‘Til Death Do Us Part: End‐of‐Life Experiences of Married Couples in a Nationally Representative Survey

Kotwal, Ashwin; Abdoler, Emily; Diaz‐Ramirez, L. Grisell; Kelley, Amy S.; Ornstein, Katherine; Boscardin, W. John; Smith, Alexander K.

doi:10.1111/jgs.15573

Cited by 6 publications

(4 citation statements)

References 41 publications

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“…Research is needed to address these disparities within noncancer populations. Given past concerns that hospice may be underutilized by individuals without a partner, it is promising that we found widowed persons were more likely to enroll in hospice relative to married individuals. The death of a partner may give individuals an opportunity to witness the burdens of disease‐modifying treatments or the benefits of hospice.…”

Section: Discussionmentioning

confidence: 89%

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Cagle

Lee

Ornstein

et al. 2019

J American Geriatrics Society

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OBJECTIVES Reliable national estimates of hospice use and underuse are needed. Additionally, drivers of hospice use in the United States are poorly understood, especially among noncancer populations. Thus the objectives of this study were to (1) provide reliable estimates of hospice use among adults in the United States; and (2) identify factors predicting use among decedents and within subsamples of cancer and noncancer deaths. DESIGN We conducted a prospective cohort study using the Health and Retirement Study survey. Excluding sudden deaths, we used data from the 2012 survey wave to predict hospice use in general, and then separately for cancer and non‐cancer deaths. SETTING Study data were provided by a population‐based sample of older adults from the U.S. PARTICIPANTS We constructed a sample of 1,209 participants who died between the 2012 and 2014 survey waves. MEASUREMENTS Hospice utilization was reported by proxy. Exposure variables included demographics, functionality (activities of daily living [ADLs]), health, depression, dementia, advance directives, nursing home residency, and cause of death. RESULTS Hospice utilization rate was 52.4% for the sample with 70.8% for cancer deaths and 45.4% for noncancer deaths. Fully adjusted model results showed being older (odds ratio [OR] = 1.54), less healthy (OR = .79), having dementia (OR = 1.52), and having cancer (OR = 5.47) were linked to greater odds of receiving hospice. Among cancer deaths, being older (OR = 1.64) and female (OR = 2.54) were the only predictors of hospice use. Among noncancer deaths, increased age (OR = 1.58), more education (OR = 1.56), being widowed (OR = 1.55), needing help with ADLs (OR = 1.13), and poor health (OR = .77) were associated with hospice utilization. CONCLUSION Findings suggest hospice remains underutilized, especially among individuals with noncancer illness. Extrapolating results to the US population, we estimate that annually nearly a million individuals who are likely eligible for hospice die without its services. Most (84%) of these decedents have a noncancer condition. Interventions are needed to increase appropriate hospice utilization, particularly in noncancer care settings. J Am Geriatr Soc 68:783–793, 2020

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Section: Discussionmentioning

confidence: 89%

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Cagle

Lee

Ornstein

et al. 2019

J American Geriatrics Society

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“…Widowhood : We defined widowhood as a new report of a spouse's death (not gender‐specific) based on self or proxy response in the biennial HRS interview, which also includes the date of the spouse's death. This approach has been used previously with HRS data 33 …”

Section: Methodsmentioning

confidence: 99%

“…34 This algorithm uses cognitive and functional data from the HRS interviews to estimate a predicted probability that the participant has dementia at the time of each biennial interview. 52) 39 (17) 2723 (59) 75-84 210 (33) 3337 (36) 142 (49) 1793 (34) 85+ 311 (54) 978 (12) 92 (35) 307 (7) Female, n (%) 381 (67) 5026 ( 57) 113 (39) 2177 (44) Race and ethnicity, n Non-Hispanic black 129 (14) 1103 ( 8) 29 (7) 416 (5) Hispanic-non-Hispanic other 94 (17) 861 ( 8) 39 ( 16) 434 (7) Less than high school education, n (%) 275 (44) 2308 (23) 98 (35) 961 ( 17 Lives alone (or with spouse only in married-partnered subset) 166 (34) 2509 (32) 196 ( 74) 3940 (84) Medicare Part C enrollee, n (%) 180 (29) 2784 (31) 85 (32) 1487 (31) Medicaid dual eligible, n (%) 174 (28) 990 (10) 64 ( 14 We classified participants with a predicted probability of 0.5 or greater as having dementia based on prior studies. 35 The distribution of dementia probabilities in our sample demonstrated that vast majority of people had probabilities of <0.3 or equal to 1, further justifying this approach.…”

Section: Primary Predictormentioning

confidence: 99%

Incidence of potentially disruptive medical and social events in older adults with and without dementia

Hunt

Gan

Espejo

et al. 2022

J American Geriatrics Society

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Background Potentially disruptive medical, surgical, and social events—such as pneumonia, hip fracture, and widowhood—may accelerate the trajectory of decline and impact caregiving needs in older adults, especially among people with dementia (PWD). Prior research has focused primarily on nursing home residents with dementia. We sought to assess the incidence of potentially disruptive events in community‐dwelling people with and without dementia. Methods Retrospective cohort study of participants aged 65+ enrolled in the Health and Retirement Study between 2010 and 2018 (n = 9346), including a subset who were married–partnered at baseline (n = 5105). Dementia was defined with a previously validated algorithm. We calculated age‐adjusted and gender‐stratified incidence per 1000 person‐years and incidence rate ratios of: 1) hospitalization for pneumonia, 2) hip fracture, and 3) widowhood in people with and without dementia. Results PWD (n = 596) were older (mean age 84 vs. 75) and a higher proportion were female (67% vs. 57%) than people without dementia (PWoD) (n = 8750). Age‐adjusted incidence rates (per 1000 person‐years) of pneumonia were higher in PWD (113.1; 95% CI 94.3, 131.9) compared to PWoD (62.1; 95% CI 54.7, 69.5), as were hip fractures (12.3; 95% CI 9.1, 15.6 for PWD compared to 8.1; 95% CI 6.9, 9.2 in PWoD). Point estimates of widowhood incidence were slightly higher for PWD (25.3; 95% CI 20.1, 30.5) compared to PWoD (21.9; 95% CI 20.3, 23.5), but differences were not statistically significant. The association of dementia with hip fracture—but not pneumonia or widowhood—was modified by gender (male incidence rate ratio [IRR] 2.24, 95% CI 1.34, 3.75 versus female IRR 1.31 95% CI 0.92,1.86); interaction term p = 0.02). Conclusions Compared to PWoD, community‐dwelling PWD had higher rates of pneumonia and hip fracture, but not widowhood. Knowing how often PWD experience these events can aid in anticipatory guidance and care planning for this growing population.

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“…Due to unmeasured items, it is impossible to compare the backgrounds of all respondents and nonresponding survivors; consequently, there may have been considerable selection bias. [47][48][49] This will be assessed further with more relevant items in future studies.…”

Section: Limitationsmentioning

confidence: 99%

Association Among End-Of-Life Discussions, Cancer Patients’ Quality of Life at End of Life, and Bereaved Families’ Mental Health

Hayashi

Sato

Ogawa

et al. 2021

Am J Hosp Palliat Care

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End-of-life discussions are essential for patients with advanced cancer, but there is little evidence about whether these discussions affect general ward patients and family outcomes. We investigated the status of end-of-life discussions and associated factors and their effects on patients’ quality of death and their families’ mental health. Participants in this retrospective cross-sectional observational study were 119 bereaved family members. Data were collected through a survey that included questions on the timing of end-of-life discussions, quality of palliative care, quality of patient death, and depression and grief felt by the families. Approximately 64% of the bereaved family members participated in end-of-life discussions between the patient and the attending physician, and 55% of these discussions took place within a month before death. End-of-life discussions were associated with the patients’ prognostic perception as “incurable, though there is hope for a cure” and “patients’ experience with end-of-life discussions with family before cancer.” There was a small decrease in depression and grief for families of patients who had end-of-life discussions. Those who did not have end-of-life discussions reported lower quality of end-of-life care.

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‘Til Death Do Us Part: End‐of‐Life Experiences of Married Couples in a Nationally Representative Survey

Cited by 6 publications

References 41 publications

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Incidence of potentially disruptive medical and social events in older adults with and without dementia

Association Among End-Of-Life Discussions, Cancer Patients’ Quality of Life at End of Life, and Bereaved Families’ Mental Health

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