Dying in hospital with dementia and pneumonia: a nationwide study using death certificate data

For people with dementia dying from pneumonia, hospitalization at the end of life may be of little benefit and result in unfavourable outcomes such as hospital death.

The aim of this study is to estimate the incidence of and factors associated with hospital death in people with dementia dying from pneumonia.

We used death certificate data of all deaths in Belgium in 2008 (n = 101,685) to examine characteristics of deaths of people with dementia dying from pneumonia. Information about the urbanization level of the place of residence and the availability of hospital beds, residential (without continuous skilled nursing) and skilled nursing beds in long-term care settings was linked through the zip code of the place of residence.

Of people with dementia dying from pneumonia (n = 1,420), 47.2% died in hospital. Of those living in long-term care settings, 25.6% died in hospital. For people living in their own home, hospital death was more likely for those who were single (adjusted odds ratio (AOR) 2.83, 95% CI 1.30-6.16) and living in strongly urbanized areas (AOR 2.48, 95% CI 1.47-4.18). For those living in long-term care settings, hospital death was more likely in regions with higher availability of residential beds (without continuous skilled nursing) in long-term care settings (AOR per unit 1.02, 95% CI 1.01-1.03).

Almost half of all those with dementia dying from pneumonia and a quarter of those living in long-term care settings died in a hospital. These results suggest shortcomings in the Belgian healthcare system in preventing potentially avoidable terminal hospitalizations in a vulnerable population.