Institute for Health, Healthcare Policy and Aging Research, Department of Family Medicine and Community Health, Rutgers University, New Brunswick, New Jersey, USA.
School of Medicine, Division of Epidemiology, Vanderbilt University, Nashville, USA.
J Am Geriatr Soc. 2022 Oct;70(10):2871-2883. doi: 10.1111/jgs.17952. Epub 2022 Jul 13.
Dementia is a leading cause of death for older adults and is more common among persons from racial/ethnic minoritized groups, who also tend to experience more intensive end-of-life care. This retrospective cohort study compared end-of-life care in persons with and without dementia and identified dementia's moderating effects on the relationship between race/ethnicity and end-of-life care.
Administrative claims data for 463,590 Medicare fee-for-service decedents from 2016 to 2018 were analyzed. Multivariable logistic and linear regression analyses examined the association of dementia with 5 intensive and 2 quality of life-focused measures. Intensity measures included hospital admission, ICU admission, receipt of any of 5 intensive procedures (CPR, mechanical ventilation, intubation, dialysis initiation, and feeding tube insertion), hospital death, and Medicare expenditures (last 30 days of life). Quality of life measures included timely hospice care (>3 days before death) and days at home (last 6 months of life). Models were adjusted for demographic and clinical factors.
54% of Medicare decedents were female, 85% non-Hispanic White, 8% non-Hispanic Black, and 4% Hispanic. Overall, 51% had a dementia diagnosis claim. In adjusted models, decedents with dementia had 16%-29% lower odds of receiving intensive services (AOR hospital death: 0.71, 95% CI: 0.70-0.72; AOR hospital admission: 0.84, 95% CI: 0.83-0.86). Patients with dementia had 45% higher odds of receiving timely hospice (AOR: 1.45, 95% CI: 1.42-1.47), but spent 0.74 fewer days at home (adjusted mean: -0.74, 95% CI: (-0.98)-(-0.49)). Compared to non-Hispanic White individuals, persons from racial/ethnic minoritized groups were more likely to receive intensive services. This effect was more pronounced among persons with dementia.
Although overall dementia was associated with fewer intensive services near death, beneficiaries from racial/ethnic groups minoritized with dementia experienced more intensive service use. Particular attention is needed to ensure care aligns with the needs and preferences of persons with dementia and from racial/ethnic minoritized groups.
痴呆症是老年人死亡的主要原因，在少数族裔人群中更为常见，他们在生命末期也往往接受更密集的护理。本回顾性队列研究比较了痴呆症患者和非痴呆症患者的生命末期护理，并确定了痴呆症对种族/族裔与生命末期护理之间关系的调节作用。
分析了 2016 年至 2018 年期间 463590 名 Medicare 按服务收费死者的行政索赔数据。多变量逻辑和线性回归分析检查了痴呆症与 5 项密集和 2 项注重生活质量的措施之间的关联。密集措施包括住院、入住 ICU、接受 5 项密集程序中的任何一项（心肺复苏、机械通气、插管、透析开始和插入饲管）、医院死亡和 Medicare 支出（生命最后 30 天）。生活质量措施包括及时的临终关怀（死亡前>3 天）和在家天数（生命最后 6 个月）。模型调整了人口统计学和临床因素。
54%的 Medicare 死者为女性，85%为非西班牙裔白人，8%为非西班牙裔黑人，4%为西班牙裔。总体而言，51%的死者有痴呆症诊断索赔。在调整后的模型中，痴呆症患者接受密集服务的可能性降低 16%-29%（AOR 医院死亡：0.71，95%CI：0.70-0.72；AOR 住院：0.84，95%CI：0.83-0.86）。痴呆症患者接受及时临终关怀的可能性增加 45%（AOR：1.45，95%CI：1.42-1.47），但在家的天数减少 0.74 天（调整均值：-0.74，95%CI：（-0.98）-（-0.49））。与非西班牙裔白人相比，少数族裔群体的人更有可能接受密集服务。这种影响在痴呆症患者中更为明显。
尽管总体而言，痴呆症与死亡临近时接受的密集服务较少相关，但来自少数族裔群体的痴呆症患者受益人的服务使用更为密集。需要特别注意确保护理符合痴呆症患者和少数族裔患者的需求和偏好。
