Elective admissions and treatments in the final three months of life: a nationwide retrospective study of older adults

Abstract

PURPOSE: Research on potentially inappropriate care at the end of life in older adults rarely distinguishes between acute and elective care. As elective care is plannable, it allows for timely deliberation on its appropriateness. This study aimed to explore elective hospital care and specific elective treatments in the final three months of life to identify areas warranting re-evaluation. METHODS: A nationwide retrospective observational study was conducted using linked administrative data, including data from electronic patient records and health insurance claims from all secondary and tertiary hospitals across the Netherlands. Included were 104,544 older adults aged ≥ 65 who died between April and December 2019. RESULTS: In the final three months of life, 41.7% of older adults received no hospital care, 14.5% received outpatient care only, 42.4% were admitted, and 15.9% were electively admitted. Some of the most frequent elective treatments were chemo- and/or immunotherapy (12,102), radiotherapy (13,924), dialysis (30,087), and cataract surgery (584). Treatments during elective admissions included gastrointestinal endoscopies (979), gastrointestinal tract organ resections (229), gastrointestinal-ostomy surgeries (228), exploratory laparotomies (177), heart valve surgeries (179), arterial interventions (coronary: 266; aorta/side branches: 147; peripheral: 786), hip surgeries (136), leg amputations (115), and artificial feeding procedures (683). A substantial proportion occurred in the final month of life. CONCLUSION: Elective hospital care is common in the final three months of life among older adults, with limited time to experience meaningful benefit. These findings highlight the need to reconsider the appropriateness of elective care at the end of life to better align care with patients' preferences.