Mortality and causes of death among long-term care residents in Helsinki, Finland 2017-2021, a longitudinal cohort study.

Abstract

Aims: Knowledge about mortality and causes of death is needed to improve the quality of end-of-life care in long-term care (LTC). This study aimed to investigate mortality and causes of deaths in LTC. We explored how age, sex, and having dementia at baseline were associated with the standardized mortality ratio (SMR) and causes of death.

Methods: Participants comprised residents (N = 2513) living in LTC facilities in Helsinki, Finland in March 2017. Background data on demographics, diagnoses, and medications were retrieved from medical charts. Causes of death were retrieved from the Finnish Cause of Death Register for deaths that were registered up to 31 December 2021.

Results: Of the 2513 participants, 2033 died during follow-up. All-cause SMR was 3.31 (95% CI 3.17-3.46) compared with the same-aged general population in Finland. SMR for men was 4.33 (95% CI 3.98-4.70), for women was 3.05 (95% CI 2.90-3.20), and for residents younger than 70 years 13.80 (95% CI 11.17-17.05). SMR decreased linearly with age. There was no difference in SMR among those with and without dementia. For both sexes the most common cause of death was dementia (67.0%), followed by cardiovascular disease (CVD; 15.9%), neurological diseases (5.2%), and cancer (3.1%). The most common cause of death in residents with dementia was dementia (77.7%), whereas in residents without dementia it was CVD (36.0%).

Conclusions: Male sex and younger age were associated with a higher SMR. Residents most frequently died of dementia. End-of-life care in LTC needs to be tailored to meet the needs of people with dementia.