PMID- 32736989
OWN - NLM
STAT- MEDLINE
DCOM- 20210630
LR  - 20231110
IS  - 1538-9375 (Electronic)
IS  - 1525-8610 (Print)
IS  - 1525-8610 (Linking)
VI  - 22
IP  - 2
DP  - 2021 Feb
TI  - End-of-Life Care among Nursing Home Residents with Dementia Varies by Nursing 
      Home and Market Characteristics.
PG  - 320-328.e4
LID - S1525-8610(20)30527-2 [pii]
LID - 10.1016/j.jamda.2020.06.021 [doi]
AB  - OBJECTIVES: Nursing homes (NHs) are critical end-of-life (EOL) care settings for 
      70% of Americans dying with Alzheimer's disease/related dementias (ADRD). Whether 
      EOL care/outcomes vary by NH/market characteristics for this population is 
      unknown but essential information for improving NH EOL care/outcomes. Our 
      objectives were to examine variations in EOL care/outcomes among decedents with 
      ADRD and identify associations with NH/market characteristics. DESIGN: 
      Cross-sectional. OUTCOMES: Place-of-death (hospital/NH), presence of pressure 
      ulcers, potentially avoidable hospitalizations (PAHs), and hospice use at EOL. 
      Key covariates were ownership, staffing, presence of Alzheimer's units, and 
      market competition. SETTING AND PARTICIPANTS: Long-stay NH residents with ADRD, 
      age 65 + years of age, who died in 2017 (N = 191,435; 14,618 NHs) in NHs or 
      hospitals shortly after NH discharge. METHODS: National Medicare claims, Minimum 
      Data Set, public datasets. Descriptive analyses and multivariable logistic 
      regressions. RESULTS: As ADRD severity increased, adjusted rates of in-hospital 
      deaths and PAHs decreased (17.0% to 6.3%; 11.2% to 7.0%); adjusted rates of dying 
      with pressure ulcers and hospice use increased (8.2% to 13.5%; 24.5% to 40.7%). 
      Decedents with moderate and severe ADRD had 16% and 13% higher likelihoods of 
      in-hospital deaths in for-profit NHs. In NHs with Alzheimer's units, likelihoods 
      of in-hospital deaths, dying with pressure ulcers, and PAHs were significantly 
      lower. As ADRD severity increased, higher licensed nurse staffing was associated 
      with 14%‒27% lower likelihoods of PAHs. Increased NH market competition was 
      associated with higher likelihood of hospice use, and lower likelihood of 
      in-hospital deaths among decedents with moderate ADRD. CONCLUSIONS AND 
      IMPLICATIONS: Decedents with ADRD in NHs that were nonprofit, had Alzheimer's 
      units, higher licensed nurse staffing, and in more competitive markets, had 
      better EOL care/outcomes. Modifications to state Medicaid NH payments may promote 
      better EOL care/outcomes for this population. Future research to understand NH 
      care practices associated with presence of Alzheimer's units is warranted to 
      identify mechanisms possibly promoting higher-quality EOL care.
CI  - Copyright (c) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine. 
      Published by Elsevier Inc. All rights reserved.
FAU - Orth, Jessica
AU  - Orth J
AD  - Department of Public Health Sciences, University of Rochester School of Medicine 
      and Dentistry, Rochester, NY. Electronic address: 
      Jessica_Orth@urmc.rochester.edu.
FAU - Li, Yue
AU  - Li Y
AD  - Department of Public Health Sciences, University of Rochester School of Medicine 
      and Dentistry, Rochester, NY.
FAU - Simning, Adam
AU  - Simning A
AD  - Department of Public Health Sciences, University of Rochester School of Medicine 
      and Dentistry, Rochester, NY; Department of Psychiatry, University of Rochester 
      School of Medicine and Dentistry, Rochester, NY.
FAU - Zimmerman, Sheryl
AU  - Zimmerman S
AD  - The Cecil G. Sheps Center for Health Services Research and The Schools of Social 
      Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 
      NC.
FAU - Temkin-Greener, Helena
AU  - Temkin-Greener H
AD  - Department of Public Health Sciences, University of Rochester School of Medicine 
      and Dentistry, Rochester, NY.
LA  - eng
GR  - R01 HS024923/HS/AHRQ HHS/United States
GR  - RF1 MH117528/MH/NIMH NIH HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20200728
PL  - United States
TA  - J Am Med Dir Assoc
JT  - Journal of the American Medical Directors Association
JID - 100893243
SB  - IM
MH  - Aged
MH  - Cross-Sectional Studies
MH  - *Dementia
MH  - Humans
MH  - Medicare
MH  - Nursing Homes
MH  - Retrospective Studies
MH  - *Terminal Care
MH  - United States
PMC - PMC7855379
MID - NIHMS1620116
OTO - NOTNLM
OT  - Alzheimer's disease and related dementia
OT  - End-of-life care
OT  - nursing homes
COIS- There are no conflicts of interests, financial or personal, for all authors.
EDAT- 2020/08/02 06:00
MHDA- 2021/07/01 06:00
PMCR- 2022/02/01
CRDT- 2020/08/02 06:00
PHST- 2020/04/20 00:00 [received]
PHST- 2020/05/30 00:00 [revised]
PHST- 2020/06/05 00:00 [accepted]
PHST- 2020/08/02 06:00 [pubmed]
PHST- 2021/07/01 06:00 [medline]
PHST- 2020/08/02 06:00 [entrez]
PHST- 2022/02/01 00:00 [pmc-release]
AID - S1525-8610(20)30527-2 [pii]
AID - 10.1016/j.jamda.2020.06.021 [doi]
PST - ppublish
SO  - J Am Med Dir Assoc. 2021 Feb;22(2):320-328.e4. doi: 10.1016/j.jamda.2020.06.021. 
      Epub 2020 Jul 28.