Last Updated: 2009-08-20 13:49:01 -0400 (Reuters Health)
NEW YORK (Reuters Health) - People in their last year of life use more health-care resources than their peers who have at least three years longer to live, new research from The Netherlands shows.
Worse health problems among these individuals were "decisive" in explaining their greater use of health care, Dr. Anne Margriet Pot of VU University Medical Center in Amsterdam and her colleagues report.
While it would seem obvious that people need more health care soon before they die -- and studies have confirmed that health care costs are highest in a person's last year of life -- data are lacking on what kind of services people actually use.
"In addition to costs, knowledge of the types and determinants of health-care utilization in the last phase of life is important," they note in the journal BMC Health Services Research.
To investigate, the researchers looked at 3,107 men and women 55 to 85 years old who were followed up three, six and nine years after the study began. Those who died within one year of the end of one of the three-year cycles (262 people in all) were classified as the "end-of-life" group, while those who had survived for at least three years after the end of a cycle were termed "survivors."
As expected, the end-of-life group used more health care. They were more likely to be male and were about eight years older, on average, than the survivors. They were also sicker, more likely to have thinking or visual impairment, more likely to be depressed, and more likely to say that their health was fair to poor.
Differences in care use varied by age. The younger study participants who didn't survive used more acute services compared to survivors, while the older non-survivors used more long-term care than their survivor peers.
Among 62-year-olds, for example, those who died were four times more likely to have been hospitalized than survivors, and 1.5 times more likely to see a medical specialist.
For 77-year-olds, non-survivors were six times as likely to be receiving professional home care, four times as likely to be getting informal care at home, and three times as likely to be receiving long-term care in an institution.
The researchers also saw differences in the type of care people received based on their socioeconomic status. Less wealthy individuals were more likely to live in a nursing home or similar care facility, while more educated people were more likely to see medical specialists.
Individuals who lived with a partner and who had children living nearby were more likely to report receiving care at home, either informally or from professionals.
People with cognitive impairment were less likely to see medical specialists than those with no such impairment, suggesting that "poor cognitive ability may hamper access to appropriate care," Pot and her team note.
These findings, they conclude, will help in planning for allocating resources to caring for people, and their caregivers, at the end of life.
SOURCE: BMC Health Services Research, August 5, 2009.
Dr. Sears comments:
This is where health-care reform will be fought in earnest because this where the real costs are located.