Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths
| Autor: | Katherine A. Ornstein, John G. Cagle, Jack M. Guralnik, Joonyup Lee |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Activities of daily living Population Psychological intervention 03 medical and health sciences 0302 clinical medicine Neoplasms Medicine Humans 030212 general & internal medicine Longitudinal Studies Prospective Studies education Prospective cohort study Cause of death Aged Aged 80 and over education.field_of_study business.industry Hospices Odds ratio Health and Retirement Study Health Surveys United States Hospice Care 030220 oncology & carcinogenesis Case-Control Studies Female Geriatrics and Gerontology business End-of-life care Demography |
| Zdroj: | Journal of the American Geriatrics SocietyREFERENCES. 68(4) |
| ISSN: | 1532-5415 |
| Popis: | Objectives Reliable national estimates of hospice use and underuse are needed. Additionally, drivers of hospice use in the United States are poorly understood, especially among noncancer populations. Thus the objectives of this study were to (1) provide reliable estimates of hospice use among adults in the United States; and (2) identify factors predicting use among decedents and within subsamples of cancer and noncancer deaths. Design We conducted a prospective cohort study using the Health and Retirement Study survey. Excluding sudden deaths, we used data from the 2012 survey wave to predict hospice use in general, and then separately for cancer and non-cancer deaths. Setting Study data were provided by a population-based sample of older adults from the U.S. Participants We constructed a sample of 1,209 participants who died between the 2012 and 2014 survey waves. Measurements Hospice utilization was reported by proxy. Exposure variables included demographics, functionality (activities of daily living [ADLs]), health, depression, dementia, advance directives, nursing home residency, and cause of death. Results Hospice utilization rate was 52.4% for the sample with 70.8% for cancer deaths and 45.4% for noncancer deaths. Fully adjusted model results showed being older (odds ratio [OR] = 1.54), less healthy (OR = .79), having dementia (OR = 1.52), and having cancer (OR = 5.47) were linked to greater odds of receiving hospice. Among cancer deaths, being older (OR = 1.64) and female (OR = 2.54) were the only predictors of hospice use. Among noncancer deaths, increased age (OR = 1.58), more education (OR = 1.56), being widowed (OR = 1.55), needing help with ADLs (OR = 1.13), and poor health (OR = .77) were associated with hospice utilization. Conclusion Findings suggest hospice remains underutilized, especially among individuals with noncancer illness. Extrapolating results to the US population, we estimate that annually nearly a million individuals who are likely eligible for hospice die without its services. Most (84%) of these decedents have a noncancer condition. Interventions are needed to increase appropriate hospice utilization, particularly in noncancer care settings. J Am Geriatr Soc 68:783-793, 2020. |
| Databáze: | OpenAIRE |
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