Abstract
During 1992 a reform bill was introduced to the Swedish health care system. The main aim was to provide social and long term medical care for frail elderly persons irrespective of whether they lived in an institution or in their own home.
Aim:
To explore a) place of death for the elderly (≥65 years) and b) the number of patients who died shortly (≤2 weeks) after discharge from hospital, both before and after the “Ädel-reform”.
Methods:
National register data was collected on gender, age, place of death, and the number of deaths within 2 weeks of discharge from hospital, during 1987 – 2005.
Findings:
Approximately 80,000 elderly died annually in Sweden during the study period. The proportion of deaths outside hospital increased from 29% to 60%. This trend was particularly pronounced for the older-elderly (80+ years). Furthermore, there was a radical increase in the number of elderly discharged from hospital shortly before death after the reform.
Conclusion:
The results suggest that the health care reform successfully achieved its goal. However, the observed increase in the number of discharges shortly before death raises questions regarding the impact of the reform on relatives, staff and the quality of end-of life care for the elderly.