Sanford School of Public Policy, Duke University, Durham, North Carolina.
Margolis Center for Health Policy, Duke University, Durham, North Carolina.
J Am Geriatr Soc. 2020 Feb;68(2):250-255. doi: 10.1111/jgs.16200. Epub 2019 Oct 14.
To assess trends and factors associated with place of death among individuals with Alzheimer's disease-related dementias (ADRD).
Cross-sectional analysis.
Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research, 2003-2017.
Natural deaths occurring between 2003 and 2017 for which ADRD was determined to be the underlying cause.
Place of death was categorized as hospital, home, nursing facility, hospice facility, and other. Aggregate data included age, race, Hispanic ethnicity, sex, urbanization, and census division. Individual-level predictors included age, race, Hispanic ethnicity, sex, marital status, and education.
From 2003 to 2017, nursing facility and hospital deaths declined from 65.7% and 12.7% to 55.0% and 8.0% while home and hospice facility deaths increased from 13.6% and .2% to 21.9% and 6.2%, respectively. Odds of hospital and hospice facility deaths declined with age while odds of nursing facility deaths increased with age. Male sex was associated with higher odds of hospital or hospice facility death and lower odds of home or nursing facility death. Nonwhite race, Hispanic ethnicity, and being married were associated with increased odds of hospital or home death and reduced odds of nursing facility death. More education was associated with higher odds of home or in a hospice facility death and reduced odds of death in a nursing facility or hospital. Significant disparities in place of death by urban-rural status were also noted.
As ADRD deaths at home increase, the need for caregiver support and home-based palliative care may become more critical. Further research should examine the care preferences and experiences of ADRD patients and caregivers, the financial impact of home death on families and insurers, and explore factors that may contribute to differences in actual and preferred place of death. J Am Geriatr Soc 68:250-255, 2020.
评估与阿尔茨海默病相关的痴呆症（ADRD）患者死亡地点的趋势和相关因素。
横断面分析。
疾病控制和预防中心广泛在线数据流行病学研究，2003-2017 年。
2003 年至 2017 年间自然死亡且被确定为根本死因的 ADRD 患者。
死亡地点分为医院、家中、护理院、临终关怀院和其他。汇总数据包括年龄、种族、西班牙裔、性别、城市化程度和人口普查区。个体预测因子包括年龄、种族、西班牙裔、性别、婚姻状况和教育程度。
从 2003 年到 2017 年，护理院和医院的死亡人数从 65.7%和 12.7%下降到 55.0%和 8.0%，而家庭和临终关怀院的死亡人数从 13.6%和 0.2%增加到 21.9%和 6.2%。医院和临终关怀院死亡的几率随年龄增加而下降，而护理院死亡的几率随年龄增加而增加。男性性别与更高的医院或临终关怀院死亡几率和更低的家庭或护理院死亡几率相关。非白种人、西班牙裔和已婚状态与更高的医院或家庭死亡几率和更低的护理院死亡几率相关。更高的教育程度与更高的家庭或临终关怀院死亡几率和更低的护理院或医院死亡几率相关。城乡地位不同的死亡地点也存在显著差异。
随着在家中死亡的 ADRD 患者人数增加，对护理人员支持和家庭姑息治疗的需求可能变得更加重要。进一步的研究应检查 ADRD 患者和护理人员的护理偏好和经验、家庭死亡对家庭和保险公司的经济影响，并探讨可能导致实际和期望死亡地点差异的因素。J Am Geriatr Soc 68:250-255, 2020.
