Influence of Age on Medicare Expenditures and Medical Care in the Last Year of Life

Abstract

Medicare expenditures in the last year of life decrease with age, especially for those aged 85 years or older. This is in large part because the aggressiveness of medical care in the last year of life decreases with increasing age.

Racial and Ethnic Differences in Preferences for End-of-Life Treatment

“…C ompared to whites, blacks are more likely to die in the hospital and to use intensive care 1,2 , and life-sustaining treatments such as mechanical ventilation (MV), hemodialysis, and feeding tubes 3 . They also incur higher medical care costs in their last 12 months than whites [4][5][6] . Some, but not all, of these differences in end-of-life utilization are due to blacks' living in regions with higher overall end-of-life treatment intensity and spending 7 and their use of higher intensity hospitals 2,3 .…”

End-of-Life Care Characteristics for Young Adults with Cancer Who Die in the Hospital

“…4 An emerging trend in the literature suggests that nonelderly adults are more likely to receive aggressive treatment in the last month of their life (chemotherapy, intensive care unit [ICU] admission, cardiopulmonary resuscitation [CPR], intubation, and mechanical ventilation), but much of what we know is based on Medicare utilization in adults over 65. [5][6][7][8][9][10] Nonelderly adults are also less likely to receive palliative and/or hospice services prior to death. 6,11 From the pediatric perspective, the majority of children who die from cancer die in the initial treatment phase, in the hospital, in an ICU, while still receiving aggressive curative therapies (e.g., chemotherapy).…”

“…[5][6][7][8][9][10] Nonelderly adults are also less likely to receive palliative and/or hospice services prior to death. 6,11 From the pediatric perspective, the majority of children who die from cancer die in the initial treatment phase, in the hospital, in an ICU, while still receiving aggressive curative therapies (e.g., chemotherapy). [12][13][14][15][16][17] Preliminary evidence from adolescents at the end of life suggests that they prefer to die at home, yet the vast majority die in a hospital setting.…”

Care in the Months before Death and Hospice Enrollment Among Older Women with Advanced Breast Cancer

“…Outpatient visits may also influence hospice referrals by providing opportunities for physicians to recognize the need for hospice care. Similarly, hospitalizations, which are frequent at the end of life, 21,26 may influence hospice use; data suggest that patients living in areas with more hospices are less likely to be hospitalized or receive other aggressive end-of-life care. 21 Outpatient and inpatient care may also influence the timing of hospice referral for hospice users.…”