Work

Trends in End-of-Life Hospitalizations of Nursing Home Residents between 2011 and 2020: Analyses of German Health Insurance Data

Year: 2025

Type: article

Abstract: OBJECTIVES: To investigate trends in end-of-life hospitalizations among nursing home residents between 2011 and 2020. DESIGN: A retrospective cohort study was conducted. SETTING AND PARTICIPANTS: Using German claims data of the statutory health and long-term care insurance fund AOK Niedersachsen, all residents aged ≥65 years who were newly admitted to a nursing home between January 1, 2011, and December 31, 2020, and became deceased in the calendar year of admission were included. METHODS: Proportions of deceased nursing home residents dying in hospital and being hospitalized in the last 7 and 30 days of life were analyzed and stratified by 2-year periods. Multiple logistic regressions were performed to examine changes over time, adjusting for covariates. RESULTS: A total of 26,359 decedents were included (mean age, 84.0 years; 61.0% female). Proportions of nursing home residents dying in hospital decreased from 32.0% to 27.4% (odds ratio [OR], 0.88; 95% CI, 0.81-0.96), being hospitalized in the last 7 days decreased from 42.5% to 36.3% (OR, 0.84; 95% CI, 0.77-0.91), and being hospitalized in the last 30 days decreased from 61.6% to 56.7% (OR, 0.88; 95% CI, 0.82-0.96) between 2011-2012 and 2019-2020. Male sex, lower care dependency, and younger age (aged ≤94 years) were associated with an increased likelihood of end-of-life hospitalizations in all analyses. Of the 7923 terminal hospitalizations, mean length of hospital stay was 9.1 days and 33.4% lasted up to 3 days, with no changes over time. CONCLUSION AND IMPLICATIONS: End-of-life hospitalizations of German nursing home residents have decreased over the years, but are still common. Because more policies have been introduced globally in recent years aimed at improving end-of-life care in nursing homes, longitudinal studies investigating trends with more recent data are needed.

Source: Journal of the American Medical Directors Association

DOI: 10.1016/j.jamda.2025.105540