Trends and Factors Associated with Place of Death for Individuals with Dementia in the United States

Cross, Sarah H.; Kaufman, Brystana G.; Taylor, Donald H.; Kamal, Arif H.; Warraich, Haider J.

doi:10.1111/jgs.16200

Cited by 47 publications

(49 citation statements)

References 24 publications

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“…The most frequent place of death for persons with cognitive impairment was in the home (32.8%); 28% of persons with cognitive impairment died in a hospital, 25.6% died in a nursing home, and 9.1% died in a hospice residence. Our findings are congruent with a recent study indicating that home deaths for PLWD are on the rise in the United States 27 . This marks a significant change in the United States over the past two decades, shifting from nursing homes as the most common site of death 6,28 to the home for those with dementia or cognitive impairment.…”

Section: Discussionsupporting

confidence: 89%

Place of Death for Persons With and Without Cognitive Impairment in the United States

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Hansen

et al. 2021

J American Geriatrics Society

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Background/Objectives There is increasing recognition that place of death is an important component of quality of end‐of‐life care (EOLC) and quality of death. This study examined where older persons with and without cognitive impairment die in the United States, what factors contribute to place of death, and whether place of death influences satisfaction with EOLC. Design Cross‐sectional secondary data analysis. Setting In‐person interviews with community‐dwelling proxy respondents. Participants Data were collected from 1,500 proxies for deceased participants in the National Health and Aging Trends Study (NHATS), a nationally‐representative sample of community‐dwelling Medicare beneficiaries aged 65 and older. Measurements Study variables were obtained from the NHATS “last month of life” interview data. Survey weights were applied to all analyses. Results Persons with cognitive impairment (CI) most often died at home, while cognitively healthy persons (CHP) were equally likely to die at home or in a hospital. Persons with CI who utilized the Medicare Hospice Benefit were 14.5 times more likely to die at home than in a hospital, and 3.4 times more likely to die at home than a nursing home. CHP who use this benefit were over six times more likely to die at home than in a hospital, and more than twice as likely to die at home than a nursing home. Place of death for CHP was also associated with age and race. Proxies of persons with CI who died at home rated EOLC as more favorable, while proxies of CHP rated in‐home and hospital care equally. Conclusion Findings add to the scant literature identifying factors associated with place of death for older adults with and without CI and results suggest that place of death is a quality of care indicator for these populations. These findings may inform EOLC planning and policy‐making and facilitate greater well‐being at end‐of‐life.

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Section: Discussionsupporting

confidence: 89%

Place of Death for Persons With and Without Cognitive Impairment in the United States

Regier

Cotter

Hansen

et al. 2021

J American Geriatrics Society

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“…Concurrently, as outpatient deaths increased (both at home and in hospice), inpatient facility and nursing home deaths decreased proportionally during the study period. These trends have been reflected in other studies, including in patients with Medicare insurance, ( 26 ) chronic lung disease, ( 27 ) dementia, ( 28 ) and malignancy. ( 29 ) Although it is difficult to attribute these changing patterns to a particular intervention or policy change, there has been a progressive move in the United States toward the expansion of hospice services in an effort to decrease health care costs and improve quality of life.…”

Section: Discussionsupporting

confidence: 59%

National Trends in Location of Death in Patients With End‐Stage Liver Disease

et al. 2021

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Despite improvement in the care of patients with end‐stage liver disease (ESLD), mortality is rising. In the United States, patients are increasingly choosing to die at hospice and home, but data in patients with ESLD are lacking. Therefore, this study aimed to describe the trends in location of death in patients with ESLD. We conducted a retrospective cross‐sectional analysis using the Centers for Disease Control and Prevention Wide‐Ranging OnLine Data for Epidemiologic Research from 2003 to 2018. Death location was categorized as hospice, home, inpatient facility, nursing home, or other. Comparisons were made between sex, age, ethnicity, race, region, and other causes of death. Comparisons were also made between rates of change (calculated as annual percent change), proportion of deaths in 2018, and multivariable logistic regression. A total of 535,261 deaths were attributed to ESLD—most were male, non‐Hispanic, and White. The proportion of deaths at hospice and home increased during the study period from 0.2% to 10.6% and 20.3% to 25.7%, respectively. Whites had the highest proportion of deaths in hospice and home. In multivariable analysis, elderly patients were more likely to die in hospice or home (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.07‐1.35), whereas Black patients were less likely (OR, 0.58; 95% CI, 0.46‐0.73). Compared with other causes of death, ESLD had the second highest proportion of deaths in hospice but lagged behind non–hepatocellular carcinoma malignancy. Deaths in patients with ESLD are increasingly common at hospice and home overall, and although the rates have been increasing among Black patients, they are still less likely to die at hospice or home. Efforts to improve this disparity, promote end‐of‐life care planning, and enhance access to death at hospice and home are needed.

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“…The rise in ADRD AAMR in rural areas may impose a disproportionate burden on caregivers as well given the increase in rural nursing home and hospice facility closures and challenges in obtaining home health and hospice in rural America. [8][9][10] Additional research is needed to explore the factors driving these trends in ADRD AAMR and to inform interventions addressing this disparity.…”

Section: Discussionmentioning

confidence: 99%

Rural‐Urban Disparities in Mortality from Alzheimer's and Related Dementias in the United States, 1999–2018

Cross

Warraich

2020

J American Geriatrics Society

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Rural-Urban Disparities in Mortality from Alzheimer's and Related Dementias in the United States, 1999States, -2018 Alzheimer's and related dementias (ADRD) are a leading cause of death in the United States. 1 Rural Americans experience greater risk factors for developing ADRD and research suggests higher ADRD prevalence in rural than urban areas. 1,2 However, while rural-urban disparities in mortality from such chronic diseases as cancer and cardiovascular disease have been documented, rural-urban differences in ADRD mortality have not been examined. 3,4 We sought to assess trends in ADRD mortality and examine differences by rural-urban status.

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Trends and Factors Associated with Place of Death for Individuals with Dementia in the United States

Cited by 47 publications

References 24 publications

Place of Death for Persons With and Without Cognitive Impairment in the United States

Place of Death for Persons With and Without Cognitive Impairment in the United States

National Trends in Location of Death in Patients With End‐Stage Liver Disease

Rural‐Urban Disparities in Mortality from Alzheimer's and Related Dementias in the United States, 1999–2018

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