Dementia stands as a significant health crisis for older adults, frequently becoming a primary cause of mortality. This condition disproportionately affects individuals from racial and ethnic minority groups, who often encounter more aggressive interventions at the end of life. A recent study investigated the landscape of end-of-life care for individuals diagnosed with dementia, shedding light on how dementia diagnosis influences the relationship between race/ethnicity and the intensity of care received during the final stages of life.
This comprehensive study utilized administrative claims data from Medicare for over 460,000 deceased beneficiaries between 2016 and 2018. Researchers meticulously analyzed this data to compare end-of-life care experiences, focusing on individuals with and without a dementia diagnosis. The investigation employed regression analyses to assess the correlation between dementia and various measures, categorized into intensive care and quality-of-life focused care.
Intensive care measures encompassed critical interventions such as hospital and ICU admissions, the application of life-sustaining procedures (CPR, mechanical ventilation, intubation, dialysis, feeding tube insertion), instances of hospital deaths, and Medicare expenditure during the last 30 days of life. Quality-of-life measures centered on access to timely hospice care (more than 3 days before death) and the number of days spent at home during the final six months of life. All analyses were carefully adjusted to account for demographic and pre-existing health conditions.
The study revealed that over half of the Medicare decedents had a recorded dementia diagnosis. Crucially, individuals with dementia were found to have significantly lower odds – between 16% and 29% – of receiving intensive end-of-life services. For instance, the adjusted odds ratio for hospital death was 0.71 (95% CI: 0.70-0.72), and for hospital admission, it was 0.84 (95% CI: 0.83-0.86).
Conversely, patients with dementia were 45% more likely to receive timely hospice care (AOR: 1.45, 95% CI: 1.42-1.47). However, they also spent an average of 0.74 fewer days at home in their last six months (adjusted mean: -0.74, 95% CI: -0.98 to -0.49). Notably, the study uncovered disparities related to race and ethnicity. Individuals from racial/ethnic minority groups were observed to be more likely to receive intensive end-of-life services compared to non-Hispanic White individuals. This disparity was even more pronounced among those with a dementia diagnosis.
In conclusion, while a dementia diagnosis is generally associated with reduced intensive care at the end of life, the study highlights a critical disparity. Racial and ethnic minority beneficiaries with dementia are still experiencing a higher utilization of intensive services. This underscores the urgent need for healthcare systems to ensure that end-of-life care aligns with the specific needs and preferences of all individuals, especially those with dementia and from racial/ethnic minority populations. Focused attention and tailored approaches are essential to deliver equitable and patient-centered end-of-life care for this vulnerable group.
