End-of-Life Care among Nursing Home Residents with Dementia Varies by Nursing Home and Market Characteristics.
Jessica Orth, Yue Li, Adam Simning and 2 others
PMID 32736989WHAT IT FOUND
Dying nursing home residents with dementia received different end-of-life care by home and market: Alzheimer's units were linked to fewer hospital deaths, pressure ulcers and avoidable hospitalizations, but not more hospice use.
Key findings
01As dementia severity increased, observed in-hospital deaths and potentially avoidable hospitalizations decreased, while dying with pressure ulcers and hospice use increased.
02Homes with Alzheimer's units had lower adjusted rates of in-hospital death, dying with pressure ulcers, and potentially avoidable hospitalizations, and lower adjusted hospice use among residents with moderate dementia.
03More licensed nurse staffing was associated with fewer potentially avoidable hospitalizations but lower hospice use.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used existing records of people who had died, so it can show associations but cannot prove that Alzheimer's units, staffing, ownership, competition, or state policies caused the differences in end-of-life care. It did not include residents' own end-of-life preferences or advance directives. Dementia may be underdiagnosed, so some residents may have been missed and the associations may be conservative. It identified nursing homes with Alzheimer's units but not which residents actually lived in those units. Some medical conditions were missing and were filled in from earlier assessments. Hospice selection bias could not be fully controlled, although home-level hospice volume was adjusted for. Remaining state differences may reflect unmeasured regional practice styles.
Declared interests
No author conflict-of-interest statement is included in the supplied article text. The publication types list U.S. government Public Health Service research support.
The easy way to misread this
Do not conclude that adding Alzheimer's units, more licensed nurse staffing, or market competition will improve end-of-life care. This was an observational record study of nursing home decedents, so it shows associations, not cause and effect.