Dementia is a critical health concern, especially for older adults, and disproportionately affects racial and ethnic minority groups. These groups often receive more aggressive medical interventions at the end of life. A recent study explored the landscape of end-of-life care for individuals with and without dementia, with a particular focus on how dementia interacts with racial and ethnic disparities in care intensity. This analysis sheds light on the complexities of Life Care Diagnosis in the context of dementia and diverse populations.
This retrospective study utilized Medicare data from 2016-2018, encompassing 463,590 deceased individuals. The research investigated the relationship between dementia and various end-of-life care measures. These measures were categorized into two groups: intensive care and quality of life-focused care. Intensive care measures included hospital and ICU admissions, intensive procedures like CPR and ventilation, hospital deaths, and Medicare costs in the last 30 days of life. Quality of life measures focused on timely hospice enrollment (more than 3 days before death) and the number of days spent at home in the last six months of life. Researchers used regression analysis, adjusting for demographic and clinical factors to isolate the impact of dementia.
The study revealed that approximately half of the Medicare decedents had a dementia diagnosis. Generally, individuals with dementia were less likely to receive intensive end-of-life services compared to those without dementia. Specifically, they had significantly lower odds (16%-29% reduction) of hospital death and hospital admission. This suggests a potential difference in life care diagnosis and treatment pathways for those with dementia, possibly reflecting a move towards less aggressive interventions.
However, the study also uncovered nuances related to quality of life and racial/ethnic disparities. While patients with dementia had a higher likelihood of receiving timely hospice care (45% increase), they unfortunately spent fewer days at home in their final six months. Furthermore, the research highlighted that racial and ethnic minority groups were more prone to receiving intensive end-of-life care compared to non-Hispanic White individuals. Crucially, this disparity was even more pronounced for individuals within these minority groups who also had dementia. This critical finding underscores the complex interplay between dementia, race/ethnicity, and the intensity of end-of-life care, emphasizing potential inequities in life care diagnosis and care delivery.
In conclusion, while a dementia diagnosis is generally associated with reduced intensive care at the end of life, this benefit is not equally distributed. Racial and ethnic minority beneficiaries with dementia are still experiencing higher rates of intensive service utilization. This points to a pressing need for healthcare systems to ensure that end-of-life care planning and life care diagnosis truly align with the individual needs and preferences of all patients, especially those with dementia and from diverse racial and ethnic backgrounds. Focused efforts are needed to address potential biases in care pathways and promote equitable and patient-centered end-of-life care for all.
