BACKGROUND End-of-life periods are often characterised by suboptimal healthcare use (HCU) patterns in persons aged 65 years and older, with negative effects on health and quality of life. Understanding care trajectories (CTs) and transitions in this period can highlight potential areas of improvement, a subject yet only little studied. OBJECTIVE To propose a typology of CTs, including care transitions, for older individuals in the 2 years preceding death. DESIGN Retrospective cohort study. METHODS We used multidimensional state sequence analysis and data from the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between a Canadian health survey and Quebec health administrative data. RESULTS In total, 2080 decedents were categorised into five CT groups. Group 1 demonstrated low HCU until the last few months, whilst group 2 showed low HCU over the first year, followed by a steady increase. A gradual increase over the 2 years was observed for groups 3 and 4, though more pronounced towards the end for group 3. A persistent high HCU was observed for group 5. Groups 2 and 4 had higher proportions of cancer diagnoses and palliative care, as opposed to comorbidities and dementia for groups 3 and 5. Overall, 68.4% of individuals died in a hospital, whilst 27% received palliative care there. Care transitions increased rapidly towards the end, most notably in the last 2 weeks. CONCLUSION This study provides an understanding of the variability of CTs in the last two years of life, including place of death, a critical step towards quality improvement.

中文翻译：

---

临终关怀轨迹和转变：基于人群的队列研究。


背景技术 65 岁及以上人群的临终期通常以次优医疗保健使用 (HCU) 模式为特征，对健康和生活质量产生负面影响。了解这一时期的护理轨迹 (CT) 和过渡可以突出潜在的改进领域，但这一主题的研究还很少。目的 提出老年人死亡前 2 年内的 CT 类型，包括护理过渡。设计回顾性队列研究。方法 我们使用多维状态序列分析和来自护理轨迹丰富数据 (TorSaDE) 队列的数据，该队列是加拿大健康调查和魁北克健康管理数据之间的联系。结果 总共 2080 名死者被分为五个 CT 组。第 1 组在过去几个月之前表现出较低的 HCU，而第 2 组在第一年表现出较低的 HCU，随后稳步上升。第 3 组和第 4 组在 2 年内逐渐增加，但第 3 组在接近尾声时更为明显。第 5 组观察到持续较高的 HCU。第 2 组和第 4 组的癌症诊断和姑息治疗的比例较高，因为反对第 3 组和第 5 组的合并症和痴呆症。总体而言，68.4% 的人在医院死亡，而 27% 的人在那里接受姑息治疗。护理过渡在接近尾声时迅速增加，尤其是在过去两周内。结论 这项研究提供了对生命最后两年 CT 变异性的了解，包括死亡地点，这是提高质量的关键一步。