Impact of In‐Hospital Death on Spending for Bereaved Spouses

Ornstein, Katherine; Garrido, Melissa M.; Siu, Albert L.; Bollens‐Lund, Evan; Langa, Kenneth M.; Kelley, Amy S.

doi:10.1111/1475-6773.12841

Cited by 7 publications

(7 citation statements)

References 61 publications

(95 reference statements)

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“…Families report worsened physical and mental health and more hospitalizations following a loved one's death when intensive, life-sustaining treatments were performed at the end of life. [11][12][13] On the other hand, comfortfocused treatments including hospice are associated with decreased depression. 11,14,15 Additionally, bereavement itself is associated with negative consequences for spouses, including not only increased mortality 16 but also reduced personal health maintenance and increased health care expenditures.…”

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confidence: 99%

Spousal Caregivers Are Caregiving Alone In The Last Years Of Life

et al. 2019

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Caregiving in the last years of life is associated with increased depression and negative health outcomes for surviving spouses, many of whom are themselves in poor health. Yet it is unclear how often spouses are caregiving alone, how they differ from supported spouses, and whether lack of support affects postbereavement outcomes. We hypothesized that spouses who were solo caregivers—that is, the only caregivers (paid or unpaid) who provided assistance with a spouse’s self-care or household activities—would experience more depression after bereavement than supported spouses would. Using information from the Health and Retirement Study, we found that 55 percent of the spouses of community-dwelling married people with disability were solo caregivers. Solo caregiving was even common among people who cared for spouses with dementia and those with adult children living close by. Bereavement outcomes did not differ between solo and supported caregiving spouses. Caregiving spouses are often isolated and may benefit from greater support, particularly during the final years before bereavement. While some state and federal policy proposals aim to systematically recognize and assess caregivers, further innovations in care delivery and reimbursement are needed to adequately support seriously ill older adults and their caregivers. Ultimately, the focus of serious illness care must be expanded from the patient to the family unit.

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confidence: 99%

Spousal Caregivers Are Caregiving Alone In The Last Years Of Life

et al. 2019

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“…The primary outcome was patient-reported occurrence of a goals-of-care conversation during a target outpatient visit. Secondary outcomes included clinician documentation of a goals-of-care conversation in the medical record, patientreported quality of communication measured by the Quality of Communication questionnaire 6 at two weeks, patient Integrating a collaborative care approach to improve depression and fatigue for patients with heart failure Bekelman et al 18 Assessing spousal needs from diagnosis of their partner's illness through bereavement Ornstein et al 25…”

Section: Summary and Main Findings: Priming Interventions In Goals-of-care Conversationsmentioning

confidence: 99%

“…Research has shown that low intensity end-of-life care, such as hospice and palliative care services provided in the home setting, mitigates the negative effect of caregiving by decreasing depression, and increasing quality of death and adjustment to death of the loved one. 25 In the article, Impact of In-Hospital death on Spending for Bereaved Spouses, the authors sought to examine how patients' location of death relates to health care utilization and spending for surviving spouses. The study was an observational study.…”

Section: A Focus On Caregiversmentioning

confidence: 99%

Update in Hospice and Palliative Care

Hyden

Gelfman

Dionne‐Odom

et al. 2020

Journal of Palliative Medicine

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The purpose of this update is to summarize and critique research articles in Hospice and Palliative Care from 2018 that are pertinent and impactful in informing clinical practice. The articles were presented at the 2019 Annual Assembly of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA). Eight original research articles published between January 1, 2018, and December 31, 2018, were identified through a systematic PubMed search using the terms ''hospice'' and ''palliative care,'' a hand search of 22 leading healthcare journals, and discussion with experts in the field. The final articles were chosen based on each study's methodological quality, its ability to be applied across different care settings, and its ability to impact clinical practice. We summarize the eight articles that were chosen and identify ways the articles can be used to inform clinical practice.

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“…13 More intensive treatment is often associated with worse caregiver bereavement. 14,15 A fundamental knowledge gap is that studies evaluating prognostic accuracy have focused predominantly on survival predictions, but prognostication can involve predictions about both quantity and quality of life, 16,17 and quality of life outcomes are fundamental to patients' decision-making when seriously ill. 18 The extent to which oncologists, patients with advanced cancer, and caregivers can accurately predict patients' future quality of life is unclear. To our knowledge, there has been no research on whether these predictions are associated with end-of-life care and caregiver bereavement.…”

Section: Introductionmentioning

confidence: 99%

“…Caregivers routinely participate in treatment decisions, 9–11 and they may also overestimate patient survival, 4,12 with implications for more intensive end‐of‐life treatments 13 . More intensive treatment is often associated with worse caregiver bereavement 14,15 . A fundamental knowledge gap is that studies evaluating prognostic accuracy have focused predominantly on survival predictions, but prognostication can involve predictions about both quantity and quality of life, 16,17 and quality of life outcomes are fundamental to patients' decision‐making when seriously ill 18 .…”

Section: Introductionmentioning

confidence: 99%

Patient, caregiver, and oncologist predictions of quality of life in advanced cancer: Accuracy and associations with end‐of‐life care and caregiver bereavement

et al. 2022

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Background Informed treatment decision‐making necessitates accurate prognostication, including predictions about quality of life. Aims We examined whether oncologists, patients with advanced cancer, and caregivers accurately predict patients’ future quality of life and whether these predictions are prospectively associated with end‐of‐life care and bereavement. Materials & Methods We conducted secondary analyses of clinical trial data. Patients with advanced cancer (n = 156), caregivers (n = 156), and oncologists (n = 38) predicted patient quality of life 3 months into the future. Patients subsequently rated their quality of life 3 months later. Medical record data documented chemotherapy and emergency department (ED)/inpatient visits in the 30 days before death (n = 79 decedents). Caregivers self‐reported on depression, anxiety, grief, purpose, and regret 7‐months post‐mortem. In mixed‐effects models, patient, caregiver, and oncologist quality‐of‐life predictions at study entry were used to predict end‐of‐life care and caregiver outcomes, controlling for patients’ quality of life at 3‐month follow‐up, demographic and clinical characteristics, and nesting within oncologists. Results Caregivers (P < 0.0001) and oncologists (P = 0.001) predicted lower quality of life than what patients actually experienced. Among decedents, 24.0% received chemotherapy and 54.5% had an ED/inpatient visit. When caregivers’ predictions were more negative, patients were less likely to receive chemotherapy (P = 0.028) or have an ED/inpatient visit (P = 0.033), and caregivers reported worse depression (P = 0.002), anxiety (P = 0.019), and grief (P = 0.028) and less purpose in life (P < 0.001) 7‐months post‐mortem. Conclusion When caregivers have more negative expectations about patients’ quality of life, patients receive less intensive end‐of‐life care, and caregivers report worse bereavement outcomes.

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Impact of In‐Hospital Death on Spending for Bereaved Spouses

Abstract: Bereaved spouses of decedents who died in the hospital had significantly greater Medicare spending and health care utilization themselves after their spouses' death.

Cited by 7 publications

References 61 publications

Spousal Caregivers Are Caregiving Alone In The Last Years Of Life

Spousal Caregivers Are Caregiving Alone In The Last Years Of Life

Update in Hospice and Palliative Care

Patient, caregiver, and oncologist predictions of quality of life in advanced cancer: Accuracy and associations with end‐of‐life care and caregiver bereavement

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