Health Reports

A Canadian peer-reviewed journal of population health and health services research

July 2024

The association between rurality, places of care and the location of death of long-term care home residents with dementia: A population-based study

by Hanbyoul Park, Christina Milani, Peter Tanuseputro and Colleen Webber

Individuals who are nearing death report a preference to be cared for and die outside the hospital. The reasons for this preference are complex and multifactorial. When hospitalized near the end of life, individuals may experience potentially aggressive or inappropriate care that may cause unnecessary pain and negatively affect their quality of life. Individuals’ preferences to die outside a hospital setting may also be related to support from their family and social network, cultural values, and the extent to which their wishes and those of their caregivers could be supported in different care settings. Despite these preferences, many Canadians still die in settings that are not their home or community, with 54.5% dying at home or in a community setting in 2020. Canadians living in rural areas face numerous health care barriers that may affect their end-of-life care, such as the quality of the care they receive and where they die. These barriers include the requirement to travel long distances to access health care services because of the lower density of hospitals, limited local availability of physicians, and reduced access to home care support in rural areas. Palliative care, an approach to care that supports the needs of individuals who are facing a serious and life-limiting illness, including those who are at the end of life, is also more difficult to access in rural areas. Likely owing to these barriers, individuals in rural areas have an increased risk of hospitalization in the last weeks and months of life and are more likely to die in the hospital than those in urban areas. Less is known about urban–rural differences in end-of-life care among residents of long-term care (LTC) homes (i.e., nursing homes). LTC homes provide 24-hour nursing, medical, and personal care for individuals whose care needs cannot typically be met in the community. Given a median survival of 18 months after admission to an LTC home, the need to plan for the end-of-life care needs of these residents is vital. In a rural setting, the challenges associated with end-of-life care for residents of LTC homes may differ from those experienced by individuals not residing in an LTC home. While health care access may be more limited in rural areas, the level of care and support provided in LTC homes may enable residents to stay in their homes throughout the end of life. Rural LTC homes have also been found to have higher physician retention and therefore greater continuity of care. These features of rural LTC homes may help improve the quality of end-of-life care provided to residents.

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Mental health among women and girls of diverse backgrounds in Canada before and during the COVID-19 pandemic: An intersectional analysis

by Jungwee Park

Many studies have reported increased inequities between men and women in mental health since the COVID-19 pandemic, including higher risks of post-traumatic stress symptoms and psychiatric disorders and loneliness. Moreover, extensive research has been undertaken to examine the unequal effects of the pandemic on self-perceived mental health among diverse groups such as Indigenous peoples and different gender groups.

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Mental health among women and girls of diverse backgrounds in Canada before and during the COVID-19 pandemic: An intersectional analysis

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