Health care use, care settings, and location of death for people with schizophrenia in long-term care

Objective — To determine if health care settings in the last year of life and location of death differ between long-term care (LTC) residents with and without schizophrenia.

Design — A retrospective cohort study using health administrative data.

Setting and participants — All adults who died in Ontario between January 1, 2010, and December 31, 2019, who were living in LTC homes 1 year before death, and who died of natural causes.

Methods — Schizophrenia was ascertained using a validated administrative data algorithm. We used descriptive statistics, negative binomial regression, and logistic regression to compare health characteristics, health care use, and location of death for individuals with and without schizophrenia in the last year of life.

Results — Of 135,560 total LTC residents, 5670 (4.2%) had a diagnosis of schizophrenia. LTC residents with schizophrenia died on average 7 years earlier (standardized difference = 0.75) yet were more likely to have no recorded chronic health conditions (standardized difference = 0.19). Those with schizophrenia had significantly higher rates of hospitalizations (adjusted rate ratio = 1.22, 95% confidence interval = 1.17-1.26) and emergency department visits (adjusted rate ratio = 1.14, 95% confidence interval = 1.10-1.18) in the last year of life, adjusted for age, sex, cause of death, and year of death. This finding was observed for both mental health-related and non-mental health-related hospitalizations and emergency department visits. LTC residents with schizophrenia were also more likely to die during a mental health-related (standardized difference = 0.21) or non-mental health-related (standardized difference = 0.15) hospitalization, with lower odds of dying in LTC (adjusted odds ratio, 0.83; 95% confidence interval, 0.78-0.88).

Conclusions and implications — LTC residents with schizophrenia have higher rates of acute care use and are more likely to die in hospital compared with residents without schizophrenia. More research is necessary to understand differences in care provisions for LTC residents with schizophrenia and understand how LTC facilities can meet the unique needs of this vulnerable population.