title: Nursing home and end-of-life care in Parkinson disease.
abstract: OBJECTIVE
  To examine long-term care facility (LTCF or nursing home) use and end-of-life care for individuals with Parkinson disease (PD).
  
  
  METHODS
  In this nationwide retrospective cohort study, we compared LTCF and hospice utilization among Medicare beneficiaries diagnosed with PD by demographic, clinical, and physician characteristics. We also examined the impact of outpatient neurologist care for institutionalized patients with PD on end-of-life care.
  
  
  RESULTS
  We identified 469,055 individuals with PD who received Medicare benefits in 2002. Nearly 25% (more than 100,000 in total) resided in an LTCF. Women with PD had greater odds of nursing facility residence (adjusted odds ratio [AOR] 1.34, 95% confidence interval [CI] 1.30-1.38) compared with men. Black individuals with PD were 34% more likely than white individuals to reside in an LTCF (AOR 1.34, 95% CI 1.30-1.38), contrary to the race patterns typically observed for LTCF use. Hip fracture (AOR 2.10, 95% CI 2.04-2.15) and dementia (AOR 4.06, 95% CI 4.00-4.12) were the strongest clinical predictors of LTCF placement. Only 33% (n = 38,334) of nursing home residents with PD had outpatient neurologist care. Eighty-four percent (n = 80,877) of LTCF residents with PD died by December 31, 2005. Hospice utilization varied little by race and sex. LTCF residents who had outpatient neurologist care were twice as likely to utilize hospice services before death (AOR 2.35, 95% CI 2.24-2.47).
  
  
  CONCLUSIONS
  A large proportion of the Medicare PD population resides in an LTCF. There is substantial unmet need for palliative care in the PD population. Increased efforts to provide specialist care to dependent individuals with PD may improve end-of-life care.
authors.affiliation: From the Departments of Neurology (D.S., D.P.T., A.W.W.) and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics (D.S., A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (C.L.D., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Medicine (C.M.B.) and Health Policy and Management (C.M.B.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (E.R.D.), Center of Human Experimental Therapeutics, University of Rochester Medical Center, NY; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.
authors.forename: Delaram
authors.initials: D
authors.lastname: Safarpour
authors.affiliation: From the Departments of Neurology (D.S., D.P.T., A.W.W.) and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics (D.S., A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (C.L.D., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Medicine (C.M.B.) and Health Policy and Management (C.M.B.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (E.R.D.), Center of Human Experimental Therapeutics, University of Rochester Medical Center, NY; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.
authors.forename: Dylan P
authors.initials: DP
authors.lastname: Thibault
authors.affiliation: From the Departments of Neurology (D.S., D.P.T., A.W.W.) and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics (D.S., A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (C.L.D., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Medicine (C.M.B.) and Health Policy and Management (C.M.B.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (E.R.D.), Center of Human Experimental Therapeutics, University of Rochester Medical Center, NY; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.
authors.forename: Cori L
authors.initials: CL
authors.lastname: DeSanto
authors.affiliation: From the Departments of Neurology (D.S., D.P.T., A.W.W.) and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics (D.S., A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (C.L.D., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Medicine (C.M.B.) and Health Policy and Management (C.M.B.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (E.R.D.), Center of Human Experimental Therapeutics, University of Rochester Medical Center, NY; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
authors.affiliation: From the Departments of Neurology (D.S., D.P.T., A.W.W.) and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics (D.S., A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (C.L.D., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Medicine (C.M.B.) and Health Policy and Management (C.M.B.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (E.R.D.), Center of Human Experimental Therapeutics, University of Rochester Medical Center, NY; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.
authors.forename: E Ray
authors.initials: ER
authors.lastname: Dorsey
authors.affiliation: From the Departments of Neurology (D.S., D.P.T., A.W.W.) and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics (D.S., A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (C.L.D., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Medicine (C.M.B.) and Health Policy and Management (C.M.B.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (E.R.D.), Center of Human Experimental Therapeutics, University of Rochester Medical Center, NY; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.
authors.forename: Brad A
authors.initials: BA
authors.lastname: Racette
authors.affiliation: From the Departments of Neurology (D.S., D.P.T., A.W.W.) and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics (D.S., A.W.W.), and Leonard Davis Institute of Health Economics (A.W.W.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (C.L.D., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Medicine (C.M.B.) and Health Policy and Management (C.M.B.), Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology (E.R.D.), Center of Human Experimental Therapeutics, University of Rochester Medical Center, NY; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa. allison.willis@uphs.upenn.edu.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Willis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data* / Q000639:trends; D009735:Nursing Homes / Q000706:statistics & numerical data* / Q000639:trends; D010300:Parkinson Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States / Q000453:epidemiology