title: Quality of end-of-life care of long-term nursing home residents with and without dementia.
abstract: OBJECTIVE
  To describe the longitudinal patterns and the within- and between-facility differences in hospice use and in-hospital deaths between long-term nursing home (NH) residents with and without dementia.
  
  
  METHODS
  Retrospective analyses of secondary data sets from 2003 to 2007.
  
  
  METHODS
  NHs in the United States.
  
  
  METHODS
  A total of 1,261,726 decedents in 16,347 NHs were included in 2003 to 2007 trend analysis and 236,619 decedents in 15,098 NHs in 2007 were included in the within- and between-facility analyses.
  
  
  METHODS
  Hospice use in the last 100 days of life and in-hospital deaths were outcome measures. Dementia was defined as having a diagnosis of Alzheimer's disease or other dementia based on Minimum Data Set (MDS) health assessments.
  
  
  RESULTS
  Overall hospice use increased from 25.6% in 2003 to 35.7% in 2007. During this time, hospice use for decedents with dementia increased from 25.1% to 36.5%, compared with an increase from 26.5% to 34.4% for decedents without dementia. The rate of in-hospital deaths remained virtually unchanged. Within the same facility, decedents with dementia were significantly more likely to use hospice (odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.04-1.11) and less likely to die in a hospital (OR = 0.76, 95% CI = 0.74-0.78). Decedents in NHs with higher dementia prevalence, regardless of individual dementia status, were more likely to use hospice (OR = 1.67, 95% CI = 1.22-2.27).
  
  
  CONCLUSIONS
  NHs appear to provide less-aggressive end-of-life care to decedents with dementia than to those without. Although significantly more residents with dementia now receive hospice care at the end of life, the quality evaluation and monitoring of hospice programs have not been systematically conducted, and additional research in this area is warranted.
authors.affiliation: Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642, USA.
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Li
authors.forename: Nan Tracy
authors.initials: NT
authors.lastname: Zheng
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000401:mortality / Q000451:nursing*; D005260:Female; D015577:Geriatric Assessment; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000592:standards*; D008297:Male; D015233:Models, Statistical; D009735:Nursing Homes / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013727:Terminal Care / Q000592:standards*; D014481:United States / Q000453:epidemiology
keywords: dementia; hospice; hospitalization; in-hospital deaths; place of death