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Moving to and dying in a nursing home depends not only on health – An analysis of socio-demographic determinants of place of death in Switzerland

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Hedinger Damian, Zellweger Ueli, Braun Julia, Kaplan Vladimir, Bopp Matthias,
Project Multimorbidity and pathways of inpatient care at the end-of-life: a national study in Switzerland
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Original article (peer-reviewed)

Journal PLoS ONE
Volume (Issue) 9(11)
Page(s) e113236
Title of proceedings PLoS ONE
DOI 10.1371/journal.pone.0113236

Open Access

URL http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0113236
Type of Open Access Publisher (Gold Open Access)

Abstract

Background: In developed countries generally about 7 out of 10 deaths occur in institutions such as acute care hospitals or nursing homes. However, less is known about the influence of non-medical determinants of place of death. This study examines the influence of socio-demographic and regional factors on place of death in Switzerland. Data and Methods: We linked individual data from hospitals and nursing homes with census and mortality records of the Swiss general population. We differentiated between those who died in a hospital after a length of stay #2 days or $3 days, those who died in nursing homes, and those who died at home. In gender-specific multinomial logistic regression models we analysed N = 85,129 individuals, born before 1942 (i.e., $65 years old) and deceased in 2007 or 2008. Results: Almost 70% of all men and 80% of all women died in a hospital or nursing home. Regional density of nursing home beds, being single, divorced or widowed, or living in a single-person household were predictive of death in an institution, especially among women. Conversely, homeownership, high educational level and having children were associated with dying at home. Conclusion: Place of death substantially depends on socio-demographic determinants such as household characteristics and living conditions as well as on regional factors. Individuals with a lower socio-economic position, living alone or having no children are more prone to die in a nursing home. Health policy should empower these vulnerable groups to choose their place of death in accordance to needs and wishes.
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