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

Lauren Nicholas, Julie P W Bynum, Theodore J. Iwashyna, David R. Weir, Kenneth M. Langa

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)667-674
Number of pages8
JournalHealth Affairs
Volume33
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Advance Directives
Terminal Care
Nursing Homes
Dementia
Advance Care Planning
Living Wills
Medicare
Cognition
Intensive Care Units
Delivery of Health Care
Cognitive Dysfunction

ASJC Scopus subject areas

  • Health Policy

Cite this

Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia. / Nicholas, Lauren; Bynum, Julie P W; Iwashyna, Theodore J.; Weir, David R.; Langa, Kenneth M.

In: Health Affairs, Vol. 33, No. 4, 2014, p. 667-674.

Research output: Contribution to journalArticle

Nicholas, Lauren ; Bynum, Julie P W ; Iwashyna, Theodore J. ; Weir, David R. ; Langa, Kenneth M. / Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia. In: Health Affairs. 2014 ; Vol. 33, No. 4. pp. 667-674.
@article{aed1c37997b7463396df7c544025662c,
title = "Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia",
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.",
author = "Lauren Nicholas and Bynum, {Julie P W} and Iwashyna, {Theodore J.} and Weir, {David R.} and Langa, {Kenneth M.}",
year = "2014",
doi = "10.1377/hlthaff.2013.1258",
language = "English (US)",
volume = "33",
pages = "667--674",
journal = "Health Affairs",
issn = "0278-2715",
publisher = "Project Hope",
number = "4",

}

TY - JOUR

T1 - Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia

AU - Nicholas, Lauren

AU - Bynum, Julie P W

AU - Iwashyna, Theodore J.

AU - Weir, David R.

AU - Langa, Kenneth M.

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84898025888&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84898025888&partnerID=8YFLogxK

U2 - 10.1377/hlthaff.2013.1258

DO - 10.1377/hlthaff.2013.1258

M3 - Article

C2 - 24711329

AN - SCOPUS:84898025888

VL - 33

SP - 667

EP - 674

JO - Health Affairs

JF - Health Affairs

SN - 0278-2715

IS - 4

ER -