ArticleJournal of the American Geriatrics Society2021
Guardianship and End-of-Life Care for Veterans with Dementia in Nursing Homes.
Article in Journal of the American Geriatrics Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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.
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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.
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Who cites it
5 citing papers in PubMed, 7 citations in OpenAlex.
- Impact of Legal Protection on Life-Support Interventions and 3-Month Mortality in the Intensive Care Unit: The Vulne-Rea Study.Healthcare (Basel, Switzerland) · 2026Article
- "Falls in older people receiving home healthcare services at armed forces hospital Southern Region: prevalence, associated factors, and consequent injuries".BMC geriatrics · 2026Article
- Guardianship: A medicolegal review for clinicians.Journal of the American Geriatrics Society · 2022Article
- End-of-Life Care for Persons Under Guardianship.Journal of pain and symptom management · 2021Article
- We Need a Paradigm Shift Around End-of-Life Decision Making.Journal of the American Geriatrics Society · 2021Article
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
BACKGROUND/
objectivesExperts have suggested that patients represented by professional guardians receive higher intensity end-of-life treatment than other patients, but there is little corresponding empirical data.
designRetrospective cohort study. SETTING AND
participantsAmong veterans aged 65 and older who died from 2011 to 2013, we used Minimum Data Set assessments to identify those who were nursing home residents and had moderately severe or severe dementia. We applied methods developed in prior work to determine which of these veterans had professional guardians. Decedent veterans with professional guardians were matched to decedent veterans without guardians in a 1:4 ratio, according to age, sex, race, dementia severity, and nursing facility type (VA based vs non-VA). MEASUREMENTS: Our primary outcome was intensive care unit (ICU) admission in the last 30 days of life. Secondary outcomes included mechanical ventilation and cardiopulmonary resuscitation in the last 30 days of life, feeding tube placement in the last 90 days of life, three or more nursing home-to-hospital transfers in the last 90 days of life, and in-hospital death.
resultsICU admission was more common among patients with professional guardians than matched controls (17.5% vs 13.7%), but the difference was not statistically significant (adjusted odds ratio = 1.33; 95% confidence interval = .89-1.99). There were no significant differences in receipt of any other treatment; nor was there a consistent pattern. Mechanical ventilation and cardiopulmonary resuscitation were more common among patients with professional guardians, and feeding tube placement, three or more end-of-life hospitalizations, and in-hospital death were more common among matched controls.
conclusionRates of high-intensity treatment were similar whether or not a nursing home resident with dementia was represented by a professional guardian. This is in part because high-intensity treatment occurred more frequently than expected among patients without guardians.
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Registered trials
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