Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, USA.
Cambia Palliative Care Center of Excellence, UW Medicine, Seattle, Washington, USA.
J Am Geriatr Soc. 2022 Oct;70(10):2847-2857. doi: 10.1111/jgs.17913. Epub 2022 Jun 7.
Little is known about end-of-life healthcare utilization and palliative care use among older adults with serious illness and limited English proficiency (LEP).
We conducted a retrospective analysis of seriously-ill older adults (65+) with and without LEP, from a large health system, who died between 2010 and 2018. Primary outcomes were measures of healthcare utilization in the last 30 and 180 days of life: hospitalization, emergency department (ED) visits, intensive care unit (ICU) admission, and 30-day readmission. Secondary outcomes were palliative care consultation and advance care planning documents. We used multivariate analyses adjusted for sociodemographic factors including race and ethnicity.
Among 18,490 decedents, 1363 had LEP. Patients with LEP were older at time of death (median age 80 vs 77 years), more likely to be female (48% vs 44%), of Asian descent (64% vs 4%), of Hispanic ethnicity (10% vs 2%), with <12th grade education (38% vs 9%), and Medicaid (36% vs 6%). In the last 30 days of life, patients with LEP had higher odds of ED visits (33% vs 20%; aOR 1.41, 95% CI 1.26-1.72; p < 0.001), readmission (12% vs 8%; aOR 1.64, 95% CI 1.30-2.07; p < 0.001), and in-hospital death (45% vs 37%; aOR 1.24, 95% CI 1.07-1.44; p = 0.005) compared to patients without LEP. Findings were similar in the last 180-days of life. Only 14% of patients with LEP and 10% of those without LEP received palliative care consultation in the last month of life. Patients with LEP were less likely to have advance care planning documents than patients without LEP (36% vs 40%; aOR 0.68, 95% CI 0.50-0.80; p < 0.001).
Older adults with serious illness and LEP have higher rates of end-of-life healthcare utilization. Additional research is needed to identify drivers of these differences and inform linguistically- and culturally-appropriate interventions to improve end-of-life care in this population.
对于身患重病且英语水平有限（LEP）的老年人，临终医疗保健的使用和姑息治疗的使用情况鲜为人知。
我们对一家大型医疗系统中在 2010 年至 2018 年间去世的身患重病的老年患者（65 岁以上）进行了回顾性分析，其中包括有 LEP 和没有 LEP 的患者。主要结局指标是生命最后 30 天和 180 天内的医疗保健利用情况：住院、急诊就诊、重症监护病房（ICU）入院和 30 天再入院。次要结局指标为姑息治疗咨询和预先护理计划文件。我们使用了调整了社会人口因素（包括种族和族裔）的多变量分析。
在 18490 名死者中，有 1363 名患者有 LEP。LEP 患者的死亡时年龄较大（中位数年龄 80 岁 vs 77 岁），女性（48% vs 44%）、亚洲血统（64% vs 4%）、西班牙裔（10% vs 2%）、受教育程度较低（<12 年级）（38% vs 9%）和医疗补助（36% vs 6%）的可能性更高。在生命的最后 30 天内，LEP 患者急诊就诊（33% vs 20%；优势比 1.41，95%置信区间 1.26-1.72；p<0.001）、再入院（12% vs 8%；优势比 1.64，95%置信区间 1.30-2.07；p<0.001）和院内死亡（45% vs 37%；优势比 1.24，95%置信区间 1.07-1.44；p=0.005）的几率均高于无 LEP 的患者。在生命的最后 180 天内也有类似的发现。只有 14%的 LEP 患者和 10%的非 LEP 患者在生命的最后一个月接受了姑息治疗咨询。与无 LEP 的患者相比，LEP 患者的预先护理计划文件的可能性较低（36% vs 40%；优势比 0.68，95%置信区间 0.50-0.80；p<0.001）。
身患重病且英语水平有限的老年人临终医疗保健的使用率更高。需要进一步研究以确定这些差异的驱动因素，并提供语言和文化上适当的干预措施，以改善这一人群的临终关怀。
