Wang Xiao Joyce, Cornell Portia Y, Belanger Emmanuelle, Thomas Kali S
Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA.
Centre for the Digital Transformation of Health/Centre for Health Policy, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia.
J Am Geriatr Soc. 2024 Aug;72(8):2491-2499. doi: 10.1111/jgs.18899. Epub 2024 Apr 3.
Residential care/assisted living (RC/AL) is an increasingly common place of end-of-life care for persons with Alzheimer's disease and related dementia (ADRD), who have unique care needs as their health declines. Approximately 22% of RC/ALs provide specialized memory care (memory-care RC/AL). Understanding how end-of-life outcomes differ by memory care among residents with ADRD could facilitate aging/dying in place for this population. The objective of this paper is to examine if end-of-life outcomes (i.e., mortality, hospice use, and number of days receiving hospice in the last month of life) differ between residents with ADRD who moved to memory-care RC/AL, compared with residents with ADRD who moved to RC/AL without memory care (general RC/AL).
Prospective cohort of 15,152 fee-for-service Medicare beneficiaries with ADRD who moved to large RC/AL (> = 25 beds) between 2016 and 2018. We used inverse probability treatment weighting to account for observable differences between memory-care and general RC/AL residents. Two-part models estimated the difference by memory care in the number of days receiving hospice care in the last months of life among RC/AL decedents.
The unadjusted mortality rates were 13.4% in general RC/AL and 15.8% in memory-care RC/AL with an adjusted difference of 1.3 percentage points higher mortality among memory-care RC/AL residents (p = 0.04). Hospice use was 8% and 10.6% among general and memory-care RC/AL residents, respectively, with an adjusted difference of 1.4 percentage points (p = 0.01) higher in memory care. Two-part models showed that decedents in memory-care RC/AL spent about 1.4 more days receiving hospice care in the last month of life (p = 0.02).
We find a higher mortality rate and higher rate of hospice use among memory-care RC/AL residents. These findings suggest that memory care may attract residents closer to the end of life and/or promote hospice use at the end of life.
对于患有阿尔茨海默病及相关痴呆症（ADRD）的患者而言，随着健康状况的恶化，他们有着独特的护理需求，而寄宿护理/辅助生活（RC/AL）正日益成为其临终护理的常见场所。约22%的RC/AL机构提供专门的记忆护理（记忆护理RC/AL）。了解ADRD患者中，临终结局在记忆护理方面存在何种差异，有助于该人群在熟悉的地方养老/离世。本文的目的是研究，与转至无记忆护理的RC/AL机构（普通RC/AL）的ADRD患者相比，转至记忆护理RC/AL机构的ADRD患者在临终结局（即死亡率、临终关怀使用情况以及生命最后一个月接受临终关怀的天数）上是否存在差异。
对2016年至2018年间转至大型RC/AL机构（≥25张床位）的15152名自费服务的医疗保险ADRD受益人进行前瞻性队列研究。我们使用逆概率治疗加权法来处理记忆护理RC/AL机构居民与普通RC/AL机构居民之间的可观察差异。两部分模型估计了RC/AL机构逝者生命最后几个月中接受临终关怀护理天数在记忆护理方面存在的差异。
普通RC/AL机构的未调整死亡率为13.4%，记忆护理RC/AL机构为15.8%，调整后的差异为记忆护理RC/AL机构居民的死亡率高出1.3个百分点（p = 0.04）。普通RC/AL机构居民和记忆护理RC/AL机构居民的临终关怀使用率分别为8%和10.6%，调整后的差异为记忆护理机构高出1.4个百分点（p = 0.01）。两部分模型显示，记忆护理RC/AL机构的逝者在生命最后一个月接受临终关怀护理的天数多约1.4天（p = 0.02）。
我们发现记忆护理RC/AL机构居民的死亡率和临终关怀使用率更高。这些发现表明，记忆护理可能会吸引更接近生命末期的居民，和/或在生命末期促进临终关怀的使用。
