Lead
The risk of overprovision of medical care is high for elderly persons with co-occurrence of illnesses. This study examines the factors that influence elderly patients’ pathways of care at the end of life through the hospitals and nursing homes in Switzerland.

Lay summary
Background
Medical advances and the aging of the population in the last decades have resulted in more and more elderly persons with multiple, often chronic illnesses. This multimorbidity often leads to intensive medical care, frequently by several specialists. Sometimes neither the patients nor their family want the medical measures, and occasionally the measures are not medically advisable. In addition, unnecessary health costs are incurred.

Aim
This study will investigate how much time elderly people at the end of life spend in hospitals and nursing homes, how intensive the medical care that they receive is, where they die, and what regional, cultural, social and economic factors determine their pathways through the medical institutions. The research team will utilise three Swiss databases: the Swiss National Cohort, the hospitals’ medical statistics and the statistics recorded by social-medical institu-tions. This will make it possible to track the paths of individuals through the medical institutions during the last years of their lives and to examine the relationship between these pathways and regional, cultural and other factors.

Significance
The results of this study can be an aid to adapting the health care system to the needs of the dying and their family members. In addition, the results can be useful in the debate on the sensible distribution of medical resources.