1
|
Levine M, Bern-Klug M. "They Make the Will, But They Want the Food:" Staff Perspectives on Challenges in Implementing Dementia Advance Directives Related to Stopping Feeding. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024:1-22. [PMID: 38949629 DOI: 10.1080/15524256.2024.2365368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Affiliation(s)
- Meredith Levine
- The Harry and Jeanette Weinberg Center for Elder Justice at the Hebrew Home at Riverdale, Bronx, New York, USA
| | | |
Collapse
|
2
|
Bagchus C, Zee MS, van der Steen JT, Klapwijk MS, Dekker NL, Onwuteaka-Philipsen BD, Pasman HRW. Challenges in recognizing and discussing changes in a resident's condition in the palliative phase: focus group discussions with nursing staff working in nursing homes about their experiences. BMC Palliat Care 2024; 23:144. [PMID: 38858719 PMCID: PMC11163817 DOI: 10.1186/s12904-024-01479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Most nursing home residents have complex care needs, require palliative care and eventually die in these facilities. Timely recognition of changes in a resident's condition is crucial for providing appropriate care. Observations by nursing staff play a significant role in identifying and interpreting these changes. METHODS Focus group discussions were conducted with nursing staff from ten nursing homes in the Netherlands to explore their experiences and challenges in recognizing and discussing changes in a resident's condition. These discussions were analysed following the principles of thematic analysis. RESULTS The analysis of the challenges nursing staff face in identifying and interpreting changes in a resident's condition, resulted in three themes. First, that recognizing changes is considered complex, because it requires specialized knowledge and skills that is generally not part of their education and must partly be learned in practice. This also depends on how familiar the nursing staff is with the resident. Furthermore, different people observe residents through different lenses, depending on their relation and experiences with residents. This could lead to disagreements about the resident's condition. Lastly, organizational structures such as the resources available to document and discuss a resident's condition and the hierarchy between nursing home professionals often hindered discussions and sharing observations. CONCLUSION Nursing staff's experiences highlight the complexity of recognizing and discussing changes in nursing home residents' conditions. While supporting the observational skills of nursing staff is important, it is not enough to improve the quality of care for nursing home residents with palliative care needs. As nursing staff experiences challenges at different, interrelated levels, improving the process of recognizing and discussing changes in nursing home residents requires an integrated approach in which the organization strengthens the position of nursing staff. It is important that their observations become a valued and integrated and part of nursing home care.
Collapse
Affiliation(s)
- C Bagchus
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
- Faculty of Health, University of Applied Sciences Leiden, Leiden, the Netherlands
| | - M S Zee
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - J T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Primary and Community Care and Radboudumc Alzheimer center, Radboud university medical center, P.O. Box 9600, 6500 HB, Nijmegen, The Netherlands
| | - M S Klapwijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - N Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Leiden, the Netherlands
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - H R W Pasman
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands.
| |
Collapse
|
3
|
Ma KZ, Hu CJ. Trends in incidence, mortality, dynamic needs and rapid evolution of healthcare in dementia. Arch Gerontol Geriatr 2024; 121:105389. [PMID: 38448314 DOI: 10.1016/j.archger.2024.105389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
- Ke-Zong Ma
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli County, Taiwan.
| | - Chaur-Jong Hu
- Department of Neurology and Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
4
|
McDarby M, Russell D, King L, Kozlov E, Luth EA. Knowledge Gaps in End-Of-Life Family Caregiving for Persons Living With Dementia: A Study of Hospice Clinician Perspectives. Am J Hosp Palliat Care 2024; 41:270-280. [PMID: 37173809 PMCID: PMC10640658 DOI: 10.1177/10499091231176298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION More than 35% of hospice care recipients 65 and older have a dementia diagnosis. Yet family care partners of persons living with dementia report feeling unprepared to address their hospice recipient's changing needs nearing end of life. Hospice clinicians may have unique insight into the knowledge needs of family care partners and strategies for end-of-life dementia caregiving. METHODS Semi-structured interviews were conducted with 18 hospice physicians, nurse practitioners, nurses, and social workers. Interview transcripts were deductively analyzed using thematic analysis to examine clinicians' perspectives on gaps and strategies related to family care partner knowledge about end-of-life dementia caregiving. RESULTS We identified 3 themes related to gaps in family care partners' knowledge: dementia is a progressive, fatal disease; end-of-life symptoms and symptom management in persons living with advanced dementia; and understanding hospice goals and guidelines. Three themes related to clinicians' strategies to increase knowledge included: providing education; teaching strategies to facilitate coping and preparedness for end-of-life care; and communicating with empathy. DISCUSSION Clinicians perceive gaps in knowledge specific to dementia and end of life among family care partners. These gaps include a lack of understanding of Alzheimer's symptom progression and strategies to manage common symptoms. Recommendations for approaches to reduce knowledge gaps include providing education and strategies delivered with empathy toward the family care partner experience. CONCLUSION Clinicians who work with persons living with dementia receiving hospice care have valuable insights regarding family care partners' gaps in knowledge. Implications on the training and preparation of hospice clinicians working with this care partner population are discussed.
Collapse
Affiliation(s)
- Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA
- VNS Health, Center for Home Care Policy & Research, New York, NY, USA
| | - Lori King
- VNS Health, Center for Home Care Policy & Research, New York, NY, USA
| | - Elissa Kozlov
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Elizabeth A. Luth
- Institute for Health, Health Care Policy, and Aging Research and Department of Family Medicine and Community Health, Rutgers University, New Brunswick, NJ, USA
| |
Collapse
|
5
|
Harada N, Koda M, Eguchi A, Hashizume M, Suzuki M, Nomura S. Changes in Place of Death among Patients with Dementia during the COVID-19 Pandemic in Japan: A Time Series Analysis. J Epidemiol 2024:JE20230279. [PMID: 38403690 DOI: 10.2188/jea.je20230279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND A key measure of the effectiveness of end-of-life care is the place of death. The COVID-19 pandemic affected end-of-life care and the circumstances of patients with dementia. METHODS This observational, retrospective cohort study used Japanese national data to examine the numbers and locations of reported deaths among patients with dementia older than 65 years during the COVID-19 pandemic. Locations were grouped as medical institutions, nursing facilities, homes, or all the above. The quasi-Poisson regression model known as the Farrington algorithm was employed. RESULTS Between December 30, 2019, and January 29, 2023, 279,703 patients who died of causes related to dementia were reported in Japan. A decline was seen in early 2020, followed by increased numbers of deaths in homes, medical facilities, and nursing homes beginning in October 2020, December 2020, and March 2021, respectively. In 2021, the percentage of excess deaths at home peaked at 35.2%, while in 2022, those in medical facilities and nursing homes peaked at 18.8% and 16.6%, respectively. In 2022, the percentage of excess deaths in nursing homes exceeded that of other locations. CONCLUSIONS The results suggest a change in the preferred place of death, along with pandemic-related visitation restrictions among healthcare facilities. Excess deaths also suggest strained medical resources and limited access to care. Methodological limitations include data from a limited period (2017 onwards) and post-2020 data used to estimate data after 2021, albeit with weighting. Considering these findings, physicians should reconfirm preferred places of death among older patients with dementia.
Collapse
Affiliation(s)
- Nahoko Harada
- Department of Nursing Science, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University
| | - Masahide Koda
- Co-learning Community Healthcare Re-innovation Office, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Akifumi Eguchi
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo
| | - Motoi Suzuki
- Infectious Disease Surveillance Center at the National Institute of Infectious Diseases
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo
- Department of Health Policy and Management, School of Medicine, Keio University
- Tokyo Foundation for Policy Research
| |
Collapse
|
6
|
Lo YT, Chi YC, Chang CM, Kawachi I, Lu TH. Changes in place of death trends among Asian American older adults with dementia in the United States from 2004 to 2021. J Am Geriatr Soc 2023; 71:3628-3631. [PMID: 37345740 DOI: 10.1111/jgs.18490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Yu-Tai Lo
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Chen Chi
- Department of Healthcare Information & Management, School of Health Technology, Ming Chuan University, Taoyuan, Taiwan
| | - Chia-Ming Chang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Medicine & Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
7
|
Nakanishi M, Yamasaki S, Sakai M, Yoshii H, Ogawa A, Nishida A. Place of death from dementia as an underlying cause during the COVID-19 pandemic in Japan: a cross-sectional study from national death certificates. Palliat Care Soc Pract 2023; 17:26323524231193039. [PMID: 37654728 PMCID: PMC10467291 DOI: 10.1177/26323524231193039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023] Open
Abstract
Background The coronavirus disease (COVID-19) pandemic has challenged palliative end-of-life care for people with dementia. The site of death can be considered as an end-of-life care quality indicator. Most people with dementia prefer to die at nursing or private homes; however, in Japan, they are often hospitalized in psychiatric hospitals for management of neuropsychiatric symptoms. As palliative end-of-life care for older adults with Alzheimer's disease and related dementias has been further challenged by the COVID-19 pandemic, little is known about its effects on the place of death in patients with dementia. Objectives This study aimed to investigate the shifts in place of death from dementia during the COVID-19 pandemic in Japan. Changes throughout the pandemic were compared between deaths from dementia and from senility. Design Cross-sectional. Methods Death certificate data of individuals aged 65 years or older who died in Japan between 1 January 2018, and 31 December 2021, were used to extract the cause and place of death. Differences in place of death between the periods were estimated using multinomial logistic analysis with reference to death in private homes. Results Deaths from dementia mostly occurred in hospitals (59%), while deaths from senility were most frequent in nursing homes (37%). After adjusting for patient characteristics, the likelihood of hospital deaths significantly increased for patients with dementia during the pandemic. Meanwhile, the likelihood of senility deaths decreased in hospitals but increased in nursing homes during the pandemic. Conclusion The shift to hospital deaths since the onset of the COVID-19 pandemic was uniquely observed in deaths from dementia. This hospital shift likely involved increased transfers from nursing and private homes to psychiatric hospitals. Further investigation is needed to examine the association between the pandemic-related change in long-term care workforce and palliative care practice in people with dementia.
Collapse
Affiliation(s)
- Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi 980-8575, Japan
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mai Sakai
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hatsumi Yoshii
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Chiba, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| |
Collapse
|
8
|
Erçin Swearinger H, Lapham J. Patterns of Unmet Needs With Assistance for Self-Care Activities at the End of Life by Place of Death Among Older Adults. Am J Hosp Palliat Care 2023; 40:805-811. [PMID: 36399397 DOI: 10.1177/10499091221127427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Older Americans experience adverse consequences linked to inadequate assistance with self-care activities. These unmet care needs increase risk of hospitalization, institutionalization, and morbidity. While a growing body of research has focused on disparities in unmet care needs and place of death outcomes among older adults separately, less is known about the intersection between the two: place of death and unmet care needs at the end of life. Therefore, this study utilized data from the National Health & Aging Trends Study (NHATS) to examine patterns of place of death and unmet care needs outcomes among older adults to identify disparities in care and inform policies and programs. We conducted weighted bivariate analyses and multivariate logistic regression models using appropriate survey weights. Findings suggest more than half of older adults experienced an unmet need at the end of their lives and increasing rates of unmet needs are experienced by older adults who died in hospitals. Older adults receiving hospice care were also found to have less unmet needs at the end of their lives. Given the well-documented consequences of unmet needs with self-care activities, ongoing research is needed to better inform policies and programs that provide assistance and support to older adults with their self-care activities during their end of lives.
Collapse
Affiliation(s)
| | - Jessica Lapham
- School of Social Work, University of Washington, Seattle, WA, USA
| |
Collapse
|
9
|
Cross SH, Kavalieratos D. Public Health and Palliative Care. Clin Geriatr Med 2023; 39:395-406. [PMID: 37385691 PMCID: PMC10571066 DOI: 10.1016/j.cger.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Meeting the needs of people at the end of life (EOL) is a public health (PH) concern, yet a PH approach has not been widely applied to EOL care. The design of hospice in the United States, with its focus on cost containment, has resulted in disparities in EOL care use and quality. Individuals with non-cancer diagnoses, minoritized individuals, individuals of lower socioeconomic status, and those who do not yet qualify for hospice are particularly disadvantaged by the existing hospice policy. New models of palliative care (both hospice and non-hospice) are needed to equitably address the burden of suffering from a serious illness.
Collapse
Affiliation(s)
- Sarah H Cross
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, 1518 Clifton Road Northeast, Atlanta, GA 30322, USA.
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, 1518 Clifton Road Northeast, Atlanta, GA 30322, USA
| |
Collapse
|
10
|
Sokol LL, Nance M, Kluger BM, Yeh C, Paulsen JS, Smith AK, Bega D. Factors Associated With the Place of Death in Huntington Disease: Analysis of Enroll-HD. J Palliat Med 2023; 26:915-921. [PMID: 36706436 PMCID: PMC10316529 DOI: 10.1089/jpm.2022.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 01/28/2023] Open
Abstract
Background: Most people prefer to die at home. Hospice is the standard in end-of-life care for people with Huntington disease (HD), a neurodegenerative genetic disorder that affects people in middle adulthood. Yet, we have little knowledge regarding the place of death for people with HD. Therefore, the current state of knowledge limits HD clinicians' ability to conduct high-quality goals of care conversations. Objectives: We sought to determine the factors associated with the place of death in people with HD. Design: We obtained cross-sectional data from Enroll-HD and included participants with a positive HD mutation of 36 or more CAG repeats. Results: Out of 16,120 participants in the Enroll-HD study, 536 were reported as deceased. The mean age at death was 60. The leading place of death was home (29%), followed by the hospital (23%). The adjusted odds ratio (aOR) of dying at a skilled nursing facility was significantly lower for those partnered (aOR: 0.48, confidence interval [95% CI]: 0.26-0.86). The aOR for dying on hospice compared to home was increased in a person with some college and above (aOR: 2.40, 95% CI: 1.21-4.75). Conclusions: Our data further suggest that models that predict the place of death for serious illnesses do not appear to generalize to HD. The distribution in the places of death within HD was not uniform. Our findings may assist HD clinicians in communication during goals of care conversations.
Collapse
Affiliation(s)
- Leonard L. Sokol
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- McGaw Bioethics Scholars Program, Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Martha Nance
- Struthers Parkinson's Center, Golden Valley, Minnesota, USA
- Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Benzi M. Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Chen Yeh
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane S. Paulsen
- Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Danny Bega
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Movement Disorders, The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
11
|
McDarby M, Russell D, King L, Kozlov E, Luth EA. Challenges and strategies among family care partners of community-dwelling persons with dementia nearing end of life. J Am Geriatr Soc 2023; 71:1785-1794. [PMID: 36740935 PMCID: PMC10258160 DOI: 10.1111/jgs.18254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND A growing number of persons living with dementia (PLwD) die at home with hospice care. However, there is limited information describing the needs of dying, community-dwelling persons with dementia and their family care partners (FCPs). Understanding the range of challenges faced by these FCPs is requisite to developing resources and refining support infrastructure. The current study identifies caregiving challenges unique to this population and strategies FCPs use to address those challenges. METHODS Semi-structured interviews were conducted with 40 current or recently bereaved FCPs of home hospice patients living with dementia, recruited from geriatrics clinics and a hospice agency in the New York metropolitan area. A thematic analysis guided by deductive and inductive approaches was used to code interview transcripts, identify broader conceptual categories, and search for themes. RESULTS Three themes were identified related to challenges faced by FCPs: (1) managing emotions and reacting to behaviors associated with advanced dementia; (2) lack of knowledge and adequate information related to dementia: disease progression and caregiving skills; and (3) maintaining FCP well-being: self-care and caregiver burden. Three themes were identified that describe strategies FCPs of PLwD employ to cope with end-of-life caregiving demands: (1) accepting help from professional caregivers and hospice support services; (2) getting knowledge and information about dementia; and (3) pragmatic approaches and acceptance of signs and symptoms of disease progression. CONCLUSIONS FCPs of PLwD near the end of life (EOL) face caregiving challenges unique to dementia and dying. While FCPs are resourceful in identifying novel strategies for managing burden and caregiving responsibilities, our results point to gaps in the current support infrastructure for this population at the EOL. Findings also identify areas of need for care partners navigating end-of-life issues.
Collapse
Affiliation(s)
- Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, North Carolina, USA
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Lori King
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Elissa Kozlov
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Elizabeth A Luth
- Institute for Health, Health Care Policy, and Aging Research and Department of Family Medicine and Community Health, Rutgers University, Piscataway, New Jersey, USA
| |
Collapse
|
12
|
Arsenault-Lapierre G, Bui TX, Le Berre M, Bergman H, Vedel I. Rural and urban differences in quality of dementia care of persons with dementia and caregivers across all domains: a systematic review. BMC Health Serv Res 2023; 23:102. [PMID: 36721162 PMCID: PMC9887943 DOI: 10.1186/s12913-023-09100-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are challenges in healthcare service delivery in rural areas, and this may be especially true for persons with dementia, who have higher needs to access to the healthcare system, and may have difficulties to commute easily and safely to these services. There is a growing body of literature regarding geographical disparities, but there is no comprehensive systematic review of geographical differences in persons with dementia across all domains of care quality. Therefore, the objective of this study is to conduct a systematic review of the literature on rural and urban differences in quality of dementia care outcomes of persons with dementia across all quality-of-care domains. METHODS We performed a digital search in Ovid MEDLINE on July 16, 2019, updated on May 3, 2021, for French or English records. We selected studies that reported outcome from at least one domain of quality of dementia care (Access, Integration, Effective Care, Efficient Care, Population Health, Safety, and Patient-Centered) in both rural and urban persons with dementia or caregivers. We used rigorous, systematic methods for screening, selection, data extraction and we analyzed outcomes reported by at least two studies using vote counting and appraised the certainty of evidence. Finally, we explored sources of heterogeneity. RESULTS From the 38 included studies, we found differences in many dementia care domains. Rural persons with dementia had higher mortality rates (Population Health), lower visits to any physicians (Access), more hospitalizations but shorter stays (Integration), higher antipsychotic medications (Safety), lower use of home care services and higher use of nursing home (Patient-Centered Care) compared to urban persons with dementia. CONCLUSIONS This comprehensive portrait of rural-urban differences in dementia care highlights possible geographically based inequities and can be used by researchers and decision makers to guide development of more equitable dementia care policies.
Collapse
Affiliation(s)
- Geneviève Arsenault-Lapierre
- Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC, H3S 1Z1, Canada.
| | - Tammy X. Bui
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada
| | - Mélanie Le Berre
- grid.14848.310000 0001 2292 3357Université de Montréal, Institut Universitaire de Gériatrie de Montréal, 4565 Chemin Queen Mary, Montreal, H3W 1W5 Canada
| | - Howard Bergman
- grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Isabelle Vedel
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada ,grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| |
Collapse
|
13
|
İşler AM, Yıldırım B. The Need for Hospice Care as a Preferred Environment of Death in Terminal Cancers: A Neglected Research Area in Turkey. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2023; 19:53-83. [PMID: 35776763 DOI: 10.1080/15524256.2022.2094524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the context of end-of-life practices in Turkey, the researchers considered it important to reveal the need for hospice care in Turkey since the number of palliative care units is low and they do not meet the needs, hospice care services are absent, and intensive care units are misused in parallel with these deficiencies. The researchers addressed the subject with a phenomenological qualitative approach. The views of healthcare professionals and patient relatives who cared for terminal cancer patients. In the context of the environment of death preferences were of interest. The study was conducted in the city center of Manisa, one of the 30 metropolitan cities located in the western region of Turkey. Of the 23 participants, 18 were healthcare professionals working in the field of oncology, and five participants were primary caregivers who lost their loved ones with terminal cancer. The caregiver family members were the family members who provided care to the terminal cancer patient with their own means at home and accompanied the patient's treatment process, since there was no hospice care. A semi-structured interview guide was utilized for the in-depth interviews. Data were transcribed by the researchers and coded in MAXQDA 2020, subjected to thematic analysis, and divided into units of meaning. At the final stage of the study, the units of meaning were combined, and four basic themes were revealed: the conceptualization of the environment of death preferences, the problems caused by death in the hospital, the necessity of hospice care, and hospice care for caregivers. The study results demonstrated that hospice care was an essential need in Turkey, and the workload of hospitals would decrease, and hospital resources could be used efficiently in the presence of hospices. At the same time, it was understood that hospices were services making it easier for terminal cancer patients and their caregivers to face death with peaceful expectations.
Collapse
Affiliation(s)
- Ayşe Mine İşler
- Department of Social Work, Tekirdağ Namık Kemal University, Süleymanpaşa, Turkey
| | - Buğra Yıldırım
- Department of Social Work, Manisa Celal Bayar University, Manisa, Turkey
| |
Collapse
|
14
|
Olvera CE, Levin ME, Fleisher JE. Community-based neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:49-66. [PMID: 36599515 DOI: 10.1016/b978-0-12-824535-4.00001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Community-based palliative care is defined as palliative care delivered outside of the hospital and outpatient clinics. These settings include the home, nursing homes, day programs, volunteer organizations, and support groups. There is strong evidence outside of the neuropalliative context that community-based palliative care can reduce hospital costs and admissions at the end of life. Research that focuses on specialized community-based palliative care for neurologic disease have similar findings, although with significant variability across conditions and geographic locations. Several of these studies have investigated home-based care for neurologic conditions including dementia, Parkinson's disease, multiple sclerosis, brain tumors, and motor neuron disease. Other work has focused on incorporating palliative care models into the treatment of patients with neurologic diseases within nursing home settings. Similar to nonneurologic community-based palliative care, little has been published on patient and caregiver quality-of-life outcomes in such models of care, although the emerging data are generally positive. Future studies should explore how best to provide comprehensive, cost-effective, scalable, and replicable models of community-based neuropalliative care, patient and caregiver outcomes in such models, and how care can be adapted between and within specific patient populations and healthcare systems.
Collapse
Affiliation(s)
- Caroline E Olvera
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States; Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, United States
| | - Melissa E Levin
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States; Chicago Medical School-Rosalind Franklin University, North Chicago, IL, United States
| | - Jori E Fleisher
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States.
| |
Collapse
|
15
|
Green G, Halevi Hochwald I, Radomyslsky Z, Nissanholtz-Gannot R. Family Caregiver's Depression, Confidence, Satisfaction, and Burden Regarding End-of-Life Home Care for People With End-Stage Dementia. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221147961. [PMID: 36573833 DOI: 10.1177/00302228221147961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
To detect differences between two care services units: regarding family-caregiver (FC) depression, perceived-burden and confidence in the provision of care to people with end-stage dementia (PWESD); examine predictors such as FC age, depression, confidence in the provision of care to PWESD and satisfaction with the community-home-care service to burden; and explore a mediation model.The participants were 139 FC, caring for PWESD living at home. The questionnaire was composed of FC background characteristics, perceived-burden, satisfaction with the community-home-care services, depression, and confidence in the provision of care to the PWESD. HCUs' FC felt significantly more burdened than HHUs' FC. Furthermore, satisfaction with the community-home-care services mediated the relationship between FC confidence in the provision of care to the PWESD and FC burden. The study results may affect the development of end-of-life care policies and services which meet the needs of PWESD and their FC.
Collapse
Affiliation(s)
- Gizell Green
- School of Nursing, Ariel University, Ariel, Israel
| | | | - Zorian Radomyslsky
- Maccabi Healthcare Services, Tel-Aviv, Israel
- School of Health Sciences, Ariel University, Ariel, Israel
| | | |
Collapse
|
16
|
Xiong Z, Feng W, Li Z. Availability of family care resources, type of primary caregiving and home death among the oldest-old: A population-based retrospective cohort study in China. SSM Popul Health 2022; 20:101308. [DOI: 10.1016/j.ssmph.2022.101308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/13/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
|
17
|
Sullivan SS, de Rosa C, Li CS, Chang YP. Dementia caregiver burdens predict overnight hospitalization and hospice utilization. Palliat Support Care 2022; 21:1-15. [PMID: 36263744 PMCID: PMC10115915 DOI: 10.1017/s1478951522001249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To determine sociodemographics and caregiver burdens associated with overnight hospitalization, hospice utilization, and hospitalization frequency among persons with dementia (PWD). METHODS Cross-sectional analysis of PWD (n = 899) of the National Health and Aging Trends Study linked to the National Study of Caregiving. Logistic and proportional odds regression determined the effects of caregiver burdens on overnight hospitalization, hospice use, and hospitalization frequency. Differences between PWD alive not-alive groups were compared on overnight hospitalization and frequency. RESULTS Alive PWD (n = 804) were 2.36 times more likely to have an overnight hospital stay (p = 0.004) and 1.96 times more likely to have multiple hospitalizations when caregivers found it physically difficult to provide care (p = 0.011). Decedents aged 65-74 (n = 95) were 4.55 times more likely to experience overnight hospitalizations than 85+, hospitalizations were more frequent (odds ratio [OR] = 4.84), and there was a significant difference between PWD alive/not alive groups (p = 0.035). Decedents were 5.60 times more likely to experience an overnight hospitalization when their caregivers had financial difficulty, hospitalizations were more frequent when caregivers had too much to handle (OR = 8.44) and/or no time for themselves (OR = 10.67). When caregivers had no time for themselves, a significant difference between alive/not alive groups (p = 0.018) was detected in hospitalization frequency. PWD whose caregivers had emotional difficulty helping were 5.89 times more likely to utilize hospice than caregivers who did not report emotional difficulty. SIGNIFICANCE OF RESULTS Care transitions among PWD at the end of life are impacted by the circumstances and experiences of their caregivers. Subjective caregiver burdens represent potentially modifiable risks for undesired care transitions and opportunities for promoting hospice use. Future work is warranted to identify and address these issues as they occur.
Collapse
Affiliation(s)
| | | | - Chin-Shang Li
- School of Nursing, University at Buffalo, Buffalo, NY, USA
| | - Yu-Ping Chang
- School of Nursing, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
18
|
Tegenborg S, Fransson P, Martinsson L. Translation, cultural adaptation and recommendations for clinical implementation of the Abbey Pain Scale to a Swedish dementia care context. Nurs Open 2022; 10:1367-1374. [PMID: 36217250 PMCID: PMC9912384 DOI: 10.1002/nop2.1386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/03/2022] [Accepted: 09/14/2022] [Indexed: 02/11/2023] Open
Abstract
AIM To translate and culturally adapt the APS for people with end-stage dementia in various care settings in Sweden and to investigate factors important for clinical implementation. DESIGN Qualitative study design with interviews with care staff. METHODS After an initial discussion of concepts, the Abbey Pain Scale was translated into Swedish and back into English to check for accuracy. The resulting Swedish version was then revised and culturally adapted through a series of interviews with nursing assistants, nurses and physicians (n = 11) to develop the final Swedish version. RESULTS A Swedish version of the Abbey Pain Scale was developed. The instrument was considered straightforward and easy to use, but needed adjustments to make it more comprehensible to staff with less education in health care or with other first languages than Swedish. It was found important to carefully introduce new staff members to the instrument, to ensure they understand all the words and items.
Collapse
|
19
|
Gotanda H, Nuckols TK, Lauzon M, Tsugawa Y. Comparison of Advance Care Planning and End-of-Life Care Intensity Between Dementia Versus Cancer Patients. J Gen Intern Med 2022; 37:3251-3257. [PMID: 35018564 PMCID: PMC9550910 DOI: 10.1007/s11606-021-07330-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND While advanced care planning (ACP) is recommended in dementia and cancer care, there are unique challenges in ACP for individuals with dementia, such as the insidious onset and progression of cognitive impairment, potentially leading to high-intensity care at the end of life (EOL) for this population. OBJECTIVE To compare ACP completion and receipt of high-intensity care at the EOL between decedents with dementia versus cancer. DESIGN Retrospective longitudinal cohort study. PARTICIPANTS Participants of the U.S. Health and Retirement Study who died between 2000 and 2014 with dementia (n = 2099) and cancer (n = 1137). MAIN MEASURES Completion of three types of ACP (living will, durable power of attorney for healthcare [DPOAH], discussions of preferences for EOL care) and three measures of EOL care intensity (in-hospital death, intensive care unit [ICU] care in the last 2 years of life, life support use in the last 2 years of life). KEY RESULTS Use of living will was lower in dementia than in cancer (adjusted proportion, 49.9% vs. 56.9%; difference, - 7.0 percentage points [pp, 95% CI, - 13.3 to - 0.7]; p = 0.03). Use of DPOAH was similar between the two groups, but a lower proportion of decedents with dementia had discussed preferences compared to decedents with cancer (53.0% vs. 68.1%; - 15.1 pp [95% CI, - 19.3 to - 10.9]; p < 0.001). In-hospital death was higher in dementia than in cancer (29.5% vs. 19.8%; + 9.7 pp [95% CI, + 5.9 to + 13.5]; p < 0.001), although use of ICU care was lower (20.9% vs. 26.1%; - 5.2 pp [95% CI, - 9.8 to - 0.7]; p = 0.03). Use of life support was similar between the two groups. CONCLUSIONS Individuals with dementia complete ACP less frequently and might be receiving higher-intensity EOL care than those with cancer. Interventions targeting individuals with dementia may be necessary to further improve EOL care for this population.
Collapse
Affiliation(s)
- Hiroshi Gotanda
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Teryl K Nuckols
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marie Lauzon
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai, Los Angeles, CA, USA
| | - Yusuke Tsugawa
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|
20
|
Osakwe ZT, Obioha CU, Muller K, Saint Fleur-Calixte R. A Description of Persons With Alzheimer Disease and Related Dementias Receiving Home Health Care: A National Analysis. J Hosp Palliat Nurs 2022; 24:00129191-990000000-00045. [PMID: 36178738 DOI: 10.1097/njh.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The end-of-life period of individuals with Alzheimer disease and related dementias receiving home health care (HHC) is understudied. We sought to describe characteristics of HHC patients with Alzheimer disease and related dementias at risk of death within a year, based on clinician assessment. We conducted a secondary data analysis of a 5% random sample of the Outcome and Assessment Information Set data set for the year 2017. We used Outcome and Assessment Information Set-C item M1034 to identify HHC patients with overall status of progressive condition leading to death within a year. Multivariable logistic regression model was used to examine the association between sociodemographic, functional, clinical, and caregiving factors and likelihood of decline leading to death within a year, as identified by HHC clinicians. Clinician perception of decline leading to death within a year was higher for Whites (vs Blacks or Hispanics) (odds ratio [OR], 0.74 [95% confidence interval (CI), 0.69-0.80], and OR, 0.63 [95% CI, 0.57-0.69], respectively). Factors associated with increased odds of decline leading to death within a year included daily pain (OR, 1.11 [95% CI, 1.06-1.17]), anxiety daily or more often (OR, 1.58 [95% CI, 1.49-1.67]), shortness of breath (OR, 1.45 [95% CI, 1.34-1.57]), use of oxygen (OR, 1.60 [95% CI, 1.52-1.69]), disruptive behavior (OR, 1.26 [95% CI, 1.20-1.31]), and feeding difficulty (OR, 2.25 [95% CI, 2.09-2.43]). High symptom burden exists among HHC patients with Alzheimer disease and related dementias identified to have a status of decline leading to death within a year.
Collapse
|
21
|
Mayan I, Yaffe K, James J, Hunt LJ. The Association Between Race and Place of Death Among Persons With Dementia. J Pain Symptom Manage 2022; 64:e109-e114. [PMID: 35618245 PMCID: PMC10026613 DOI: 10.1016/j.jpainsymman.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT Little is known about racial differences in place of death for persons with dementia (PWD), who may be especially vulnerable to receiving care at end of life that is not concordant with their goals or that places higher burden on caregivers. OBJECTIVES To determine if there are racial and ethnic differences in place of death among PWD. METHODS We analyzed data from the nationally representative National Health and Aging Trends study. Participants were included if they had probable dementia as defined by a previously validated algorithm and died between 2012 and 2020. Race and ethnicity were self-reported. Place of death was obtained from post-mortem interviews with bereaved caregivers. RESULTS The sample included 993 decedents with dementia (81.4% white; 11.0% black, 7.6% hispanic). A higher percentage of black and hispanic decedents died in the hospital (30.3% and 32.8%, respectively) compared to white decedents (19.0%). A higher percentage of white decedents died in the nursing home (31.0%) than black (22.4%) or hispanic decedents (15.0%) In adjusted analyses, black decedents had a higher odds of hospital death (AOR 1.50; 95% CI 1.01, 2.24) compared to white decedents, with similar trends found for hispanic decedents. CONCLUSION We found racial and ethnic differences in location of death for PWD, with black and hispanic PWD more likely to die in the hospital compared to white PWD. More research is needed to determine if the differences found represent goal concordant care or rather lack of access to high quality of care at the end of life.
Collapse
Affiliation(s)
- Inbal Mayan
- Global Brain Health Institute (I.M.), University of California, San Francisco, CA, USA; Tel Aviv University Sackler School of Medicine (I.M.), Ramat Aviv, Israel.
| | - Kristine Yaffe
- Departments of Psychiatry and Behavioral Science (K.Y.), Neurology and Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Jennifer James
- Departments of Psychiatry and Behavioral Science (J.J.), Neurology and Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Lauren J Hunt
- Department of Physiological Nursing (L.J.H.), University of California, San Francisco, CA, USA
| |
Collapse
|
22
|
Akunor HS, McCarthy EP, Hendricksen M, Roach A, Hendrix Rogers A, Mitchell SL, Lopez RP. Nursing Home Staff Perceptions of End-of-Life Care for Residents With Advanced Dementia: A Multisite Qualitative Study. J Hosp Palliat Nurs 2022; 24:152-158. [PMID: 35195109 PMCID: PMC9058147 DOI: 10.1097/njh.0000000000000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nursing homes (NHs) are an important site of death for residents with advanced dementia. Few studies have explored the experiences of NH staff about providing end-of-life care for residents with advanced dementia. This study aimed to describe NH staff perceptions on where end-of-life care should be delivered, the role of Medicare hospice care, and their experiences providing end-of-life care to residents with advanced dementia. Data from the Assessment of Disparities and Variation for Alzheimer's disease Nursing home Care at End of life study were used to explore the study objectives. Semistructured interviews with 158 NH staff working in 13 NHs across the United States were analyzed. Most NH staff endorsed the NH as a better site of death for residents with advanced dementia compared with a hospital. They expressed mixed perceptions about hospice care. However, regardless of their role, the staff expressed experiencing difficult emotions while providing end-of-life care to residents with dementia because of the close attachments they had formed with them and bearing witness to their decline. The findings show that most NH staff have strong emotional attachments to their dying residents with dementia and prefer to care for them at the NH rather than transfer them to the hospital.
Collapse
|
23
|
Cross SH, Anderson DM, Cox CE, Agarwal S, Haines KL. Trends in Location of Death Among Older Adult Americans After Falls. Gerontol Geriatr Med 2022; 8:23337214221098897. [PMID: 35559359 PMCID: PMC9087234 DOI: 10.1177/23337214221098897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/29/2022] [Accepted: 04/18/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Fall-related mortality is increasing among older adults, yet
trends and changes in the location of fall-attributed deaths are unknown; additionally,
potential disparities are understudied. Methods: To assess trends/factors
associated with place of death among older adult fall deaths in the US, a cross-sectional
analysis of deaths using mortality data from 2003–2017 was performed.
Results: Most deaths occurred in hospitals, however, the proportion
decreased from 66.4% (n = 9,095) to 50.7% (n = 15,817).
The proportion occurring in nursing facilities decreased from 15.9% (n =
2175) to 15.3% (n = 4,778), while deaths at home and in hospice
facilities increased. Male, Black, Native American, and married decedents had increased
odds of hospital death. Conclusion: As fall deaths increase among older
adults, end-of-life needs of this population deserve increased attention. Research should
explore needs and preferences of older adults who experience falls and their caregivers to
reduce disparities in place of death and to ensure high quality of care is received.
Collapse
Affiliation(s)
- Sarah H. Cross
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - David M. Anderson
- Duke-Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, NC, USA
| | - Christopher E. Cox
- Division of Pulmonary Critical Care, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Suresh Agarwal
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Krista L. Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
24
|
Lassell RKF, Moreines LT, Luebke MR, Bhatti KS, Pain KJ, Brody AA, Luth EA. Hospice interventions for persons living with dementia, family members and clinicians: A systematic review. J Am Geriatr Soc 2022; 70:2134-2145. [PMID: 35441699 PMCID: PMC9283206 DOI: 10.1111/jgs.17802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hospice care was initially designed for seriously ill individuals with cancer. Thus, the model and clinicians were geared toward caring for this population. Despite the proportion of persons living with dementia (PLWD) receiving hospice care substantially increased over the past 10 years, and their longer lengths of stay, established hospice interventions for this population are scarce. No systematic review has previously evaluated those interventions that do exist. We synthesized hospice intervention studies for PLWD, their families, and hospice professionals by describing the types of interventions, participants, outcomes, and results; assessing study quality; and identifying promising intervention strategies. METHODS A systematic review was conducted using a comprehensive search of five databases through March 2021 and follow-up hand searches. Included studies were peer-reviewed, available in English, and focused on hospice interventions for persons with dementia, and/or care partners, and clinicians. Using pre-determined inclusion and exclusion criteria, data was extracted guided by the Cochrane Checklist, and quality was assessed using a 26-item Consolidated Standards of Reporting Trials (CONSORT) Checklist. RESULTS The search identified 3235 unique studies in total, of which 10 studies met inclusion criteria. The search revealed three types of interventions: clinical education and training, usual care plus care add-on services, and "other" delivered to 707 participants (mostly clinicians). Five studies included underrepresented racial and ethnic groups. Outcomes measured knowledge and skills, psychosocial and health outcomes, feasibility, and acceptability, with significant improvements in six studies. Study quality was reflective of early-stage research with clinical education and training strategies showing deliberate progression towards real-world efficacy testing. IMPLICATIONS Hospice interventions for PLWD are sparse and in early-phase research. More research is needed with rigorous designs, diverse samples, and outcomes considering the concordance of care.
Collapse
Affiliation(s)
- Rebecca K F Lassell
- Rory Meyers College of Nursing, Hartford Institute for Geriatric Nursing, New York University, New York, New York, USA
| | - Laura T Moreines
- Rory Meyers College of Nursing, Hartford Institute for Geriatric Nursing, New York University, New York, New York, USA
| | - Matthew R Luebke
- Department of Human Development, Cornell University, Ithaca, New York, USA
| | - Karandeep S Bhatti
- Neurology Department, Cooper University Hospital, Camden, New Jersey, USA
| | - Kevin J Pain
- Weill Cornell Medicine, Samuel J. Wood Library and C. V. Starr Biomedical Information Center, New York, New York, USA
| | - Abraham A Brody
- Rory Meyers College of Nursing, Hartford Institute for Geriatric Nursing, New York University, New York, New York, USA.,Grossman School of Medicine, Division of Geriatrics and Palliative Care, New York University, New York, New York, USA
| | - Elizabeth A Luth
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.,Department of Family Medicine and Community Health, Rutgers University, New Brunswick, New Jersey, USA
| |
Collapse
|
25
|
Kim SH. Illnesses and Symptoms in Older Adults at the End of Life at Different Places of Death in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073924. [PMID: 35409606 PMCID: PMC8998111 DOI: 10.3390/ijerph19073924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 12/10/2022]
Abstract
Context: A comprehensive plan has been launched by the Korean government to expand hospice and palliative care from hospital-based inpatient units to other services, such as palliative care at home, palliative consultation, and palliative care at a nursing home. Objective: To examine the illnesses and symptoms at the end of life associated with the place of death among older Korean adults. Methods: This secondary data analysis included a stratified random sample of 281 adults identified from the exit survey of the Korean Longitudinal Study of Aging aged ≥65 years and who died in 2017–2018. Results: Overall, 69% of the patients died at hospitals, 13% died at long-term care facilities (LTCF), and 18% died at home. In the multinomial logistic regression analysis adjusting for age, sex, and marital status, older adults who died in the hospital had higher odds (2.02–4.43 times) of having limitations in activities of daily living (ADL) as well as symptoms of anorexia, depression, weakness, dyspnea, and periodic confusion 1 month before death than those who died at home. Older adults who died in an LTCF were more likely to have limitations in ADL and instrumental ADL as well as a higher likelihood (2–5 times) of experiencing pain, anorexia, fatigue, depression, weakness, dyspnea, incontinence, periodic confusion, and loss of consciousness than those who died at home. Conclusion: Since the majority of subjects died either in a hospital or an LCTF, and this proportion is expected to increase, policy planning should focus on improving the palliative case in these settings. Future policies and clinical practices should consider the illness and symptoms of older patients at the end of life across different care settings.
Collapse
Affiliation(s)
- Su Hyun Kim
- Research Institute of Nursing Science, College of Nursing, Kyungpook National University, Gukchaebosang-ro 680, Daegu 41944, Korea
| |
Collapse
|
26
|
Cypher M, Axman LM. Determinants of Location of Death: A Secondary Analysis Utilizing Multinomial Logistic Regression. Am J Hosp Palliat Care 2022; 39:1397-1402. [PMID: 35232266 DOI: 10.1177/10499091221077883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STATEMENT OF PROBLEM A discrepancy exists between where people would like to die and what actually occurs. More research about the factors influencing the location of death is required. Sources of Data and Research Design: Multinomial logistic regression was used to examine a sample taken from the fourth round of data collection performed by the National Health and Aging Trends Study conducted in 2014. Conclusions Reached: Census location, age, dementia, and use of hospice were found to have a statistically significant (P < .05) influence on the location of death (P = .000). The results suggest that the use of hospice increased the odds of dying at home (OR = 17.467, CI = 7.43-41.063) and in a nursing home (OR = 34.334, CI = 12.444-94.727) as compared to dying in the hospital. Further research is required on the topic of geographic location and place of death.
Collapse
|
27
|
Gotanda H, Zhang JJ, Xu H, Tsugawa Y. Site of death among individuals with and without dementia in 2016–2018. J Am Geriatr Soc 2022; 70:1865-1867. [DOI: 10.1111/jgs.17704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/11/2022] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroshi Gotanda
- Division of General Internal Medicine Cedars‐Sinai Medical Center Los Angeles California USA
| | - Jessica J. Zhang
- Department of Medicine David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Haiyong Xu
- Division of General Internal Medicine and Health Services Research David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research David Geffen School of Medicine at UCLA Los Angeles California USA
- Department of Health Policy and Management UCLA Fielding School of Public Health Los Angeles California USA
| |
Collapse
|
28
|
Tay R, Tan JYS, Hum AYM. Factors Associated With Family Caregiver Burden of Home-Dwelling Patients With Advanced Dementia. J Am Med Dir Assoc 2021; 23:1248-1256. [PMID: 34634231 DOI: 10.1016/j.jamda.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To realize patients' preferences for home death, this study aimed to identify factors associated with family caregiver burden of home-dwelling patients with advanced dementia and examine its relationship with end-of-life care treatment decisions. DESIGN A prospective cohort study. SETTING AND PARTICIPANTS Patient-family caregiver dyads enrolled in a home-based palliative care program for patients with advanced dementia, with family caregiver burden assessed using the Zarit Burden Interview (ZBI) on enrolment, were included. METHODS Independent variables included sociodemographic data, patients' clinical phase, symptom severity, quality of life, informal paid help availability, and community resources utilized. Dependent variable was continuous ZBI scores and ZBI scores dichotomized into <24 and ≥24 for predicting depression risk. Place of death and interventions received 2 weeks before death were also collected. Data were analyzed using multivariate linear and logistic regression. RESULTS From October 2014 to December 2020, a total of 377 family caregivers were assessed with ZBI. Median score was 25 (IQR 15-36), and 54.4% of them were at risk of depression. Younger family caregivers had higher ZBI scores (β = -0.22, 95% CI -0.38, -0.07), with the depression risk doubling for family caregivers aged <60 years (OR 2.13, 95% CI 1.33, 3.43). Absence of informal paid help also increased the ZBI scores (β = -9.04, 95% CI -14.86, -3.22) and depression risk (OR 2.50, 95% CI 1.03, 6.09). In addition, caregivers' ZBI scores increased with patients' neuropsychiatric symptom severity (β = 0.49, 95% CI 0.08, 0.89), and caregivers of clinically unstable patients had a higher depression risk (OR 1.80, 95% CI 1.03, 3.12). Baseline caregiver burden was not associated with treatment decisions made at the end of life. CONCLUSIONS AND IMPLICATIONS Younger family caregivers caring for clinically unstable patients with severe neuropsychiatric symptoms experienced greater burden without informal paid help. For end-of-life care at home in advanced dementia to be tenable, relevant national agencies and stakeholders are recommended to work collectively to support family caregivers holistically.
Collapse
Affiliation(s)
- RiYin Tay
- Dover Park Hospice, Singapore; The Palliative Care Centre for Excellence in Research and Education, Singapore.
| | - Joyce Y S Tan
- The Palliative Care Centre for Excellence in Research and Education, Singapore
| | - Allyn Y M Hum
- Dover Park Hospice, Singapore; The Palliative Care Centre for Excellence in Research and Education, Singapore; Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
29
|
Lopez RP, McCarthy EP, Mazor KM, Hendricksen M, McLennon S, Johnson KS, Mitchell SL. ADVANCE: Methodology of a qualitative study. J Am Geriatr Soc 2021; 69:2132-2142. [PMID: 33971029 PMCID: PMC8373706 DOI: 10.1111/jgs.17217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Quantitative studies have documented persistent regional, facility, and racial differences in the intensity of care provided to nursing home (NH) residents with advanced dementia including, greater intensity in the Southeastern United States, among black residents, and wide variation among NHs in the same hospital referral region (HRR). The reasons for these differences are poorly understood, and the appropriate way to study them is poorly described. DESIGN Assessment of Disparities and Variation for Alzheimer's disease Nursing home Care at End of life (ADVANCE) is a large qualitative study to elucidate factors related to NH organizational culture and proxy perspectives contributing to differences in the intensity of advanced dementia care. Using nationwide 2016-2017 Minimum DataSet information, four HRRs were identified in which the relative intensity of advanced dementia care was high (N = 2 HRRs) and low (N = 2 HRRs) based on hospital transfer and tube-feeding rates among residents with this condition. Within those HRRs, we identified facilities providing high (N = 2 NHs) and low (N = 2 NHs) intensity care relative to all NHs in that HRR (N = 16 total facilities; 4 facilities/HRR). RESULTS/CONCLUSIONS To date, the research team conducted 275 h of observation in 13 NHs and interviewed 158 NH providers from varied disciplines to assess physical environment, care processes, decision-making processes, and values. We interviewed 44 proxies (black, N = 19; white, N = 25) about their perceptions of advance care planning, decision-making, values, communication, support, trust, literacy, beliefs about death, and spirituality. This report describes ADVANCE study design and the facilitators and challenges of its implementation, providing a template for the successful application of large qualitative studies focused on quality care in NHs.
Collapse
Affiliation(s)
| | - Ellen P. McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
| | - Kathleen M. Mazor
- Meyers Primary Care Institute, Worcester, MA
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Meghan Hendricksen
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston MA
| | | | - Kimberly S. Johnson
- Division of Geriatrics, Department of Medicine, Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
- Geriatrics Research Education and Clinical Center, Veteran Affairs Medicine Center, Durham, NC
| | - Susan L. Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
| |
Collapse
|
30
|
Luth EA, Russell DJ, Xu JC, Lauder B, Ryvicker MB, Dignam RR, Baughn R, Bowles KH, Prigerson HG. Survival in hospice patients with dementia: the effect of home hospice and nurse visits. J Am Geriatr Soc 2021; 69:1529-1538. [PMID: 33608869 DOI: 10.1111/jgs.17066] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospice, or experiences a live discharge or long length of stay. OBJECTIVE Examine how home hospice and nurse visit frequency relate to dying in hospice within the Medicare-intended 6-month period. DESIGN Retrospective cohort study. SETTING Non-profit hospice agency. PARTICIPANTS Three thousand eight hundred and thirty seven patients with dementia who received hospice services from 2013 to 2017. METHODS Multivariable survival analyses examined the effects of receiving home hospice (vs. nursing home) and timing of nurse visits on death within 6 months of hospice enrollment, compared to live discharge or long length of stay. Models adjust for relevant demographic and clinical factors. RESULTS Thirty-nine percent (39%) of patients experienced live discharge or long length of stay. Home hospice patients were more likely to experience live discharge or long length of stays (HR for death: 0.77, 95%CI: 0.69-0.86, p < 0.001). Frequency of nurse visits was inversely associated with live discharge and long lengths of stay (HR for death: 2.87, 95%CI: 2.47-3.33, p < 0.001). CONCLUSION Nearly 40% of patients with dementia in our study experienced live discharge or a long length of stay. Additional research is needed to understand why home hospice may result in live discharge or a long length of stay for patients with dementia. Nurse visits were associated with death, suggesting their responsiveness to deteriorating patient health. Hospice guidelines may need to permit longer stays so community-dwelling patients with dementia, a growing segment of hospice patients, can remain continuously enrolled in hospice and avoid burden and costs associated with live discharge.
Collapse
Affiliation(s)
- Elizabeth A Luth
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David J Russell
- Center for Home Care & Policy Research, Visiting Nurse Service of New York, New York, New York, USA.,Department of Sociology, Appalachian State University, Boone, North Carolina, USA
| | - Jiehui Cici Xu
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Bonnie Lauder
- Hospice and Palliative Care Services, Visiting Nurse Service of New York, New York, New York, USA
| | - Miriam B Ryvicker
- Center for Home Care & Policy Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Ritchell R Dignam
- Hospice and Palliative Care Services, Visiting Nurse Service of New York, New York, New York, USA
| | - Rosemary Baughn
- Hospice and Palliative Care Services, Visiting Nurse Service of New York, New York, New York, USA
| | - Kathryn H Bowles
- Center for Home Care & Policy Research, Visiting Nurse Service of New York, New York, New York, USA.,Biobehavioral Health Science, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Holly G Prigerson
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
31
|
Kaplan A, Fortune B, Ufere N, Brown RS, Rosenblatt R. National Trends in Location of Death in Patients With End-Stage Liver Disease. Liver Transpl 2021; 27:165-176. [PMID: 37160006 DOI: 10.1002/lt.25952] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023]
Abstract
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.
Collapse
Affiliation(s)
- Alyson Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Brett Fortune
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Nneka Ufere
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| |
Collapse
|
32
|
Luth EA, Pan CX, Viola M, Prigerson HG. Dementia and Early Do-Not-Resuscitate Orders Associated With Less Intensive of End-of-Life Care: A Retrospective Cohort Study. Am J Hosp Palliat Care 2021; 38:1417-1425. [PMID: 33467864 DOI: 10.1177/1049909121989020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Dementia is a leading cause of death among US older adults. Little is known about end-of-life care intensity and do-not-resuscitate orders (DNRs) among patients with dementia who die in hospital. AIM Examine the relationship between dementia, DNR timing, and end-of-life care intensity. DESIGN Observational cohort study. SETTING/PARTICIPANTS Inpatient electronic health record extraction for 2,566 persons age 65 and older who died in 2 New York City hospitals in the United States from 2015 to 2017. RESULTS Multivariable logistic regression analyses modeled associations between dementia diagnosis, DNR timing, and 6 end-of-life care outcomes. 31% of subjects had a dementia diagnosis; 23% had a DNR on day of hospital admission. Patients with dementia were 18%-40% less likely to have received 4 of 6 types of intensive care (mechanical ventilation AOR: 0.82, 95%CI: 0.67 -1.00; intensive care unit admission AOR: 0.60, 95%CI: 0.49-0.83). Having a DNR on file was inversely associated with staying in the intensive care unit (AOR: 0.57, 95%CI: 0.47-0.70) and avoiding other intensive care measures. DNR placement later during the hospitalization and not having a DNR were associated with more intensive care compared to having a DNR upon admission. CONCLUSIONS Having dementia and a do-not resuscitate order upon hospital admission are associated with less intensive end-of-life care. Additional research is needed to understand why persons with dementia receive less intensive care. In clinical practice, encouraging advance care planning prior to and at hospital admission may be particularly important for patients wishing to avoid intensive end-of-life care, including patients with dementia.
Collapse
|
33
|
Regier NG, Cotter VT, Hansen BR, Taylor JL, Wright RJ. Place of Death for Persons With and Without Cognitive Impairment in the United States. J Am Geriatr Soc 2021; 69:924-931. [PMID: 33474723 DOI: 10.1111/jgs.16979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Natalie G Regier
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA
| | - Valerie T Cotter
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA
| | - Bryan R Hansen
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA
| | - Janiece L Taylor
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA
| | - Rebecca J Wright
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA
| |
Collapse
|
34
|
Cross SH, Lakin JR, Mendu M, Mandel EI, Warraich HJ. Trends in Place of Death for Individuals With Deaths Attributed to Advanced Chronic or End-Stage Kidney Disease in the United States. J Pain Symptom Manage 2021; 61:112-120.e1. [PMID: 32791183 DOI: 10.1016/j.jpainsymman.2020.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/29/2020] [Accepted: 08/05/2020] [Indexed: 12/30/2022]
Abstract
CONTEXT An important aspect of end-of-life care, place of death is understudied in advanced chronic (CKD) and end-stage kidney disease (ESKD). OBJECTIVE We sought to examine trends and factors associated with where advanced CKD/ESKD patients die. METHODS We conducted a retrospective cross-sectional study using mortality data from 2003 to 2017 for deaths attributed primarily to advanced CKD/ESKD in the United States. RESULTS Between 2003 and 2017, 222,247 deaths were attributed to advanced CKD/ESKD. From 2003 to 2017, deaths occurring in hospitals declined from 56.0% (n = 5356) to 35.6% (n = 7764), whereas increases occurred in deaths at home (13.5% [n = 1292] to 24.3% [n = 5306]), nursing facilities (18.6% [n = 1776] to 19.3% [n = 4221]), and hospice facilities (0.3% [n = 29] to 13.4% [n = 2917]). Nonwhite race was associated with increased odds of hospital death (Black [OR = 1.59; 95% CI = 1.55, 1.62]; Native American [OR = 1.47; 95% CI = 1.32, 1.63]; Asian [OR = 1.43; 95% CI = 1.32, 1.55] and reduced odds of nursing facility (Black [OR = 0.622; 95% CI = 0.600, 0.645]; Native American [OR = 0.638; 95% CI = 0.572, 0.712]; Asian [OR = 0.574; 95% CI = 0.533, 0.619], or hospice facility death (Black [OR = 0.843; 95% CI = 0.773, 0.918]; Native American [OR = 0.380; 95% CI = 0.289, 0.500]; Asian [OR = 0.609; 95% CI = 0.502, 0.739]). Older age was associated with reduced odds of hospital death (≥85 [OR = 0.334; 95% CI = 0.312, 0.358]) and increased odds of home (≥85 [OR = 1.55; 95% CI = 1.43, 1.68]), nursing facility (≥85 [OR = 3.09; 95% CI = 2.76, 3.45]) or hospice facility death (≥85 [OR = 1.60; 95% CI = 1.49, 1.72]). CONCLUSIONS Hospitals remain the most common place of death from advanced CKD/ESKD; however, the proportion of home, nursing facility, and hospice facility deaths have increased.
Collapse
Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA.
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Mallika Mendu
- Harvard Medical School, Boston, Massachusetts, USA; Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ernest I Mandel
- Harvard Medical School, Boston, Massachusetts, USA; Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Haider J Warraich
- Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiology Section, Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts, USA
| |
Collapse
|
35
|
Cross SH, Warraich HJ. Rural-Urban Disparities in Mortality from Alzheimer's and Related Dementias in the United States, 1999-2018. J Am Geriatr Soc 2020; 69:1095-1096. [PMID: 33368161 DOI: 10.1111/jgs.16996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Haider J Warraich
- Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
36
|
Liao JY, Chen PJ, Wu YL, Cheng CH, Yu SJ, Huang CH, Li CM, Wang YW, Zhang KP, Liu IT, Umegaki H, Hamano J, Mori M, Petersen I, Sampson EL, Hsiung CA. HOme-based Longitudinal Investigation of the multidiSciplinary Team Integrated Care (HOLISTIC): protocol of a prospective nationwide cohort study. BMC Geriatr 2020; 20:511. [PMID: 33246407 PMCID: PMC7694342 DOI: 10.1186/s12877-020-01920-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/18/2020] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The use of home health care (HHC) is increasing worldwide. This may have an impact not only on patients and their caregivers' health but on care resource utilization and costs. We lack information on the impact of HHC on the broader dimensions of health status and care resource utilization. More understanding of the longitudinal HHC impact on HHC patients and caregivers is also needed. Moreover, we know little about the synergy between HHC and social care. Therefore, the present study aims to observe longitudinal changes in health, care resource utilization and costs and caregiving burden among HHC recipients and their caregivers in Taiwan. METHODS A prospective cohort study "Home-based Longitudinal Investigation of the Multidisciplinary Team Integrated Care (HOLISTIC)" will be conducted and 600 eligible patient-caregiver dyads will be recruited and followed with comprehensive quantitative assessments during six home investigations over two years. The measurements include physical function, psychological health, cognitive function, wellbeing, shared decision making and advance care planning, palliative care and quality of dying, caregiving burden, continuity and coordination of care, care resource utilization, and costs. DISCUSSION The HOLISTIC study offers the opportunity to comprehensively understand longitudinal changes in health conditions, care resource utilization and costs and caregiving burden among HHC patients and caregivers. It will provide new insights for clinical practitioners and policymakers. TRIAL REGISTRATION ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020.
Collapse
Affiliation(s)
- Jung-Yu Liao
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, 807, Taiwan.
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, 807, Taiwan.
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, W1T 7NF, UK.
| | - Yu-Lin Wu
- Department of Nursing, St. Mary's Junior College of Medicine, Nursing and Management, Yilan County, 266, Taiwan
| | - Ching-Hsia Cheng
- Department of Social Welfare, National Chung-Cheng University, Chiayi County, 621, Taiwan
| | - Sang-Ju Yu
- Home Clinic Dulan, Taitung County, 959, Taiwan
| | - Chi-Hsien Huang
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi Prefecture, 466-8550, Japan
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, 824, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, 840, Taiwan
| | - Chia-Ming Li
- Department of Family Medicine, National Taiwan University Hospital, Beihu Branch, Taipei City, 108, Taiwan
| | - Ying-Wei Wang
- Health Promotion Administration, Ministry of Health and Welfare, Taipei City, 103, Taiwan
| | | | - I-Te Liu
- Taiwan Society of Home Health Care, Taipei City, 106, Taiwan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi Prefecture, 466-8550, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Shizuoka, 433-8558, Japan
| | - Irene Petersen
- UCL Department of Primary Care and Population Sciences, University College London, London, NW3 2PF, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, W1T 7NF, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Chao A Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| |
Collapse
|
37
|
Rahman M, White EM, Thomas KS, Jutkowitz E. Assessment of Rural-Urban Differences in Health Care Use and Survival Among Medicare Beneficiaries With Alzheimer Disease and Related Dementia. JAMA Netw Open 2020; 3:e2022111. [PMID: 33090226 PMCID: PMC7582125 DOI: 10.1001/jamanetworkopen.2020.22111] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE There is poor understanding as to how survival and health care use varies among older adults living with Alzheimer disease and related dementia (ADRD) in rural vs urban areas of the United States. OBJECTIVE To describe survival and trajectories of hospital, hospice, nursing home, and home health care use among rural and urban Medicare beneficiaries with ADRD in the 6 years after diagnosis. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study linked Medicare claims data from January 1, 2009, to December 31, 2016, with nursing home and home health assessment data from all US counties. A total of 555 333 Medicare fee-for-service beneficiaries newly diagnosed with ADRD in 2010 were included. A total of 424 561 individuals (76.5%) resided in metropolitan counties, 75 001 (13.5%) in micropolitan counties, and 55 771 (10.0%) in rural counties. EXPOSURES Rurality of beneficiary's county of residence. MAIN OUTCOMES AND MEASURES Number of days survived after initial ADRD diagnosis; percent of survived days per month spent in the hospital, hospice nursing home, community with home health care services, and community without home health care services. RESULTS A total of 555 333 Medicare beneficiaries (mean [SD] age, 82.0 [7.5] years; 345 294 women [62.2%]; 480 286 White [86.5%]) were evaluated. Compared with metropolitan county residents, rural beneficiaries were younger (mean [SD] age, 81.6 [7.6] vs 82.1 [7.5] years), were less likely to be women (34 100 [61.1%] vs 264 688 [62.3%]), were more likely to be White (50 886 [91.2%] vs 361 205 [85.1%]) and Medicaid-eligible (14 264 [25.6%] vs 71 656 [16.9%]), and had fewer preexisting chronic conditions (mean [SD], 6.9 [2.8] vs 7.4 [2.9]). Medicare beneficiaries residing in metropolitan counties survived a mean (SD) of 1183.5 (826.0) days after diagnosis. Adjusting for individual demographic and clinical characteristics, rural and micropolitan county residents survived approximately 1.5 months less than metropolitan residents. The adjusted share of survived days spent in nursing homes was 5.7 (95% CI, 4.0-7.5) percentage points higher for rural vs metropolitan residents. The adjusted share of days in hospitals was 0.7 (95% CI, -0.9 to -0.4) percentage points lower, and the share of days in community without home health care was 4.6 (95% CI, -6.1 to -3.1) percentage points lower for rural vs metropolitan county residents. There were no statistically significant differences in home health or hospice use. Similar patterns were found for micropolitan vs metropolitan residents as for rural vs metropolitan residents, although the magnitude of the differences were smaller. Differences in time spent in community and nursing homes between rural vs metropolitan beneficiaries became more pronounced with further time from diagnosis. CONCLUSIONS AND RELEVANCE Study results suggest that, after diagnosis, rural Medicare beneficiaries with ADRD spend more time in nursing homes and less time in the community, receive less home health care, and have shorter survival than their urban counterparts.
Collapse
Affiliation(s)
- Momotazur Rahman
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Elizabeth M. White
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Kali S. Thomas
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Eric Jutkowitz
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| |
Collapse
|
38
|
Shahid I, Kumar P, Khan MS, Arif AW, Farooq MZ, Khan SU, Davis DM, Michos ED, Krasuski RA. Deaths from heart failure and cancer: location trends. BMJ Support Palliat Care 2020:bmjspcare-2020-002275. [PMID: 32571782 DOI: 10.1136/bmjspcare-2020-002275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increasing utilisation of hospice services has been a major focus in oncology, while only recently have cardiologists realised the similar needs of dying patients with heart failure (HF). We examined recent trends in locations of deaths in these two patient populations to gain further insight. METHODS Complete population-level data were obtained from the Mortality Multiple Cause-of-Death Public Use Record from the National Center for Health Statistics database, from 2013 to 2017. Location of death was categorised as hospital, home, hospice facility or nursing facility. Demographic characteristics evaluated by place of death included age, sex, race, ethnicity, marital status and education, and a multivariable logistic regression analysis was performed to analyse possible associations. RESULTS Among 2 780 715 deaths from cancer, 27% occurred in-hospital and 14% in nursing facilities; while among 335 350 HF deaths, 27% occurred in-hospital and 30% in nursing facilities. Deaths occurred at hospice facilities in 14% of patients with cancer, compared with just 8.7% in HF (p=0.001). For both patients with HF and cancer, the proportion of at-home and in-hospice deaths increased significantly over time, with majority of deaths occurring at home. In both cancer and HF, patients of non-Hispanic ethnicity (cancer: OR 1.29, (1.27 to 1.31), HF: OR 1.14, (1.07 to 1.22)) and those with some college education (cancer: OR 1.10, (1.09 to 1.11); HF: OR 1.06, (1.04 to 1.09)) were significantly more likely to die in hospice. CONCLUSION Deaths in hospital or nursing facilities still account for nearly half of cancer or HF deaths. Although positive trends were seen with utilisation of hospice facilities in both groups, usage remains low and much remains to be achieved in both patient populations.
Collapse
Affiliation(s)
- Izza Shahid
- Department of Internal Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Pankaj Kumar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Shahzeb Khan
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Abdul Wahab Arif
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Muhammad Zain Farooq
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Safi U Khan
- Department of Internal Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Dorothy M Davis
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Erin D Michos
- Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Richard A Krasuski
- Department of Cardiovascular Medicine, Duke University Health System, Durham, North Carolina, USA
| |
Collapse
|
39
|
Cross SH, Ely EW, Kavalieratos D, Tulsky JA, Warraich HJ. Place of Death for Individuals With Chronic Lung Disease: Trends and Associated Factors From 2003 to 2017 in the United States. Chest 2020; 158:670-680. [PMID: 32229227 DOI: 10.1016/j.chest.2020.02.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/09/2020] [Accepted: 02/15/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although chronic lung disease is a common cause of mortality, little is known about where individuals with chronic lung disease die. RESEARCH QUESTION The aim of this study was to determine the trends and factors associated with place of death among individuals with chronic lung disease. STUDY DESIGN AND METHODS This cross-sectional analysis of natural deaths was conducted by using the Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research from 2003 to 2017 for which COPD, interstitial lung disease (ILD), or cystic fibrosis (CF) was the underlying cause. Place of death was categorized as hospital, home, nursing facility, hospice facility, and other. RESULTS From 2003 to 2017, more than 2.2. million deaths were primarily attributed to chronic lung disease (51.6% female, 92.4% white). Most were attributed to COPD (88.9%), followed by ILD (10.8.%), and CF (0.3%). Hospital and nursing facility deaths declined from 44.4% (n = 59,470) and 22.6% (n = 30,285) to 28.3% (n = 49,655) and 19.7% (n = 34,495), while home and hospice facility deaths increased from 23.3% (n = 31,296) and 0.1% (n = 192) to 34.7% (n = 60,851) and 9.0% (n = 15,861), respectively. Male sex, being married, and having some college education were associated with increased odds of home death, whereas non-white race and Hispanic ethnicity were associated with increased odds of hospital death. Compared with individuals with COPD, individuals with ILD and CF had increased odds of hospital death and reduced odds of home, nursing facility, or hospice facility death. INTERPRETATION Home deaths are rising among decedents from chronic lung disease, increasing the need for quality end-of-life care in this setting. Further research should explore the end-of-life needs and preferences of these patients and their caregivers, with particular attention paid to patients with ILD and CF who continue to have high rates of hospital death.
Collapse
Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University, Durham, NC
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN; VA Tennessee Valley Geriatric Research Education Clinical Center, Nashville, TN; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Dio Kavalieratos
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - James A Tulsky
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiology Section, Department of Medicine, Boston VA Healthcare System, Boston, MA.
| |
Collapse
|
40
|
Oh A, Smith AK, Allison TA. Key Ingredients of an Ideal System for High-Quality Community Care for Persons With Dementia. J Am Geriatr Soc 2020; 68:238-240. [PMID: 31868915 PMCID: PMC8015407 DOI: 10.1111/jgs.16303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 12/30/2022]
Abstract
This editorial comments on the article by Cross et al.
Collapse
Affiliation(s)
- Anna Oh
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Alexander K. Smith
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Theresa A. Allison
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, CA
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| |
Collapse
|