Objective: This study aims to increase knowledge concerning end of life health care utilization among an urban-dwelling Parkinson’s disease (PD) cohort. More specifically we investigated frequency of acute hospital visits and access to specialized palliative care (SPC) during the last three months of life, as well as place of death. Additionally, we aimed to examine whether health care utilization differed in relation to health, sex, residential or socioeconomic status.

Background: People at late-stage PD present with complex symptoms and high levels of disability. Despite this heavy disease burden, people at late-stage PD are generally underrepresented in the literature and knowledge of healthcare utilization at the end of life in PD is therefore sparse.

Method: We conducted a population-based register study on deceased patients (≥18 years) with a PD diagnosis during their last year of life (n=922), based on caregiver-provided data from Region Stockholm´s data warehouse, for the study period 2015-2021. Univariate and multivariate logistic regression analyses were performed to test associations and adjusted Odds ratios (aORs) were calculated.

Results: In total, 922 persons (63% men and 37% women) who had PD as their main diagnosis during the last three months of life and died with PD were included in the analyses. Of these, 120 people (13%) received SPC during their last three months of life. Receipt of SPC was positively associated with risk for frailty (measured by Hospital Frailty Risk Score), (aOR); 2.65 (1.43-4.94, p=0.002). During the last month of life, approx. half of the cohort had emergency room visits and frailty was the only significant variable (aOR, 3.90 (2.75-5.55)). For those in ordinary accommodation, male gender and frailty were strongly associated with acute hospital deaths (aOR, 1.90 (1.15-3.13, p=0.01) and 3.70 (1.96-6.98, p<0.0001)) respectively. Receipt of SPC was strongly associated with reduced need of unplanned ER visits, aOR 0.36 (0.21-0.62, p=0.0002). When controlled for health and socioeconomic-related factors, men with PD were 88% more likely to die in acute hospitals settings.

Conclusion: Considering a high disease burden, referral rates to SPC at end of life in PD are relatively low. Identifying people with high risk for frailty could assist the planning of optimal end-of-life care for people with late-stage PD. Gender-specific disparities in health-care utilization are apparent.

« Back to 2024 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/health-care-utilization-at-the-end-of-life-in-parkinsons-disease/