Department of Community Health, Brown University, Providence, RI, USA.
Am J Alzheimers Dis Other Demen. 2010 Dec;25(8):666-73. doi: 10.1177/1533317510385809.
BACKGROUND/RATIONALE: Persons with dementia often die in nursing homes (NHs); however, concerns exist about their low use of Medicare hospice.
For 1999 through 2006 in all US states and DC we merged NH resident assessment data with Medicare claims and enrollment data to identify NH decedents with dementia and hospice use. We studied two groups, those with advanced dementia and those with mild-to-moderately severe dementia.
Across study years, 22.2% of all NH decedents had mild-to-moderately severe dementia and 19.6% had advanced dementia. In 1999, 14.5% of decedents with advanced and 13.2% with mild-to-moderately severe dementia accessed hospice, increasing to 42.5% and 37.9% respectively in 2006. Between 1999 and 2006, mean days of hospice stays increased from 46 to 118 for advanced dementia and from 39 to 79 for mild-to-moderately severe dementia. These mean length of stay differences resulted from a relatively lower proportion of short hospice stays (≤ 7 days) together with higher proportions of longer stays (≥ 181 days) among advanced versus mild-to-moderately severe dementia decedents. Hospice access and lengths of stay among US states varied widely.
Over 40% of US NH decedents have mild-to-moderately severe or advanced dementia. For these NH decedents, access to and duration of Medicare hospice has increased. However, there is considerable variation in hospice use across US states.
背景/理由：患有痴呆症的人常在疗养院（NH）中去世；然而，人们对他们对医疗保险临终关怀的低使用率表示担忧。
在 1999 年至 2006 年期间，在美国所有州和哥伦比亚特区，我们将 NH 居民评估数据与医疗保险索赔和登记数据合并，以确定患有痴呆症和使用临终关怀的 NH 死者。我们研究了两组人群，一组是患有晚期痴呆症的人群，另一组是患有轻度至中度严重痴呆症的人群。
在整个研究期间，所有 NH 死者中，有 22.2%患有轻度至中度严重痴呆症，有 19.6%患有晚期痴呆症。1999 年，有 14.5%的晚期痴呆症死者和 13.2%的轻度至中度严重痴呆症死者接受了临终关怀，到 2006 年，这一比例分别增加到 42.5%和 37.9%。1999 年至 2006 年间，晚期痴呆症患者的临终关怀天数从 46 天增加到 118 天，轻度至中度严重痴呆症患者的临终关怀天数从 39 天增加到 79 天。这些平均住院天数的差异是由于晚期痴呆症患者中较短的临终关怀期（≤7 天）比例相对较低，而较长的临终关怀期（≥181 天）比例较高所致。美国各州的临终关怀服务获取和持续时间差异很大。
超过 40%的美国 NH 死者患有轻度至中度严重或晚期痴呆症。对于这些 NH 死者，他们获得医疗保险临终关怀的机会和持续时间有所增加。然而，美国各州的临终关怀使用率存在很大差异。
