Hospital healthcare utilisation among older adults admitted to a university hospital in the last months of life: A retrospective observational study

• Main Authors: Ng, Tyng Sam, Lam, Chee Loong, Ong, Terence
• Format: Article
• Published: Malaysian Medical Association 2022
• Subjects: Medical technology
• Online Access: http://eprints.um.edu.my/43725/

Introduction: Health needs increase in older age. This translates into higher healthcare utilisation and expenditure compared to any other age group. Much of this is driven by frailty and multimorbidity. Many older people spend their last days in hospital. The aim of this study was to explore the utilisation of healthcare services among older adults admitted to a university hospital in the last 6 months of life. Materials and methods: Patients aged 70 years and over who died on medical wards of a university hospital in 2019 were included based on a stratified sampling approach using three categories. The categories were which medical ward the patient was admitted under, ICD-10 reported cause of death, and gender. The proportion of patients distributed across all three categories was calculated and 200 patients out of 472 deaths in that year were randomly selected to ensure mirrored proportion distributed across these three categories. Data on demographics and healthcare utilisation were collected. Healthcare utilisation parameters included clinical encounters, radiological investigations, and medical procedures undergone. Results: The median age was 83 years with more women (51) than men. Septicaemia was the commonest cause of death (24.5), followed by pulmonary disease (21.0), and cardiovascular disease (19.5). In the last 6 months before death, median inpatient stay was 9 days. The median number of Emergency Department and outpatient attendance was one episode, respectively, and number of radiology was four investigations. Over one-third of patients had multiple hospital admission. During the terminal admission, the median inpatient stay was 6 days. 45 had a nasogastric tube in-situ. Antibiotics used during the last 24 hours of life and polypharmacy (≥5 medications) were high at 74.5 and 82.5, respectively. 7 of patients received cardiopulmonary resuscitation. Conclusion: This study has provided descriptive evidence of hospital care delivered in the last months of life. The majority had contact with a healthcare team prior to their terminal admission. Many during their terminal admission had healthcare procedures, investigations, antibiotics, and issues of polypharmacy during this time. With an aging population, how care is organised and delivered is important in promoting good care in their later years. © 2022, Malaysian Medical Association. All rights reserved.