title: Family perceptions of end-of-life care for long-term care residents with dementia: differences between the United States and the Netherlands.
abstract: OBJECTIVE
  To examine cross-national care and outcomes related to end-of-life experiences.
  
  
  METHODS
  Postdeath interviews and self-administered questionnaires completed with family caregivers of residents with dementia who died in long-term care settings or shortly after transfer.
  
  
  METHODS
  One hundred eighty-three nursing home and residential care/assisted living settings in the United States and the Netherlands.
  
  
  METHODS
  Family caregivers of 196 residents with dementia who had died (126 in the United States and 70 in the Netherlands).
  
  
  METHODS
  Nine standardized measures of care and outcomes and single-item measures of overall quality of care and life.
  
  
  RESULTS
  In adjusted and unadjusted analyses, U.S. family caregivers reported better care and outcomes on most of the standardized measures and better quality of care (single item) in the last 3 days of life; caregivers in the Netherlands reported better quality of life (single item) in the last month and 3 days of life. Exploratory analyses related to hospice use found differences in bivariate but not adjusted comparisons.
  
  
  CONCLUSIONS
  Because previous research favored care in the Netherlands to that in the United States, findings suggest improvement in end-of-life care and outcomes in the United States and stability in the Netherlands. Greater hospice use does not explain improvements in the United States directly and may relate, at least in part, to care provided by long-term care staff themselves. Better understanding of the nature and process of these improvements may suggest areas for additional improvement.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina 27599, USA. lauren_cohen@unc.edu
authors.forename: Lauren W
authors.initials: LW
authors.lastname: Cohen
authors.forename: Jenny T
authors.initials: JT
authors.lastname: van der Steen
authors.forename: David
authors.initials: D
authors.lastname: Reed
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hodgkinson
authors.forename: Mirjam C
authors.initials: MC
authors.lastname: van Soest-Poortvliet
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
mesh_terms: D000369:Aged, 80 and over; D001290:Attitude; D017028:Caregivers / Q000523:psychology*; D003431:Cross-Cultural Comparison; D003704:Dementia; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009426:Netherlands; D011795:Surveys and Questionnaires; D013727:Terminal Care; D014481:United States