Study Offers Insights into Elders' Last Days

Dorian Martin Health Guide
  • My mother didn’t want to die in a nursing home. When she was in her 60s (and way before Alzheimer’s diagnosis), I remember her telling me that she wanted me to just take her to a desert and let her walk off into the sand dunes if she started having memory loss like her mother had. In an ideal world, if she hadn’t had Alzheimer’s, I think Mom would have wanted to die at home.

    It turns out that more elders in the United States are getting that wish fulfilled. A new study out of Brown University found that from 2000 to 2009, the percentage of elders who died in the hospital declined from 33 percent to 25 percent. The researchers also found a large decrease in the number of deaths in acute care hospitals by Medicare beneficiaries who had a diagnosis of dementia, cancer or chronic obstructive pulmonary disease. These findings were based on an analysis of claims from 800,000 fee-for-service Medicare beneficiaries who were 66 years old and above. These people died either in 2000, 2005 or 2009.

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    In 2009, 33 percent of all elders died at home, which was a three-percent increase from 2000. However, only 23 percent of elders who had dementia died at home in 2009. In comparison, 43 percent of elders with cancer and 28 percent of elders who had COPD spent their last minutes at home in 2009. In all three of these cases, these percentages reflect a 2-4 percent increase since 2000.

    Hospice care also is becoming increasingly prevalent. This study reported that the percentage of elders who use hospice care increased from 22 percent in 2000 to 42 percent in 2009. Forty-eight percent of elders with dementia were being cared for in hospice programs when they died, as compared to 60 percent of elders who died from cancer.

    While that’s great news, there’s a darker side to this report. The researchers found that more elders are not only being admitted repeatedly to the hospital during the last three months of their lives, but also are spending time in intensive care during their days. Furthermore, the percentage of elders who had short stays (three days or less) in hospice jumped from 22 percent in 2000 to 28 percent by 2009.  Of the cases that were studied in 2009, 40 percent had been in an intensive care unit immediately prior to entering hospice. ““Short hospice lengths of stay raise concerns that hospice is an ‘add-on’ to a growing pattern of more utilization of intensive services at the end of life,” the researchers noted.

    So if you have a loved one with dementia who is nearing death, what do you need to consider? First of all, let’s talk about signs that indicate a loved one is in the final stages of Alzheimer’s disease. According to the National Institute on Aging (NIA), these include:

    • The person is unable to move around on his or her own.
    • The person cannot speak or be understood.
    • The person needs help with most if not all daily activities of life.
    • The person experiences difficulty in eating, such as swallowing, or does not have an appetite.

    Caregiving for people who have dementia and who are dying in the home can be very stressful for caregivers. That’s because people who have Alzheimer’s disease can present special issues as they near the end of their life. It is often difficult to know what type of supportive care is needed because the person who has advanced dementia often can no longer communicate. Therefore, if you want your loved one to die at home, you may find it helpful to contact palliative care or hospice professionals who can be especially helpful in providing direction at the end of a loved one’s life.

  • Primary Sources for This Sharepost:

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    National Institute on Aging. (2012). End of life: Helping with comfort and care. National Institutes of Health.

    Teno, J. M. (2013). Changes in end-of-life care for Medicare beneficiaries. The Journal of the American Medical Association.

Published On: February 11, 2013