Table 1 Baseline characteristics of the studies included
From: Hospitalization at the end of life among nursing home residents with dementia: a systematic review
First author, year | Country | Data source | Year of data | Sample (with dementia) | Inclusion/ exclusion criteria | How was dementia assessed? | Mean age at death (% females) |
|---|---|---|---|---|---|---|---|
Aaltonen, 2014 [33] | Finland | Nationwide registry data (Care register for health care and Care register for social care) Causes of Death Register | 2002–2008 | 13,159a NHR | Died at 70 years or older In NH during their last months of life (in care both 6 months and 3 months before death, stayed there for ≥90 days during the last 6 months of life) | Any cause of death (immediate, underlying, intermediate, contributing) with ICD-10 codes: F00, F01, F02, F03, G30 | 87 years (76%) |
Agar, 2017 [34] | Australia | Face-to-face or telephone interviews Nursing home and medical records Questionnaires | 2013–2014 | 64b NHR from 10 NH | Nursing homes with ≥50% of residents with dementia providing intensive levels of care Residents with advanced dementia | Medical records, FAST, AKPS Advanced dementia: - documented diagnosis of dementia - and FAST (≥6a, stable for 1 month) - and AKPS ≤50 | 85.8 years (58%) |
Allers, 2018 [13] | Germany | Health insurance claims data (DAK) Long-term care insurance data | 2010–2014 | not reported | ≥65 years old, newly admitted to a NH Insured continuously for at least 365 days without NH placement before | ICD-10 codes in the quarter of NH admission: F00.x, F01.x, F02.0, F02.3, F03, G30.x, G31.0, G31.1, G31.82, G31.9, R54 | not reported |
Cai, 2016 [35] | USA | MDS 2.0 Medicare beneficiary summary file Medicare claims | 2007–2010 | 293,967 NHR | ≥65 years old In NH ≥90 days before death Continuously enrolled in Medicare fee-for-service Plans Medicare–Medicaid dually eligible during the last 30 days of life | CPS constructed of MDS 2.0 data - mild cognitive impairment: CPS 0–2 - moderate cognitive impairment: CPS 3–4 - severe cognitive impairment: CPS 5–6 | CPS 3–4: 85.9 years (70.1%)c CPS 5–6: 85.7 years (76.3%)c |
Gessert, 2008 [36] | USA | Administrative databases from Centers for Medicare and Medicaid services MDS | 2000–2001 | 3703 NHR | Urban and rural NH ≥67 years old Not enrolled in Health Maintenance Organization No hospice benefits during 2 years prior to death Not comatose | Severe and persistent cognitive impairment based on the CPS - CPS = 6 on ≥2 consecutive MDS reports at least 60 days apart - absence of MDS reports with CPS ≤4 there after | 87.1 years (76.4%)c |
Hendriks, 2017 [20] | Netherlands | Questionnaires from the Dutch end-of-life in dementia study (DEOLD) | 2007–2011 | 330 residents from 34 LTCF | Residents admitted to psychogeriatric wards | Known diagnosis of dementia upon nursing home admission (by a physician) Advanced dementia: CPS 5–6 + GDS 7 | 85.2 years (not reported) |
Houttekier, 2014 [21] | Belgium | Questionnaires (with access to medical files) from the “Dying well with Dementia” study | 2010 | 195 NHR from 69 NH | Inclusion process in two steps: First: residents had to be completely care dependent for ADL and disoriented in time and space or had to have a Katz scale score ≥ 3 Second: Resident had to have dementia (reported by nurse or GP) | After inclusion CPS and GDS was assessed: - mild/moderate: CPS < 5, GDS < 7 - severe: CPS ≥5 and GDS < 7 or CPS < 5 and GDS = 7 -very severe/ advanced: CPS ≥5, GDS = 7 | < 85 years: 31.7% 85–90 years: 37.7% > 90 years: 30.6% (61.4%) |
Krishnan, 2015 [37] | Canada | MDS 2.0 Medical charts Death certificates | 2010–2013 | 58 NHR from 1 NH | All residents were included | Dementia recorded on death certificate as underlying or immediate cause of death | not reported |
Lamberg, 2005 [30] | USA | MDS Medical long-term care records | 2001–2003 | 240 NHR from 1 NH | Long term residents (stay ≥30 days) Advanced dementia (CPS 5–6) | CPS 5–6 Long term care medical records to identify cause of cognitive impairment | 92 years (median) (75.8%) |
Li, 2013 [22] | USA | MDS 2.0 Medicare beneficiary file Hospice and hospital claims | 2003–2007 | 143,980 NHRc | ≥65 years old > 3 months in nursing home No rehabilitation or postacute stay Not comatose No transfers to another NH after last assessment Not enrolled in managed care in last 30 days of life | Diagnosis of Alzheimer’s disease or other dementia on the last full MDS assessment | 87.4 years (71.9%)c |
Livingston, 2013 [31] | UK | Care home resident records Interviews Questionnaires | 30 NHRd from 1 NH | Living in the NH for at least 1 month before death Resident records had to be available | Medical records Diagnosis of dementia or suspected dementia (symptoms fulfilling standard dementia criteria) | not reported | |
Sloane, 2008 [15] | USA | (Telephone) interviews with staff and family Study cohort from the Collaborative Studies of long-term care (CS-LTC) | 2002–2005 | 247 NHR | NHR who spent 15 out of 30 days in a NH Died no more than 3 days after leaving the NH | NH staff members were asked whether the decedent was an Alzheimer’s type resident 3 months before death and if dementia was a contributing factor towards the resident’s death | not reported |
Temkin-Greener, 2013 [32] | USA | Nationwide administrative data from the chronic condition data warehouse Medicare denominator files MDS | 2003–2007 | 384,355 NHR | Died in NH or within 8 days of discharge to a different care setting Not enrolled in managed care in last 30 days of life Not from Virgin Islands or Puerto Rico | not reported | not reported |