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. 2021 Apr;69(4):924-931.
doi: 10.1111/jgs.16979. Epub 2021 Jan 20.

Place of Death for Persons With and Without Cognitive Impairment in the United States

Natalie G Regier  1   2 , Valerie T Cotter  1   2 , Bryan R Hansen  1   2 , Janiece L Taylor  1   2 , Rebecca J Wright  1   2
Affiliations

Place of Death for Persons With and Without Cognitive Impairment in the United States

Natalie G Regier et al. J Am Geriatr Soc. 2021 Apr.

Abstract

Background/objectives: There is increasing recognition that place of death is an important component of quality of end-of-life care (EOLC) and quality of death. This study examined where older persons with and without cognitive impairment die in the United States, what factors contribute to place of death, and whether place of death influences satisfaction with EOLC.

Design: Cross-sectional secondary data analysis.

Setting: In-person interviews with community-dwelling proxy respondents.

Participants: Data were collected from 1,500 proxies for deceased participants in the National Health and Aging Trends Study (NHATS), a nationally-representative sample of community-dwelling Medicare beneficiaries aged 65 and older.

Measurements: Study variables were obtained from the NHATS "last month of life" interview data. Survey weights were applied to all analyses.

Results: Persons with cognitive impairment (CI) most often died at home, while cognitively healthy persons (CHP) were equally likely to die at home or in a hospital. Persons with CI who utilized the Medicare Hospice Benefit were 14.5 times more likely to die at home than in a hospital, and 3.4 times more likely to die at home than a nursing home. CHP who use this benefit were over six times more likely to die at home than in a hospital, and more than twice as likely to die at home than a nursing home. Place of death for CHP was also associated with age and race. Proxies of persons with CI who died at home rated EOLC as more favorable, while proxies of CHP rated in-home and hospital care equally.

Conclusion: Findings add to the scant literature identifying factors associated with place of death for older adults with and without CI and results suggest that place of death is a quality of care indicator for these populations. These findings may inform EOLC planning and policy-making and facilitate greater well-being at end-of-life.

Keywords: Medicare; NHATS; caregiver; dementia; end-of-life; place of death.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to report.

Figures

Figure 1.
Figure 1.
Crosstabulation of cognitive status and place of death. Cognitively impaired N = 472 (weighted n = 1.5 million), cognitively healthy N = 1,024 (weighted n = 4.0 million); home p = .171, hospital p = .002, nursing home p < .001, hospice residence p = .384, other p = .484
Figure 2.
Figure 2.
Outcomes of study aims by cognitive status. CHP, cognitively healthy persons; PWCI, persons with cognitive impairment
See this image and copyright information in PMC

References

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