End-of-life care utilization of older adults with heart failure and/or COPD: the role of family availability.
Lynn F Reinke, Rachael Alexander, Eli Iacob and 3 others
PMID 41252792WHAT IT FOUND
For older adults with heart failure or COPD near the end of life, having a spouse in Utah was linked to higher hospitalization rates; having a spouse without children was linked to higher emergency visit rates.
The study did not show that spouses caused this.
Key findings
01In adjusted models, decedents with a spouse but no children had higher emergency visit rates than decedents with no family.
02In adjusted models, decedents with a spouse only or with both spouse and children had higher hospitalization rates than decedents with no family.
03After adjustment, heart failure plus COPD had higher hospitalization rates than heart failure only, while COPD only did not.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This observational cohort cannot show that family presence caused emergency visits or hospitalizations. Family availability was only a registry proxy for living in Utah; it did not measure caregiving, contact, decision-making, or support quality. The study did not measure patient preferences, place-of-death goals, palliative care interventions, or functional dependency. The data cover 1998 to 2016 and may not match current palliative care models, family structures, or caregiving norms. The sample is Utah-based and mostly White non-Hispanic, so results may not generalize to more diverse regions. The COPD-only group had 851 decedents, and the authors note its estimates may have reduced statistical power. Some care outside Utah or in excluded facilities may have been missed. The analysis was exploratory, and formal power analyses were not conducted.
Declared interests
The publication types list Research Support, N.I.H., Extramural, but the supplied text has no author conflict-of-interest or funding declaration.
The easy way to misread this
Do not conclude that having a spouse caused more emergency or hospital visits. This is an observational study of linked family presence, not measured caregiving, patient preferences, or symptom severity.