of death

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