Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia

Elizabeth A. Luth, David J. Russell, Abraham A. Brody, Ritchell Dignam, Sara J. Czaja, Miriam Ryvicker, Kathryn H. Bowles, Holly G. Prigerson

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: The end-of-life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia. DESIGN: Retrospective cohort study. SETTING: A large not-for-profit agency in New York City. PARTICIPANTS: A total of 2629 hospice patients with dementia age 65 years and older. MEASUREMENTS: Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits). RESULTS: Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI] = 1.34-4.38; Hispanic: aOR = 2.99; 95% CI = 1.81-4.94). Home hospice (aOR = 7.57; 95% CI = 4.04-14.18), longer length of service (aOR = 1.04; 95% CI = 1.04-1.05), and more days between nurse visits and discharge (aOR = 1.86; 95% CI = 1.56-2.21) were also associated with live discharge. CONCLUSION: To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end-of-life trajectory of patients with dementia.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Hospices
Dementia
Odds Ratio
Confidence Intervals
Hispanic Americans
African Americans
Logistic Models
Demography
Medicaid
Marital Status
Health Status
Health Services
Comorbidity
Hospitalization
Cohort Studies
Retrospective Studies
Nurses

Keywords

  • dementia
  • health disparities
  • hospice
  • live discharge

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia. / Luth, Elizabeth A.; Russell, David J.; Brody, Abraham A.; Dignam, Ritchell; Czaja, Sara J.; Ryvicker, Miriam; Bowles, Kathryn H.; Prigerson, Holly G.

In: Journal of the American Geriatrics Society, 01.01.2019.

Research output: Contribution to journalArticle

Luth, Elizabeth A. ; Russell, David J. ; Brody, Abraham A. ; Dignam, Ritchell ; Czaja, Sara J. ; Ryvicker, Miriam ; Bowles, Kathryn H. ; Prigerson, Holly G. / Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia. In: Journal of the American Geriatrics Society. 2019.
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abstract = "OBJECTIVES: The end-of-life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia. DESIGN: Retrospective cohort study. SETTING: A large not-for-profit agency in New York City. PARTICIPANTS: A total of 2629 hospice patients with dementia age 65 years and older. MEASUREMENTS: Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits). RESULTS: Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95{\%} confidence interval [CI] = 1.34-4.38; Hispanic: aOR = 2.99; 95{\%} CI = 1.81-4.94). Home hospice (aOR = 7.57; 95{\%} CI = 4.04-14.18), longer length of service (aOR = 1.04; 95{\%} CI = 1.04-1.05), and more days between nurse visits and discharge (aOR = 1.86; 95{\%} CI = 1.56-2.21) were also associated with live discharge. CONCLUSION: To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end-of-life trajectory of patients with dementia.",
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T1 - Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia

AU - Luth, Elizabeth A.

AU - Russell, David J.

AU - Brody, Abraham A.

AU - Dignam, Ritchell

AU - Czaja, Sara J.

AU - Ryvicker, Miriam

AU - Bowles, Kathryn H.

AU - Prigerson, Holly G.

PY - 2019/1/1

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N2 - OBJECTIVES: The end-of-life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia. DESIGN: Retrospective cohort study. SETTING: A large not-for-profit agency in New York City. PARTICIPANTS: A total of 2629 hospice patients with dementia age 65 years and older. MEASUREMENTS: Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits). RESULTS: Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI] = 1.34-4.38; Hispanic: aOR = 2.99; 95% CI = 1.81-4.94). Home hospice (aOR = 7.57; 95% CI = 4.04-14.18), longer length of service (aOR = 1.04; 95% CI = 1.04-1.05), and more days between nurse visits and discharge (aOR = 1.86; 95% CI = 1.56-2.21) were also associated with live discharge. CONCLUSION: To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end-of-life trajectory of patients with dementia.

AB - OBJECTIVES: The end-of-life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia. DESIGN: Retrospective cohort study. SETTING: A large not-for-profit agency in New York City. PARTICIPANTS: A total of 2629 hospice patients with dementia age 65 years and older. MEASUREMENTS: Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits). RESULTS: Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI] = 1.34-4.38; Hispanic: aOR = 2.99; 95% CI = 1.81-4.94). Home hospice (aOR = 7.57; 95% CI = 4.04-14.18), longer length of service (aOR = 1.04; 95% CI = 1.04-1.05), and more days between nurse visits and discharge (aOR = 1.86; 95% CI = 1.56-2.21) were also associated with live discharge. CONCLUSION: To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end-of-life trajectory of patients with dementia.

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