@article {7357, title = {Estimating the quantity and economic value of family caregiving for community-dwelling older persons in the last year of life.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Sep}, pages = {1654-9}, publisher = {57}, abstract = {

OBJECTIVES: To estimate the quantity and economic value of informal care provided to older persons during their final year of life in the community.

DESIGN: Retrospective analysis of publicly available nationally representative survey data.

SETTING: This retrospective study used data from the Health and Retirement Study, a nationally representative, longitudinal study of community-dwelling older people.

PARTICIPANTS: Older people who died between 2000 and 2002.

MEASUREMENTS: Data were extracted from the 2002 "exit survey" and linked with characteristics of caregivers from the helper file. Ordinary least squares regression was used to estimate hours of informal caregiving for community-dwelling older people (N=990). Adjusted hours were multiplied by the 2002 national average home aide wage (9.16 USD per hour). Sensitivity tests were performed using the 10th percentile wage rate (6.56 USD) and 90th percentile wage rate (12.34 USD).

RESULTS: Older people who died in the community received on average 65.8 hours per week of informal care in the last year of life. The estimated economic value ranges from 22,514 USD to 42,351 USD, which is equivalent to the annual direct replacement cost with a home aide in 2002.

CONCLUSION: Family members provide substantial assistance during the last year of life for older people who die in the community. If the informal care provided in the last year of life is replaced with a home aide, the total economic value for the United States would be approximately 1.4 billion USD (in 2002).

}, keywords = {Activities of Daily Living, Adult, Aged, Aged, 80 and over, Caregivers, Costs and Cost Analysis, Disability Evaluation, Female, Health Surveys, Home Health Aides, Home Nursing, Humans, Independent Living, Male, Middle Aged, Retrospective Studies, Terminal Care, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02390.x}, author = {Rhee, YongJoo and Howard B Degenholtz and Anthony T. Lo Sasso and Linda L Emanuel} } @article {6984, title = {Brief communication: the relationship between having a living will and dying in place.}, journal = {Ann Intern Med}, volume = {141}, year = {2004}, month = {2004 Jul 20}, pages = {113-7}, publisher = {141}, abstract = {

BACKGROUND: Living wills, a type of advance directive, are promoted as a way for patients to document preferences for life-sustaining treatments should they become incompetent. Previous research, however, has found that these documents do not guide decision making in the hospital.

OBJECTIVE: To test the hypothesis that people with living wills are less likely to die in a hospital than in their residence before death.

DESIGN: Secondary analysis of data from a nationally representative longitudinal study.

SETTING: Publicly available data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

PATIENTS: People older than 70 years of age living in the community in 1993 who died between 1993 and 1995.

MEASUREMENTS: Self-report and proxy informant interviews conducted in 1993 and 1995.

RESULTS: Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community. For people living in the community, the probability of in-hospital death decreased from 0.65 (95\% CI, 0.58 to 0.71) to 0.52 (CI, 0.42 to 0.62). For people living in nursing homes, the probability of in-hospital death decreased from 0.35 (CI, 0.23 to 0.49) to 0.13 (CI, 0.07 to 0.22).

LIMITATIONS: Retrospective survey data do not contain detailed clinical information on whether the living will was consulted.

CONCLUSION: Living wills are associated with dying in place rather than in a hospital. This implies that previous research examining only people who died in a hospital suffers from selection bias. During advance care planning, physicians should discuss patients{\textquoteright} preferences for location of death.

}, keywords = {Aged, Death, Health Status, Homes for the Aged, Hospices, Hospital Mortality, Housing, Humans, Living Wills, Nursing homes, Retrospective Studies}, issn = {1539-3704}, doi = {10.7326/0003-4819-141-2-200407200-00009}, author = {Howard B Degenholtz and Rhee, YongJoo and Robert M. Arnold} }