End‐of‐life healthcare utilization and palliative care use among older adults with limited English proficiency

Abstract

Background Little is known about end‐of‐life healthcare utilization and palliative care use among older adults with serious illness and limited English proficiency (LEP). Methods We conducted a retrospective analysis of seriously‐ill older adults (65+) with and without LEP, from a large health system, who died between 2010 and 2018. Primary outcomes were measures of healthcare utilization in the last 30 and 180 days of life: hospitalization, emergency department (ED) visits, intensive care unit (ICU) admission, and 30‐day readmission. Secondary outcomes were palliative care consultation and advance care planning documents. We used multivariate analyses adjusted for sociodemographic factors including race and ethnicity. Results Among 18,490 decedents, 1363 had LEP. Patients with LEP were older at time of death (median age 80 vs 77 years), more likely to be female (48% vs 44%), of Asian descent (64% vs 4%), of Hispanic ethnicity (10% vs 2%), with <12th grade education (38% vs 9%), and Medicaid (36% vs 6%). In the last 30 days of life, patients with LEP had higher odds of ED visits (33% vs 20%; aOR 1.41, 95% CI 1.26–1.72; p < 0.001), readmission (12% vs 8%; aOR 1.64, 95% CI 1.30–2.07; p < 0.001), and in‐hospital death (45% vs 37%; aOR 1.24, 95% CI 1.07–1.44; p = 0.005) compared to patients without LEP. Findings were similar in the last 180‐days of life. Only 14% of patients with LEP and 10% of those without LEP received palliative care consultation in the last month of life. Patients with LEP were less likely to have advance care planning documents than patients without LEP (36% vs 40%; aOR 0.68, 95% CI 0.50–0.80; p < 0.001). Conclusions Older adults with serious illness and LEP have higher rates of end‐of‐life healthcare utilization. Additional research is needed to identify drivers of these differences and inform linguistically‐ and culturally‐appropriate interventions to improve end‐of‐life care in this population.

Disparities in advance care planning rates persist among emergency general surgery patients: Current state and recommendations for improvement

“…21 For example, among 18,490 seriously ill older adults, patients with non-English preferred language had higher end-of life health care utilization (higher odds of emergency department visits, readmission, in-hospital death) but were less likely to have ACP documents. 22 Consistent with prior authors, we agree that eliciting all patients' health goals, values, and preferences is important to actively work against disparities that may disadvantage racial and ethnic minorities from receiving highquality, goal-aligned care. 23 To address the lack of standardized, easily accessible ACP documentation among our EGS patients, we developed a multipronged, interdisciplinary quality improvement approach largely focused on surgical residents.…”

“…Non-English preferred language is known to be a significant barrier to ACP among surgical patients, 14 and several factors likely contribute to these differences, including cultural norms and patient preferences, yet lack of access to high-quality language-concordant ACP continues to be demonstrated across clinical contexts 21 . For example, among 18,490 seriously ill older adults, patients with non-English preferred language had higher end-of life health care utilization (higher odds of emergency department visits, readmission, in-hospital death) but were less likely to have ACP documents 22 . Consistent with prior authors, we agree that eliciting all patients' health goals, values, and preferences is important to actively work against disparities that may disadvantage racial and ethnic minorities from receiving high-quality, goal-aligned care 23 …”

The effectiveness of out-of-hours palliative care telephone advice lines: A rapid systematic review

“…Limited language proficiency was not addressed by any included study, even though language barriers constitutes a key challenge associated with worse quality of care, 63 and higher rates of emergency care use at the end of life. 64 Another gap in the existing literature relates to integration with other services, for example, the extent to which patient records were accessible to staff responding to calls and shared with other health care professionals. Inadequate integration with the wider health care system has previously been identified as contributing to inequity in access to community-based palliative care and may limit benefits for patients and carers.…”

A rapid systematic review of the effectiveness of out-of-hours palliative care telephone advice lines for people living at home and their carers

“…While a few studies 41, 44, 52 considered differences in the use of telephone advice lines according to diagnosis, no studies analysed patterns of use according to socioeconomic position, ethnicity, or those with limited language proficiency. Language barriers in particular constitutes a key challenge associated with worse quality of care 59 and higher rates of emergency care use at the end of life 60 .…”