College of Health, Oregon State University, Corvallis, Oregon, USA.
Community Health and Aging Outcomes Laboratory, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.
Gerontologist. 2024 Nov 1;64(11). doi: 10.1093/geront/gnae131.
Home health care supports patient goals for aging in place. Our objective was to determine if home health care use in the last 3 years of life reduces the risk of inpatient death without hospice.
We analyzed the characteristics of 2,065,300 Medicare beneficiaries who died in 2019 and conducted multinomial logistic regression analyses to evaluate the association between the use and timing of home health care, dementia diagnosis, and place of death.
Receiving any home health care in the last 3 years of life was associated with a lower probability of inpatient death without hospice (Pr 23.3% vs 31.5%, p < .001), and this effect was stronger when home health care began prior to versus during the last year of life (Pr 22.5% vs 24.3%, p < .001). Among all decedents, the probability of death at home with hospice compared to inpatient death with hospice was greater when any home health care was used (Pr 46.0% vs 36.5%, p < .001), and this association was strongest among beneficiaries with dementia who started home health care at least 1 year prior to death (Pr 55.6%, p < .001).
Use of home health care during the last 3 years of life was associated with reduced rates of inpatient death without hospice, and increased rates of home death with hospice. Increasing affordable access to home health care can positively affect end-of-life care outcomes for older Americans and their family caregivers, especially those with dementia.
家庭保健支持患者就地养老的目标。我们的目的是确定在生命的最后 3 年内使用家庭保健是否可以降低没有临终关怀的住院死亡风险。
我们分析了 2019 年 2065300 名 Medicare 受益人的特征，并进行多项逻辑回归分析，以评估在生命的最后 3 年内使用和安排家庭保健、痴呆诊断和死亡地点与死亡之间的关联。
在生命的最后 3 年内接受任何家庭保健都与没有临终关怀的住院死亡风险降低相关（Pr23.3%比 31.5%，p<0.001），当家庭保健在生命的最后一年之前而不是期间开始时，这种效果更强（Pr22.5%比 24.3%，p<0.001）。在所有死者中，与有临终关怀的住院死亡相比，有临终关怀的在家死亡的概率更高，当使用任何家庭保健时（Pr46.0%比 36.5%，p<0.001），这种关联在至少提前 1 年开始家庭保健的痴呆症患者中最强（Pr55.6%，p<0.001）。
在生命的最后 3 年内使用家庭保健与降低没有临终关怀的住院死亡风险相关，并增加有临终关怀的在家死亡风险。增加负担得起的家庭保健服务的可及性可以积极影响美国老年人及其家庭护理人员的临终关怀结果，特别是那些患有痴呆症的人。
