Center for Healthcare Quality and Outcomes, Research Triangle Institute, Research Triangle Park, North Carolina, USA.
Merck & Co., Inc., Rahway, New Jersey, USA.
J Gerontol A Biol Sci Med Sci. 2023 Jun 1;78(6):1053-1059. doi: 10.1093/gerona/glad003.
Dementia is a terminal illness marked by progressive cognitive decline. This study characterized trajectories of functional status and health care use for people with and without dementia at the end of their life.
We used the Health and Retirement Study linked with Medicare claims to generate a series of generalized linear models. Models predicted functional status and health care use for decedents with and without dementia during each month in the last 4 years of life (48 months).
People with dementia have high, sustained functional impairments during the entire last 4 years of life. People with dementia have the same predicted average activities of daily living score (1.92) at 17 months before death (95% confidence interval [CI]: 1.857, 1.989) as individuals without dementia at 6 months before death (95% CI: 1.842, 1.991). Dementia was associated with significantly less hospice during the final 3 months of life, with a 12.5% (95% CI: 11.046, 13.906) likelihood of hospice in the last month of life with dementia versus 17.3% (95% CI: 15.573, 18.982) without dementia. Dementia was also associated with less durable medical equipment (p < .001), less home health care (p < .005), and fewer office visits (p < .001). There were not significant differences in likelihood of hospitalization in the last 48 months with or without dementia.
People with dementia can functionally appear to be at end of life (EOL) for years before their death. Simultaneously, they receive less health care, particularly home health and hospice, in their last months. Models of care that target people with dementia should consider the unique and sustained burden of dementia at EOL.
痴呆症是一种以进行性认知能力下降为特征的终末期疾病。本研究描述了生命末期患有痴呆症和不患有痴呆症的人群的功能状态和医疗保健使用轨迹。
我们使用健康与退休研究（Health and Retirement Study）与医疗保险索赔数据相结合，生成了一系列广义线性模型。模型预测了在生命的最后 4 年（48 个月）的每个月中，患有和不患有痴呆症的死者的功能状态和医疗保健使用情况。
患有痴呆症的人在生命的最后 4 年中一直存在严重的功能障碍。患有痴呆症的人在死亡前 17 个月（95%置信区间 [CI]：1.857，1.989）的日常生活活动评分（1.92）与死亡前 6 个月（95% CI：1.842，1.991）的无痴呆症患者相同。痴呆症与生命最后 3 个月的临终关怀显著减少相关，在生命的最后一个月患有痴呆症的患者接受临终关怀的可能性为 12.5%（95% CI：11.046，13.906），而无痴呆症的患者为 17.3%（95% CI：15.573，18.982）。痴呆症还与耐用医疗设备（p<0.001）、家庭保健（p<0.005）和门诊就诊（p<0.001）减少有关。在生命的最后 48 个月中，患有和不患有痴呆症的患者住院的可能性没有显著差异。
患有痴呆症的人在死亡前几年可能在功能上已经处于生命末期（EOL）。与此同时，他们在最后几个月接受的医疗保健，特别是家庭保健和临终关怀，较少。针对痴呆症患者的护理模式应考虑到 EOL 时痴呆症的独特和持续负担。
