Researchers compare end-of-life care in persons with and without dementia

Researchers know that race and ethnicity influence the intensity of end-of-life medical care, but the differences were more pronounced among people with dementia, researchers found .

“Dementia seems to have a synergistic effect,” said an assistant professor in the Rutgers School of Family Medicine and Community Health. American Geriatrics Journal.

“This difference is not a problem if it reflects a patient’s preference for intensive services,” said Luth, who is also a faculty member in health, health care policy, and aging research at the Rutgers Institute. increase.

However, to understand whether these differences may be due to other factors, such as systemic racism, discrimination, poor communication with physicians, or other barriers to access to health care, it is necessary to Additional research is required.”

Elizabeth Ruth, Assistant Professor, Department of Family Medicine and Community Health, Rutgers University

To measure the role of race and ethnicity in end-of-life care for people with dementia, Ruth and colleagues at Vanderbilt, Cornell, and Harvard calculated the total health care costs of 463,590 Medicare beneficiaries nationwide. Did. Using claims data, researchers tabulated inpatient, outpatient, carrier, skilled nursing facility, and hospice spending during the last 30 days of the patient’s life. Higher costs indicated higher intensity of care.

In addition to determining that 51% of Medicare patients die with a diagnosis of dementia, researchers made another new finding. Race and ethnicity can influence how people with dementia live out their final days.

“People with dementia received intensive services less frequently than those without dementia, but those with dementia who received intensive services were more likely to be from racial or ethnic minority groups. It was very likely,” Ruth said.

The magnitude of this effect varied by dementia status. For example, among people without dementia, compared with non-Hispanic whites, Asian Americans and Pacific Islanders were 73% more likely to receive intensive care at the end of life. Among those diagnosed with , Asian Americans and Pacific Islanders were 175% more likely to be admitted to intensive care.

Luth said the findings should spur efforts to improve end-of-life care and outcomes for people with dementia. Medicare reimbursement for doctor-led conversations about advance care planning can help, as can end-of-life care counseling for all hospitalized patients, she said.

“In the absence of a designated decision maker, the default approach to end-of-life care is to provide intensive services,” Ruth said. If no one supports the method, the default will always be more hospitalizations, which may not be the type of care patients want or need.”