Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia.

TitleAdvance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia.
Publication TypeJournal Article
Year of Publication2014
AuthorsNicholas, LHersch, Bynum, JPW, Iwashyna, TJ, Weir, DR, Langa, KM
JournalHealth Affairs
Volume33
Issue4
Pagination667-74
Date Published2014 Apr
ISSN Number1544-5208
KeywordsAdvance directives, Dementia, Disabilities, End-of-life care, Nursing homes, Older Adults
Abstract

The number of older adults with cognitive impairment is increasing, and such adults often require a surrogate to make decisions about health care. However, little is known about the aggressiveness of end-of-life care for these people, especially those who reside in the community. We found that cognitive impairment is common among older adults approaching the end of life, whether they live in the community or in a nursing home, and that nearly 30 percent of patients with severe dementia remained in the community until death. Among those patients, having an advance directive in the form of a living will was associated with significantly less aggressive care at the end of life, compared to similar patients without an advance directive-as measured by Medicare spending ($11,461 less per patient), likelihood of in-hospital death (17.9 percentage points lower), and use of the intensive care unit (9.4 percentage points lower). In contrast, advance directives were not associated with differences in care for people with normal cognition or mild dementia, whether they resided in the community or in a nursing home. Timely advance care planning after a diagnosis of cognitive impairment may be particularly important for older adults who reside in the community.

DOI10.1377/hlthaff.2013.1258
Alternate JournalHealth Aff (Millwood)
Citation Key8928
PubMed ID24711329
PubMed Central IDPMC4159465
Grant ListU01 AG009740 / AG / NIA NIH HHS / United States
P01 AG031098 / AG / NIA NIH HHS / United States
K01AG041763 / AG / NIA NIH HHS / United States
U01AG009740 / AG / NIA NIH HHS / United States
K01 AG041763 / AG / NIA NIH HHS / United States