%0 Journal Article %J Health Serv Res %D 2019 %T Effects of long-term care setting on spousal health outcomes. %A Dong, Jing %A Pollack, Harold %A R. Tamara Konetzka %K Adaptation, Psychological %K Aged %K Caregivers %K Community Health Services %K Female %K Humans %K Long-term Care %K Male %K Patient Preference %K social isolation %K Spouses %X

OBJECTIVE: To provide empirical evidence on the effects of home and community-based services (HCBS) (vs nursing home) use on spousal health.

DATA SOURCES: Merged data from the 1996 to 2012 Health and Retirement Study (HRS) and the Area Health Resource File (AHRF).

STUDY DESIGN: We assess the impact of HCBS use on spousal health. We use an instrumental variable (IV) approach to account for the potential endogeneity of the choice of care setting and reverse causality. Our instrument is the supply of skilled nursing home beds per 1000 people older than 65 years.

DATA EXTRACTION METHODS: Our sample includes spouses of HCBS or nursing home users, resulting in 8608 observations.

PRINCIPAL FINDINGS: We find that HCBS use leads to harmful effects on spousal physical health, which may be caused by increased informal care responsibilities. We also find improved spousal mental health, especially in depression symptoms, which may be caused by increased satisfaction.

CONCLUSIONS: We find evidence of both beneficial (mental health) and harmful (physical health) consequences for spouses of individuals receiving LTC at home relative to in an institution. Our results are important in estimating the potential cost and effectiveness of HCBS expansion.

%B Health Serv Res %V 54 %P 158-166 %8 2019 02 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30246337?dopt=Abstract %R 10.1111/1475-6773.13053 %0 Journal Article %J J Pain Symptom Manage %D 2017 %T Timing of Advance Directive Completion and Relationship to Care Preferences. %A Enguidanos, Susan %A Jennifer A Ailshire %K Advance care planning %K Advance directives %K Aged %K Aged, 80 and over %K Female %K Humans %K Male %K Middle Aged %K Patient Participation %K Patient Preference %K Retrospective Studies %X

CONTEXT: Given recent Medicare rules reimbursing clinicians for engaging in advance care planning, there is heightened need to understand factors associated with the timing of advance directive (AD) completion before death and how the timing impacts care decisions.

OBJECTIVE: The purpose of this study was to investigate patterns in timing of AD completion and the relationship between timing and documented care preferences. We hypothesize that ADs completed late in the course of illness or very early in the disease trajectory will reflect higher preferences for aggressive care.

METHODS: We conducted a retrospective study using logistic regressions to analyze data from the Health and Retirement Study, a nationally representative longitudinal survey of older adults.

RESULTS: The analytic sample included exit interviews conducted from 2000 to 2012 among 2904 proxy reporters of deceased participants who had an AD. Nearly three-quarters (71%) of ADs were completed a year or more before death. Being younger or a racial/ethnic minority, and having lower education, a diagnosis of cancer or lung disease, and an expected death were associated with completing an AD within the three months before death, while having the lowest quartile of assets and memory problems were inversely associated with AD completion. Minorities, those with lower education, expected death, and timing of AD completion were associated with electing aggressive care.

CONCLUSION: Early documentation of care wishes may not be associated with an increased likelihood of electing aggressive care; however, ADs completed in the last months of life have higher rates of election of aggressive care.

%B J Pain Symptom Manage %V 53 %P 49-56 %8 2017 01 %G eng %U https://linkinghub.elsevier.com/retrieve/pii/S0885-3924(16)30336-0 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27720793?dopt=Abstract %R 10.1016/j.jpainsymman.2016.08.008