临终 (EOL) 转入医院对于老年人来说可能是一个负担，并可能导致不良结果。我们调查了疾病轨迹和护理地点与 EOL 繁重过渡之间的关联。使用管理数据进行回顾性队列研究。2015 年至 2018 年期间死亡且在死亡前 6 个月接受长期护理 (LTC) 或家庭护理的年龄 ≥ 65 岁的安大略人.疾病轨迹是根据EOL功能衰退来定义的：绝症、器官衰竭、虚弱、猝死等。护理场所包括 LTC、EOL 家庭护理和非 EOL 家庭护理。负担转变被定义为早期（在生命的最后 90 天内因任何原因≥3 次住院或≥2 次因肺炎、尿路感染、败血症或脱水而住院）或晚期（在过去 3 天内因任何原因≥1 次住院）生活的日子）。多项逻辑回归测试了疾病轨迹和护理地点之间对繁重转变的影响。在 110,776 名死者中，40.7% 患有器官衰竭，37.5% 虚弱，12.8% 患有绝症，其余则猝死或其他类别。大多数人接受长​​期护理 (LTC) (62.5%)，37.5% 接受家庭护理，其中 6.8% 接受指定的 EOL 家庭护理，30.7% 接受非 EOL 家庭护理。疾病轨迹和护理环境之间存在显着的交互作用 (P < .001)。与绝症相比，器官衰竭与所有护理环境中早期转变的几率增加相关[比值比 (OR) 范围为 1.14-1.21]。仅对于非 EOL 家庭护理接受者来说，虚弱与早期过渡的几率增加有关（OR 1.17，95% CI 1.06-1.28）。在所有情况下，器官衰竭和虚弱均与晚期转变的几率增加相关，其中器官衰竭在 LTC 中的几率更大（器官衰竭 OR 2.29，95% CI 2.02-2.60，相对于虚弱 OR 1.79，95% CI 1.58-2.04）。影响：在繁重的过渡中存在差异，特别是对于长期护理中器官衰竭的非癌症死者。加强姑息治疗可能有助于减少繁琐的过渡并改善患者的治疗效果。版权所有 © 2024。由 Elsevier Inc. 出版。

End-of-life (EOL) transitions to hospital can be burdensome for older adults and may contribute to poor outcomes. We investigated the association of disease trajectory and place of care with EOL burdensome transitions.Retrospective cohort study using administrative data.Ontarians aged ≥65 years who died between 2015 and 2018 and received long-term care (LTC) or home care 6 months before death.Disease trajectories were defined based on EOL functional decline: terminal illness, organ failure, frailty, sudden death, and other. Places of care included LTC, EOL home care, and non-EOL home care. Burdensome transitions were defined as early (≥3 hospitalizations for any reason or ≥2 hospitalizations due to pneumonia, urinary tract infection, sepsis, or dehydration in the last 90 days of life) or late (≥1 hospitalizations for any reason in the last 3 days of life). Multinomial logistic regression tested for effect modification between disease trajectory and places of care on burdensome transitions.Of 110,776 decedents, 40.7% had organ failure, 37.5% frailty, and 12.8% terminal illness, with the remainder in sudden death or other categories. Most were in LTC (62.5%), and 37.5% received home care, with 6.8% receiving designated EOL home care and 30.7% non-EOL home care. There was a significant interaction (P < .001) between disease trajectory and care settings. Compared with terminal illness, organ failure was associated with increased odds of early transitions across all care settings [odds ratios (ORs) ranging 1.14-1.21]. Frailty was associated with increased odds of early transitions solely for non-EOL home care recipients (OR 1.17, 95% CI 1.06-1.28). Organ failure and frailty were associated with increased odds of late transitions across all settings, with organ failure having greater odds in LTC (organ failure OR 2.29, 95% CI 2.02-2.60, vs frailty OR 1.79, 95% CI 1.58-2.04).and Implications: Disparities exist in burdensome transitions, notably for noncancer decedents with organ failure in LTC. Enhancing palliative care may help reduce burdensome transitions and improve patient outcomes.Copyright © 2024. Published by Elsevier Inc.