Ueli Zellweger

Der Sterbeort: „Wo sterben die Menschen heute in der Schweiz?“

ZusammenfassungHintergrundAmtliche Informationen zum Sterbeort werden seit 1987 im Bundesamt für Statistik (BfS) nicht mehr erhoben. Somit können aus dieser Quelle für die Schweiz keine Aussagen über die Entwicklung des Sterbeortes gemacht werden.MethodenMittels eines Fragebogens wurden Ärztinnen und Ärzte aus der Deutsch-Schweiz, welche zwischen dem 1. Juni und dem 30. Oktober 2001 ein Todesfallformular unterzeichneten, zum konkreten Todesfall schriftlich befragt. Die Häufigkeitsverteilungen zum Sterbeort (zu Hause, im Spital, Alters-, Pflege- und Krankenheim, anderer Ort) werden mit den amtlichen Daten zum Sterbeort für die Jahre 1969 bis 1986 verglichen. Anhand logistischer Regressionen werden die Einflussgrößen für die Sterbeorte identifiziert.ErgebnisseDer Tod ereignete sich im Jahre 2001 in der Deutsch-Schweiz am häufigsten im Spital (37,2% der Todesfälle). Am zweit häufigsten fand der Tod im Alters-, Kranken- oder Pflegeheim statt (33,5%) und an dritter Stelle stand das Sterben zu Hause (22,7%). Determinanten für den Sterbeort waren die Todesursache, das Geschlecht, der Zivilstand und teilweise die Religion. Während sich zwischen 1969 und 1986 eine Entwicklung zum institutionellen Sterben abzeichnete, verlagerte sich zwischen 1986 und 2001 das Sterben innerhalb der Institutionen von den Spitälern weg in die Alters- und Pflegeheime.SchlussfolgerungDie Bedeutung der Alters- und Pflegeheime als Sterbeort dürfte in Zukunft noch stärker wachsen, da in der kommenden Zeit der Anteil von alten Menschen ansteigen wird. Um Personen zu ermöglichen, die Pflege- und Betreuungsaufgaben von Angehörigen zu Hause erfüllen zu können, müssten die ambulanten Hilfsdienste erhöht werden und Anreize geschaffen und Unterstützungen geboten werden.SummaryBackgroundOfficial information on the place of death has not been collected by the Swiss Federal Office of Statistics since 1987. Thus, no statements can be made for the developments in Switzerland.MethodsPhysicians from the German speaking part of Switzerland who had filled in a death certificate between June 1 and October 30, 2001 were sent a questionnaire about circumstances of the specific death case. The frequencies of the place of death (at home, in hospital, in home for elderly, in nursing home, other place) were compared with the official data of the years 1969 until 1986. Using logistic regressions predictors for the place of death were estimated.ResultsIn 2001 in the German speaking part of Switzerland death occurred most frequently in hospital (37.2% of all death cases) followed by a home for elderly (33.5%) and dying at home (22.7%). Relevant predictors for the place of death were cause of death, sex, marital status and partly religion. Whereas between 1969 and 1986 a development towards dying in institutions was found, between 1986 and 2001 the place of death shifted within the institutions from hospitals to homes for elderly.ConclusionThe relevance of the home for elderly as the place of death will further grow in the future. To allow people to fulfill the tasks of caring for their relatives at home the ambulant emergency services will have to be augmented and relatives have to be motivated and supported.

Routine data sources challenge international diabetes Federation extrapolations of national diabetes prevalence in Switzerland.

OBJECTIVE Information on diabetes prevalence in the general population is scarce and often based on extrapolations. We evaluated whether prevalence could be estimated from routine data sources. RESEARCH DESIGN AND METHODS The sources were 1) hospital discharges (2008, n = 828,171), 2) death registry (2007/2008, n = 118,659), and 3) Swiss Health Survey (SHS; 2007, n = 18,665). Persons without diabetes as underlying cause of death (death registry) or principal diagnosis (hospital discharges) were regarded as surrogate for a general population random sample. RESULTS In those aged 20–84 years, 4.5% of men and 3% of women were expected to have diabetes. By source, estimations were 4.4 and 2.8% (hospital discharges), 3.8 and 3.1% (death registry), and 4.9 and 3.7% (SHS) for men and women, respectively. Among sources, age–sex patterns were similar. CONCLUSIONS In countries with adequate data quality, combination of routine data may provide valid and reliable estimations of diabetes prevalence. Our figures suggest that International Diabetes Federation extrapolations substantially overestimate diabetes prevalence in Switzerland.

Moving to and dying in a nursing home depends not only on health - an analysis of socio-demographic determinants of place of death in Switzerland.

Background In developed countries generally about 7 out of 10 deaths occur in institutions such as acute care hospitals or nursing homes. However, less is known about the influence of non-medical determinants of place of death. This study examines the influence of socio-demographic and regional factors on place of death in Switzerland. Data and Methods We linked individual data from hospitals and nursing homes with census and mortality records of the Swiss general population. We differentiated between those who died in a hospital after a length of stay ≤2 days or ≥3 days, those who died in nursing homes, and those who died at home. In gender-specific multinomial logistic regression models we analysed N = 85,129 individuals, born before 1942 (i.e., ≥65 years old) and deceased in 2007 or 2008. Results Almost 70% of all men and 80% of all women died in a hospital or nursing home. Regional density of nursing home beds, being single, divorced or widowed, or living in a single-person household were predictive of death in an institution, especially among women. Conversely, homeownership, high educational level and having children were associated with dying at home. Conclusion Place of death substantially depends on socio-demographic determinants such as household characteristics and living conditions as well as on regional factors. Individuals with a lower socio-economic position, living alone or having no children are more prone to die in a nursing home. Health policy should empower these vulnerable groups to choose their place of death in accordance to needs and wishes.

A recruitment method to obtain community samples of children for survey research in Switzerland

In conducting epidemiological surveys of children in Switzerland, it is often very difficult to recruit large, representative community samples. To date, most large epidemiological surveys on children have used convenience samples, like school children (Jeannin et al. 2005); (Kuntsche and Kuendig 2006); (Steinhausen et al. 1998). One major limitation of school surveys is that certain information about the family and parents is often unavailable. Unlike other countries such as the USA, Switzerland has no so-called ‘census tracts’ (geographic regions defined for the purpose of taking a census) that can be used as sampling units. Most Swiss epidemiological surveys of adults have adopted two-stage sampling, selecting households by address or telephone number. However, information on household structure is not available before contacting the families. After calling a particular number or selecting a certain address, a designated person, usually of a particular age and/or gender, is chosen to participate. However, this method is impractical for studies on children, due to the narrow age range. When we only want to sample children, and especially children of a particular age (e.g. those 10–14 years old), we must screen more households to achieve a desired sample size. This Hints & Kinks presents a method for recruiting random community samples of children through local political municipalities (German: Gemeinden/French: communes/Italian: comuni) in Switzerland. Municipalities are the smallest governmental division in Switzerland. Their number has gradually decreased (from 3,095 in 1960 to 2,596 in 2010), mainly because smaller municipalities have found it difficult to absorb the necessary administrative costs of civil services. The population size of a municipality varies from less than 20 to more than 3,00,000 for a city like Zurich (Bundesamt für Statistik 2010). Every resident in Switzerland, regardless of nationality, must register in their municipality; consequently, municipalities have the most complete socio-demographic information and could be used as a basic sampling unit. We conducted a pilot study in June 2007 at Canton of Zurich to test this method of selecting random samples through municipalities. The underlying purpose of the study was to estimate the prevalence of Swiss children with special healthcare needs.

Medical end-of-life practices in Swiss cultural regions: a death certificate study

BackgroundEnd-of-life decisions remain controversial. Switzerland, with three main languages shared with surrounding countries and legal suicide assistance, allows exploration of the effects of cultural differences on end-of-life practices within the same legal framework.MethodsWe conducted a death certificate study on a nationwide continuous random sample of Swiss residents. Using an internationally standardized tool, we sent 4998, 2965, and 1000 anonymous questionnaires to certifying physicians in the German-, French-, and Italian-speaking regions.ResultsThe response rates were 63.5%, 51.9%, and 61.7% in the German-, French-, and Italian-speaking regions, respectively. Non-sudden, expected deaths were preceded by medical end-of-life decisions (MELDs) more frequently in the German- than in the French- or Italian-speaking region (82.3% vs. 75.0% and 74.0%, respectively), mainly due to forgoing life-prolonging treatment (70.0%, 59.8%, 57.4%). Prevalence of assisted suicide was similar in the German- and French-speaking regions (1.6%, 1.2%), with no cases reported in the Italian-speaking region. Patient involvement was smaller in the Italian- than in the French- and German-speaking regions (16.0%, 31.2%, 35.6%). Continuous deep sedation was more frequent in the Italian- than in the French- and German-speaking regions (34.4%, 26.9%, 24.5%), and was combined with MELDs in most cases.ConclusionWe found differences in MELD prevalence similar to those found between European countries. On an international level, MELDs are comparably frequent in all regions of Switzerland, in line with the greater role given to patient autonomy. Our findings show how cultural contexts and legislation can interact in shaping the prevalence of MELDs.