Rural–Urban Differences in End-of-Life Care: Implications for Practice

Abstract

Most older adults with advanced illnesses express the wish to die at home. Home-based care from home health and hospice agencies makes this possible, but there are great geographic variations in utilization. Interviews and focus groups with key constituents in home health and hospice agencies across the 8-county region of Western New York State were used to explore how rural-urban location and agency type (home health or hospice) influence variations in end-of-life care. Emergent themes were: Rural-Urban Differences (geographic challenges, market forces, and programming issues) and End-of-life Care Issues (macrosocial, mezzosocial, and microsocial factors). Implications for social work practice are discussed.

Assessing End-of-Life Preferences for Advanced Dementia in Rural Patients Using an Educational Video: A Randomized Controlled Trial

“…Furthermore, studying differences in rural-urban end-of-life care is vital for making palliative care services available to all patients regardless of geography. 5,6 Variations in the use of end-of-life care services between the elderly in rural and urban settings are known to exist, 7,8 with rural populations tending to use fewer medical interventions at the end of life than those in urban settings. [9][10][11][12][13] Such variations may be attributed to a variety of factors including different access to medical services, 3,14-16 expectations of patients, 3 race, [17][18][19][20][21][22][23][24][25] and rural-urban cultural differences.…”

Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer

“…Variations in quality markers of end-of-life care have been observed across physicians [8,9], health centers [10], geographical regions [11–14], and various subgroups of the population [9,15–18]. In particular, racial/ethnic disparities both in receipt of aggressive care and hospice use have been documented extensively.…”

Care at the end of life for people with dementia living in a care home: a qualitative study of staff experience and attitudes

“…Thus, although UK guidance states choices about care at the end of life and decisions need to be discussed and documented for patients likely to die within 12 months (Bell, ) and policy prioritises good dementia care at the end of life including advance care planning, co‐ordinated working between service providers and care staff and the adoption of palliative care frameworks for people with dementia, (Royal College of Physicians, ; Department of Health, ; Goodman et al ., ) fewer dementia residents make advanced decisions than those with terminal cancer (Mitchell et al ., ). Dying care home residents with advanced dementia are often transferred to hospital, which may not be in line with their wishes or best interest (Royal College of Physicians, ; Waldrop & Kirkendall, ). There, they commonly experience uncomfortable interventions without demonstrable benefit or improved survival times (Lamberg et al ., ; Sampson et al ., ).…”