New CIHI study is the first of its kind to look at how Canadians use
health care services at the end of life
OTTAWA, Sept. 6 /CNW Telbec/ - More than half of the over 65,000 people
who died in Western Canada in 2003-2004 died in a hospital, according to a new
report by the Canadian Institute for Health Information (CIHI). In-hospital
deaths were more common in Manitoba (68%) and Alberta (65%) than in British
Columbia (52%) or Saskatchewan (51%). Health Care Use at the End of Life in
Western Canada is the first report of its kind to examine the use of health
services by people nearing the end of their lives.
"Studies have shown that when given the option, most people would prefer
to die at home, instead of in a hospital or in an institutional setting," says
Anne McFarlane, CIHI's Executive Director for Western Canada. "This report
shows that patients typically require more health care services in the final
days, weeks and months of life. Understanding the types of services they need
is crucial for developing new end-of-life care strategies, especially as the
number of older persons in our population increases in the coming years."
The study looked at four broad categories of patients who were nearing
the end of their lives. Terminal Illness patients (68%), which include those
with cancer, were the most likely to have died in a hospital, compared to
Organ Failure (62%), Frailty (50%) or Sudden Death (29%) patients. Of the
almost 37,000 people who died in hospital, just over a quarter received some
form of palliative care, and the majority of these were terminally ill
In B.C., 17% of deaths occurred at home, while 27% occurred in a
long-term care facility; in Alberta, 15% of deaths occurred at home and 16%
occurred in a long-term care facility; and in Manitoba, 11% of deaths occurred
at home and 20% occurred in a long-term care facility. Data for Saskatchewan
were not available.
Hospital use increases in the six months and 30 days before death
In the last 30 days before they died, 37% of western Canadian decedents
were hospitalized at least once, and over half (57%) were hospitalized in the
last six months of life. By province, those who died in B.C. were less likely
to be hospitalized in the last month of their lives than those in Alberta,
Saskatchewan or Manitoba.
In the last 30 days before death, patients in B.C. spent an average of
4.5 days in hospital, compared to 8.7 days in Manitoba, 8.4 days in Alberta
and 7.3 days in Saskatchewan. The length of hospital stay varied within
provinces, as decedents from smaller, rural or northern regional health
authorities (RHAs) spent more days in hospital before death than decedents
from larger, more urbanized RHAs.
While hospital use increased for most individuals in the last six months
of life, it rose most rapidly for those in the Terminal Illness group. Within
the six months before death, 75% of terminally ill patients were hospitalized,
compared to 57% of those in the Organ Failure group and 43% of those in the
Pain management at the end of life
The study found marked differences in pain management at the end of life.
Variations exist in the dispensing of morphine-equivalent (a standardized
measure of pain medication) drugs in the community. Pain-medication use was
lower in B.C. than in Saskatchewan and Manitoba (data for Alberta were not
available), and Saskatchewan had the highest morphine-equivalent prescription
drug use at all time periods during the last year of life. Examination of the
most common pain medications used in the last six months revealed similar
patterns in each of the three provinces, with morphine and acetaminophen with
codeine the two most common drugs/chemicals used, as measured by the total
number of claimants.
Patients dying of a terminal illness had the highest use of prescription
drugs compared to other groups, particularly within 30 days before death,
indicating a stronger reliance on drugs-including those used for pain
management-as death approached. Further from death, particularly between 6 and
12 months before death, Organ Failure and Frailty decedents showed higher drug
use. As expected, morphine-equivalent use was highest among the Terminal
Illness decedent group.
"Management of pain and discomfort is an important feature of care at end
of life," says Dr. Peter Kirk, Director of Research and Academic Development
at the Vancouver Island Health Authority. "Provincial variations in the use of
pain medication may reflect differences in prescribing practices, clinical
practices and the roles of cancer agencies or drug formularies. It is exciting
to have this kind of information for the first time; however this is just a
first step. We will need to keep collecting and exploring this type of
information to complete the picture on end-of-life care in Canada."
The Canadian Institute for Health Information (CIHI) collects and
analyzes information on health and health care in Canada and makes it publicly
available. Canada's federal, provincial and territorial governments created
CIHI as a not-for-profit, independent organization dedicated to forging a
common approach to Canadian health information. CIHI's goal: to provide
timely, accurate and comparable information. CIHI's data and reports inform
health policies, support the effective delivery of health services and raise
awareness among Canadians of the factors that contribute to good health.
The report and the following figures and tables are available from CIHI's
website at www.cihi.ca.
Table 1. Percentage Distribution of In-Hospital Deaths by Province, 2003-
2004 (Unadjusted) (Table 7 in the report)
Table 2. Percentage Distribution of In-Hospital Deaths by Trajectory
Group, 2003-2004 (Unadjusted) (Table 10 in the report)
Table 3. Number and Percentage of Decedents Hospitalized at Selected Time
Periods Before Death, by Province, 2003-2004 (Adjusted by Age
and Sex) (Table 13 in the report)
For further information:
For further information: Media contacts: Christina Lawand, (613)
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Hollingsworth, (613) 241-7860 ext. 4140, Cell: (613) 612-3914,