ArticleJournal of the American Medical Directors Association2021
End-of-Life Care among Nursing Home Residents with Dementia Varies by Nursing Home and Market Characteristics.
Article in Journal of the American Medical Directors Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Sociodemographic Disparities in the Use of Hospice by U.S. Nursing Home Residents: A Systematic Review.The American journal of hospice & palliative care · 2026Pooled it
- Geographic variations in place of death and palliative care utilisation in the last three months of life in high-income countries: a systematic review.BMC palliative care · 2025Pooled it
- A systematic review of specialty dementia care units in long-term care settings.International journal of geriatric psychiatry · 2023Pooled it
- Strategies to Improve Emergency Transitions From Long-Term Care Facilities: A Scoping Review.The Gerontologist · 2024Article
- Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: a retrospective cohort study.BMC geriatrics · 2023Article
- End-of-Life Care Transitions in Assisted Living: Associations With State Staffing and Training Regulations.Journal of the American Medical Directors Association · 2023Article
- Chronic wounds in persons living with dementia: An integrative review.International journal of older people nursing · 2022Review
- Nursing Home Alzheimer's Special Care Units: Geographic Location Matters.Journal of the American Medical Directors Association · 2022Article
- Dementia Care in Delaware:: The Role of Long-Term Care Resources.Delaware journal of public health · 2021Article
- Racial disparity in end-of-life hospitalizations among nursing home residents with dementia.Journal of the American Geriatrics Society · 2021Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
objectivesNursing homes (NHs) are critical end-of-life (EOL) care settings for 70% of Americans dying with Alzheimer's disease/related dementias (ADRD). Whether EOL care/outcomes vary by NH/market characteristics for this population is unknown but essential information for improving NH EOL care/outcomes. Our objectives were to examine variations in EOL care/outcomes among decedents with ADRD and identify associations with NH/market characteristics.
designCross-sectional. OUTCOMES: Place-of-death (hospital/NH), presence of pressure ulcers, potentially avoidable hospitalizations (PAHs), and hospice use at EOL. Key covariates were ownership, staffing, presence of Alzheimer's units, and market competition. SETTING AND
participantsLong-stay NH residents with ADRD, age 65 + years of age, who died in 2017 (N = 191,435; 14,618 NHs) in NHs or hospitals shortly after NH discharge.
methodsNational Medicare claims, Minimum Data Set, public datasets. Descriptive analyses and multivariable logistic regressions.
resultsAs ADRD severity increased, adjusted rates of in-hospital deaths and PAHs decreased (17.0% to 6.3%; 11.2% to 7.0%); adjusted rates of dying with pressure ulcers and hospice use increased (8.2% to 13.5%; 24.5% to 40.7%). Decedents with moderate and severe ADRD had 16% and 13% higher likelihoods of in-hospital deaths in for-profit NHs. In NHs with Alzheimer's units, likelihoods of in-hospital deaths, dying with pressure ulcers, and PAHs were significantly lower. As ADRD severity increased, higher licensed nurse staffing was associated with 14%‒27% lower likelihoods of PAHs. Increased NH market competition was associated with higher likelihood of hospice use, and lower likelihood of in-hospital deaths among decedents with moderate ADRD. CONCLUSIONS AND IMPLICATIONS: Decedents with ADRD in NHs that were nonprofit, had Alzheimer's units, higher licensed nurse staffing, and in more competitive markets, had better EOL care/outcomes. Modifications to state Medicaid NH payments may promote better EOL care/outcomes for this population. Future research to understand NH care practices associated with presence of Alzheimer's units is warranted to identify mechanisms possibly promoting higher-quality EOL care.
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