Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.
Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2021 Apr;69(4):924-931. doi: 10.1111/jgs.16979. Epub 2021 Jan 20.
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.
Cross-sectional secondary data analysis.
In-person interviews with community-dwelling proxy respondents.
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.
Study variables were obtained from the NHATS "last month of life" interview data. Survey weights were applied to all analyses.
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.
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.
背景/目的：越来越多的人认识到，死亡地点是临终关怀（EOLC）和死亡质量的一个重要组成部分。本研究在美国调查了有认知障碍和无认知障碍的老年人的死亡地点、导致死亡地点的因素，以及死亡地点是否影响对 EOLC 的满意度。
横断面二次数据分析。
对国家健康老龄化趋势研究（NHATS）中社区居住的代理人进行面对面访谈。
数据来自国家健康老龄化趋势研究（NHATS）的 1500 名死亡参与者的代理人，这是一个代表社区居住的医疗保险受益人的全国性样本，年龄在 65 岁及以上。
研究变量来自 NHATS“生命的最后一个月”访谈数据。所有分析均应用调查权重。
有认知障碍（CI）的人最常在家庭中死亡，而认知健康的人（CHP）在家或在医院死亡的可能性相同。使用医疗保险临终关怀福利的 CI 患者在家中死亡的可能性是在医院的 14.5 倍，在家庭中死亡的可能性是在疗养院的 3.4 倍。使用该福利的 CHP 在家中死亡的可能性是在医院的六倍以上，在家中死亡的可能性是在疗养院的两倍以上。CHP 的死亡地点也与年龄和种族有关。在家中死亡的 CI 患者的代理人对 EOLC 的评价更为有利，而在家中死亡和在医院接受治疗的 CHP 患者的代理人的评价则相同。
这些发现增加了关于有认知障碍和无认知障碍的老年人与死亡地点相关的因素的文献，结果表明，死亡地点是这些人群的护理质量指标。这些发现可能为 EOLC 规划和决策提供信息，并促进临终时的更大福祉。
