Racial and Ethnic Differences in Hospice Use and Hospitalizations at End-of-Life Among Medicare Beneficiaries With Dementia

Lin, Pei‐Jung; Zhu, Yingying; Olchanski, Natalia; Cohen, Joshua T.; Neumann, Peter J.; Faul, Jessica D.; Fillit, Howard; Freund, Karen M.

doi:10.1001/jamanetworkopen.2022.16260

Cited by 44 publications

(30 citation statements)

References 40 publications

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“…31 Prior studies suggest that end-of-life care utilization and treatment preferences may differ among different races. 32,33 In our study, we did not find significant differences across racial groups in hospice enrollment, gastrostomy utilization, and hospitalization within 1 year of death.…”

Section: Discussioncontrasting

confidence: 56%

Differences Among Native Hawaiian, Asian, and White Patients with Progressive Supranuclear Palsy

et al. 2023

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Background Most studies of progressive supranuclear palsy (PSP) have been conducted in White populations. Objective The objective of this study was to identify whether differences exist for patients with PSP among Whites, East Asians (EAs), and Native Hawaiians/Pacific Islanders (NHPIs) in Hawaii. Methods We conducted a single‐center, retrospective study of patients meeting Movement Disorder Society probable PSP criteria (2006–2021). Data variables included age of onset and diagnosis, comorbidities, and survival rate. Variables were compared across groups using Fisher's exact test, Kruskal–Wallis rank sum test, and log‐rank tests. Results A total of 94 (59 EAs, 9 NHPIs, 16 Whites, and 10 Others) patients were identified. Mean age ± standard deviation (in years) of symptom onset/diagnosis were both youngest in NHPIs (64.0 ± 7.2/66.3 ± 8.0) followed by Whites (70.8 ± 7.6/73.9 ± 7.8), then EAs (75.9 ± 8.2/79.2 ± 8.3) (P < 0.001). Median survival from diagnosis was significantly lower (P < 0.05) in NHPIs (2 years) compared with EAs (4 years) and Whites (6 years). Conclusions There may be racial disparities for PSP, and studies are needed to identify genetic, environmental, and socioeconomic contributions. © 2023 International Parkinson and Movement Disorder Society.

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Section: Discussioncontrasting

confidence: 56%

Differences Among Native Hawaiian, Asian, and White Patients with Progressive Supranuclear Palsy

et al. 2023

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“…In the Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life longitudinal study of nursing home residents with dementia, distressing symptoms such as pain and shortness of breath increased near the EOL 37 High prevalence of burdensome transitions at the EOL stage among patients with ADRD is well documented 38 . Notably, having previous inpatient stay in the hospital was associated with greater likelihood of clinician perception of decline leading to death within a year.…”

Section: Discussionmentioning

confidence: 98%

A Description of Persons With Alzheimer Disease and Related Dementias Receiving Home Health Care

Osakwe

Obioha

Muller

et al. 2022

J Hosp Palliat Nurs

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The end-of-life period of individuals with Alzheimer disease and related dementias receiving home health care (HHC) is understudied. We sought to describe characteristics of HHC patients with Alzheimer disease and related dementias at risk of death within a year, based on clinician assessment. We conducted a secondary data analysis of a 5% random sample of the Outcome and Assessment Information Set data set for the year 2017. We used Outcome and Assessment Information Set-C item M1034 to identify HHC patients with overall status of progressive condition leading to death within a year. Multivariable logistic regression model was used to examine the association between sociodemographic, functional, clinical, and caregiving factors and likelihood of decline leading to death within a year, as identified by HHC clinicians. Clinician perception of decline leading to death within a year was higher for Whites (vs Blacks or Hispanics) (odds ratio [OR], 0.74 [95% confidence interval (CI), 0.69-0.80], and OR, 0.63 [95% CI, 0.57-0.69], respectively). Factors associated with increased odds of decline leading to death within a year included daily pain (OR, 1.11 [95% CI, 1.06-1.17]), anxiety daily or more often (OR, 1.58 [95% CI, 1.49-1.67]), shortness of breath (OR, 1.45 [95% CI, 1.34-1.57]), use of oxygen (OR, 1.60 [95% CI, 1.52-1.69]), disruptive behavior (OR, 1.26 [95% CI, 1.20-1.31]), and feeding difficulty (OR, 2.25 [95% CI, 2.09-2.43]). High symptom burden exists among HHC patients with Alzheimer disease and related dementias identified to have a status of decline leading to death within a year.

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“…Hospitalizations frequently increase during the final months of an older person’s life: two-thirds of Medicare fee-for-service beneficiaries are hospitalized in the final 6 months of life and 25% have multiple hospitalizations [ 1 , 2 ]. The transitions of care that occur at the end of life can lead to more readmissions [ 3 ], disruptions that may be further exacerbated by the presence of dementia.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries

Turbow¹,

Vaughan²,

Culler³

et al. 2023

JMIR Aging

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Background Although electronic health information sharing is expanding nationally, it is unclear whether electronic health information sharing improves patient outcomes, particularly for patients who are at the highest risk of communication challenges, such as older adults with Alzheimer disease. Objective To determine the association between hospital-level health information exchange (HIE) participation and in-hospital or postdischarge mortality among Medicare beneficiaries with Alzheimer disease or 30-day readmissions to a different hospital following an admission for one of several common conditions. Methods This was a cohort study of Medicare beneficiaries with Alzheimer disease who had one or more 30-day readmissions in 2018 following an initial admission for select Hospital Readmission Reduction Program conditions (acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, and pneumonia) or common reasons for hospitalization among older adults with Alzheimer disease (dehydration, syncope, urinary tract infection, or behavioral issues). Using unadjusted and adjusted logistic regression, we examined the association between electronic information sharing and in-hospital mortality during the readmission or mortality in the 30 days following the readmission. Results A total of 28,946 admission-readmission pairs were included. Beneficiaries with same-hospital readmissions were older (aged 81.1, SD 8.6 years) than beneficiaries with readmissions to different hospitals (age range 79.8-80.3 years, P<.001). Compared to admissions and readmissions to the same hospital, beneficiaries who had a readmission to a different hospital that shared an HIE with the admission hospital had 39% lower odds of dying during the readmission (adjusted odds ratio [AOR] 0.61, 95% CI 0.39-0.95). There were no differences in in-hospital mortality observed for admission-readmission pairs to different hospitals that participated in different HIEs (AOR 1.02, 95% CI 0.82-1.28) or to different hospitals where one or both hospitals did not participate in HIE (AOR 1.25, 95% CI 0.93-1.68), and there was no association between information sharing and postdischarge mortality. Conclusions These results indicate that information sharing between unrelated hospitals via a shared HIE may be associated with lower in-hospital, but not postdischarge, mortality for older adults with Alzheimer disease. In-hospital mortality during a readmission to a different hospital was higher if the admission and readmission hospitals participated in different HIEs or if one or both hospitals did not participate in an HIE. Limitations of this analysis include that HIE participation was measured at the hospital level, rather than at the provider level. This study provides some evidence that HIEs can improve care for vulnerable populations receiving acute care from different hospitals.

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Racial and Ethnic Differences in Hospice Use and Hospitalizations at End-of-Life Among Medicare Beneficiaries With Dementia

Cited by 44 publications

References 40 publications

Differences Among Native Hawaiian, Asian, and White Patients with Progressive Supranuclear Palsy

Differences Among Native Hawaiian, Asian, and White Patients with Progressive Supranuclear Palsy

A Description of Persons With Alzheimer Disease and Related Dementias Receiving Home Health Care

The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries

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