Qinghua Li1, Nan Tracy Zheng, Helena Temkin-Greener. 1. Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642, USA.
Abstract
OBJECTIVES: To describe the longitudinal patterns and the within- and between-facility differences in hospice use and in-hospital deaths between long-term nursing home (NH) residents with and without dementia. DESIGN: Retrospective analyses of secondary data sets from 2003 to 2007. SETTING: NHs in the United States. PARTICIPANTS: A total of 1,261,726 decedents in 16,347 NHs were included in 2003 to 2007 trend analysis and 236,619 decedents in 15,098 NHs in 2007 were included in the within- and between-facility analyses. MEASUREMENTS: Hospice use in the last 100 days of life and in-hospital deaths were outcome measures. Dementia was defined as having a diagnosis of Alzheimer's disease or other dementia based on Minimum Data Set (MDS) health assessments. RESULTS: Overall hospice use increased from 25.6% in 2003 to 35.7% in 2007. During this time, hospice use for decedents with dementia increased from 25.1% to 36.5%, compared with an increase from 26.5% to 34.4% for decedents without dementia. The rate of in-hospital deaths remained virtually unchanged. Within the same facility, decedents with dementia were significantly more likely to use hospice (odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.04-1.11) and less likely to die in a hospital (OR = 0.76, 95% CI = 0.74-0.78). Decedents in NHs with higher dementia prevalence, regardless of individual dementia status, were more likely to use hospice (OR = 1.67, 95% CI = 1.22-2.27). CONCLUSION: NHs appear to provide less-aggressive end-of-life care to decedents with dementia than to those without. Although significantly more residents with dementia now receive hospice care at the end of life, the quality evaluation and monitoring of hospice programs have not been systematically conducted, and additional research in this area is warranted.
OBJECTIVES: To describe the longitudinal patterns and the within- and between-facility differences in hospice use and in-hospital deaths between long-term nursing home (NH) residents with and without dementia. DESIGN: Retrospective analyses of secondary data sets from 2003 to 2007. SETTING: NHs in the United States. PARTICIPANTS: A total of 1,261,726 decedents in 16,347 NHs were included in 2003 to 2007 trend analysis and 236,619 decedents in 15,098 NHs in 2007 were included in the within- and between-facility analyses. MEASUREMENTS: Hospice use in the last 100 days of life and in-hospital deaths were outcome measures. Dementia was defined as having a diagnosis of Alzheimer's disease or other dementia based on Minimum Data Set (MDS) health assessments. RESULTS: Overall hospice use increased from 25.6% in 2003 to 35.7% in 2007. During this time, hospice use for decedents with dementia increased from 25.1% to 36.5%, compared with an increase from 26.5% to 34.4% for decedents without dementia. The rate of in-hospital deaths remained virtually unchanged. Within the same facility, decedents with dementia were significantly more likely to use hospice (odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.04-1.11) and less likely to die in a hospital (OR = 0.76, 95% CI = 0.74-0.78). Decedents in NHs with higher dementia prevalence, regardless of individual dementia status, were more likely to use hospice (OR = 1.67, 95% CI = 1.22-2.27). CONCLUSION: NHs appear to provide less-aggressive end-of-life care to decedents with dementia than to those without. Although significantly more residents with dementia now receive hospice care at the end of life, the quality evaluation and monitoring of hospice programs have not been systematically conducted, and additional research in this area is warranted.
Authors: Dana B Mukamel; Thomas Caprio; Richard Ahn; Nan Tracy Zheng; Sally Norton; Timothy Quill; Helena Temkin-Greener Journal: J Palliat Med Date: 2012-04 Impact factor: 2.947
Authors: D Saliba; R Kington; J Buchanan; R Bell; M Wang; M Lee; M Herbst; D Lee; D Sur; L Rubenstein Journal: J Am Geriatr Soc Date: 2000-02 Impact factor: 5.562
Authors: Pedro Gozalo; Joan M Teno; Susan L Mitchell; Jon Skinner; Julie Bynum; Denise Tyler; Vincent Mor Journal: N Engl J Med Date: 2011-09-29 Impact factor: 91.245
Authors: Tessa van der Maaden; Simone A Hendriks; Henrica C W de Vet; Menno T Zomerhuis; Martin Smalbrugge; Elise P Jansma; Raymond T C M Koopmans; Cees M P M Hertogh; Jenny T van der Steen Journal: Drugs Aging Date: 2015-01 Impact factor: 3.923
Authors: Ellen McCreedy; Lacey Loomer; Jennifer A Palmer; Susan L Mitchell; Angelo Volandes; Vincent Mor Journal: J Am Med Dir Assoc Date: 2018-03-10 Impact factor: 4.669
Authors: Lara Pivodic; Tinne Smets; Nele Van den Noortgate; Bregje D Onwuteaka-Philipsen; Yvonne Engels; Katarzyna Szczerbińska; Harriet Finne-Soveri; Katherine Froggatt; Giovanni Gambassi; Luc Deliens; Lieve Van den Block Journal: Palliat Med Date: 2018-10-01 Impact factor: 4.762
Authors: Susan C Miller; Julie C Lima; Orna Intrator; Edward Martin; Janet Bull; Laura C Hanson Journal: J Pain Symptom Manage Date: 2017-04-22 Impact factor: 3.612
Authors: Paul R Duberstein; Michael Chen; Michael Hoerger; Ronald M Epstein; Laura M Perry; Sule Yilmaz; Fahad Saeed; Supriya G Mohile; Sally A Norton Journal: J Pain Symptom Manage Date: 2019-10-19 Impact factor: 3.612