Quality of End‐of‐Life Care of Long‐Term Nursing Home Residents with and without Dementia

Li, Qinghua; Zheng, Nan; Temkin‐Greener, Helena

doi:10.1111/jgs.12330

Cited by 54 publications

(65 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…25 Furthermore, aggressive treatments that require hospitalization of nursing home residents with advanced dementia may produce little improvement in their quality of life 26 and may be futile care. Hospice use might have played a role in mediating the impact of dementia on hospitalization and ED visits, which would be consistent with the increasing use and duration of Medicare-covered hospice care for nursing home residents during our study period.…”

Section: Discussionmentioning

confidence: 99%

Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death

et al. 2014

View full text Add to dashboard Cite

Hospitalizations and emergency department (ED) visits for people with Alzheimer's disease and related disorders are of particular concern because many of these patients are physically and mentally frail, and the care delivered in these settings is costly. Using data from the Health and Retirement Study linked with Medicare claims from the period 2000-08, we found that among community-dwelling elderly fee-for-service Medicare beneficiaries, those who had dementia were significantly more likely than those who did not to have a hospitalization (26.7 percent versus 18.7 percent) and an ED visit (34.5 percent versus 25.4 percent) in each year. Comparing nursing home residents who had dementia with those who did not, we found only small differences in hospitalizations (45.8 percent versus 41.9 percent, respectively) and ED use (55.3 percent versus 52.7 percent). As death neared, however, utilization rose sharply across settings and by whether or not beneficiaries had dementia: Nearly 80 percent of community-dwelling decedents were hospitalized, and an equal proportion had at least one ED visit during the last year of life, regardless of dementia. Our research suggests that substantial portions of hospitalizations and ED visits both before and during the last year of life were potentially avoidable. A lzheimer's disease and related disorders place substantial emotional, physical, and financial burdens on patients, their families, and society. One important source of these burdens is frequent hospitalizations and emergency department (ED) visits, many of which are potentially avoidable. These encounters are disruptive, costly, and particularly challenging for people with dementia, who are vulnerable to many adverse health outcomes, including delirium, 1 falls, 2 functional decline, 3 physical restraints, 4 and agitation and related behavioral symptoms. 5These problems are aggravated by the poor communication abilities and coexisting medical conditions associated with dementia. 6 Older people with dementia also have special difficulties in transitioning across care settings. 7 Hence, unnecessary or potentially avoidable hospitalizations and ED visits have important implications for both the quality of care and the quality of life for people with dementia, 8,9 especially at the end of life. 10Few studies have focused on hospital and ED use, especially potentially avoidable use, among older people with dementia.11-14 As a result, current understanding of hospital and ED use by people who have dementia compared to use by people who do not remains limited. Furthermore, there have been few analyses of the impact of dementia on hospital and ED use across community and institutional settings.

show abstract

Section: Discussionmentioning

confidence: 99%

Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death

et al. 2014

View full text Add to dashboard Cite

show abstract

“…One possible explanation of this finding is that patients with multiple comorbidities, impaired functional status, an extensive disease stage, or needing end-of-life care often require extensive use of healthcare resources such as nursing facilities. It has been estimated that 67% of patients aged >65 years who were diagnosed with dementia, die in a nursing home [9]. …”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Dementia in Older Adults with Solid Tumors

Wongrakpanich

Hurst²,

Bustamante³

et al. 2016

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

Background: The public health burden of cancer and dementia in the geriatric population is well documented. There is limited data on how dementia predicts mortality among geriatric patients with solid tumors. The objective of this study is to determine the prognostic significance of dementia on survival in patients with solid tumors. Methods: We performed a 5-year retrospective study on elderly subjects aged ≥60 years with and without dementia that were diagnosed with solid tumors. Results: Among 3,460 patients with solid tumors, 132 (3.8%) patients were found to have dementia. The median age at diagnosis was 71 years. Kaplan-Meier curves demonstrated that patients with dementia had an inferior median survival compared to the nondemented group (30 vs. 56 months; log-rank p < 0.001). Cox proportional hazard regression modeling identified age >80 years, female gender, diabetes mellitus, congestive heart failure, atrial fibrillation, chronic obstructive pulmonary disease, chronic kidney disease, dementia, and radiation therapy as risk factors for decreased overall survival. Conclusions: We demonstrated that dementia is associated with shorter overall survival in elderly patients with solid tumors.

show abstract

Section: Introductionmentioning

confidence: 99%

“…(6) Still, over half of Medicare beneficiaries with dementia in NHs do not access hospice prior to death. (6) Also, of beneficiaries with dementia accessing hospice, 25 percent do so in the last eight days of life and 10 percent enroll over a year before death. (7) This pattern of care emanates in part from the Medicare hospice benefit’s eligibility criterion of a six-month physician-certified terminal prognosis (if the disease runs its normal course) and its required forfeiture of Medicare Part A benefits (including hospital and skilled nursing facility care).…”

Section: Introductionmentioning

confidence: 99%

“…(11–15) In NHs, research has shown hospice palliative care is associated with better care processes, outcomes and fewer end-of-life hospitalizations for persons with dementia,(6, 9) and palliative care intervention studies focusing on persons with advanced dementia have shown improvements in care processes. (16–18) Our recent observational study of the effect of specialty palliative care consultations (i.e., consultations by external specialists, primarily nurse practitioners with palliative care expertise) for a population of NH residents, showed residents with consultations, compared to propensity-score (pscore) matched controls with no consultations, had lower end-of-life use of hospitals and emergency rooms, and fewer (potentially) burdensome end-of-life transitions.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Specialty Palliative Care Consultations for Nursing Home Residents With Dementia

Miller

Lima

Intrator

et al. 2017

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

Context U.S. nursing home (NH) residents with dementia have limited access to specialty palliative care beyond Medicare hospice. Objectives To examine the value of expanded palliative care access for NH residents with moderate to very severe dementia. Methods We merged palliative care consultation data in 31 NHs in two states to Medicare data to identify residents with consultations, moderate to very severe dementia, and deaths in 2006–2010. Initial palliative consultations were identified as occurring later and earlier (1–30 days and 31–180 days before death, respectively). Three controls for each consultation recipient were selected using propensity-score matching. Weighted multivariate analyses evaluated the effect of consultations on hospital or acute care use 7 and 30 days before death, and on (potentially) burdensome transitions (i.e., hospital or hospice admission 3 days before death or two plus acute care transitions 30 days before death). Results With earlier consultation (versus no consultation), hospitalization rates in the 7 days before death were on average 13.2 percentage points lower (95% confidence interval (CI): −21.8%, −4.7%); and, with later consultation 5.9 percentage points lower (95% CI: −13.7%, +4.9%). For earlier consultations (versus no consultations), rates were 18.4 percentage points lower (95% CI: −28.5%, −8.4%) for hospitalizations and 11.9 lower (95% CI: −20.7%, −3.1%) for emergency room visits 30 days before death; they were 20.2 percentage points lower (95% CI: −28.5%, −12.0%) for burdensome transitions. Conclusion Consultations appear to reduce acute care use and (potentially) burdensome transitions for dying residents with dementia. Reductions were greater when consultations were earlier.

show abstract

Quality of End‐of‐Life Care of Long‐Term Nursing Home Residents with and without Dementia

Cited by 54 publications

References 29 publications

Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death

Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death

Prognostic Significance of Dementia in Older Adults with Solid Tumors

Specialty Palliative Care Consultations for Nursing Home Residents With Dementia

Contact Info

Product

Resources

About