Featured Research

from universities, journals, and other organizations

Cognitive impairment common among community-dwelling, nursing-home resident elderly nearing end-of-life

Date:
April 7, 2014
Source:
Johns Hopkins Bloomberg School of Public Health
Summary:
More than 70% of elderly Medicare beneficiaries experience cognitive impairment or severe dementia near the end-of-life and may need surrogate decision makers for healthcare decisions. Advance care planning for older adults with dementia may be particularly important for individuals who do not reside in a nursing home or a long-term care facility, according to a new article.

More than 70% of elderly Medicare beneficiaries experience cognitive impairment or severe dementia near the end-of-life and may need surrogate decision makers for healthcare decisions. Advance care planning for older adults with dementia may be particularly important for individuals who do not reside in a nursing home or a long-term care facility, according to an article published in the April issue of Health Affairs.

Related Articles


Researchers at the Johns Hopkins Bloomberg School of Public Health reviewed data from the Health and Retirement Study (HRS) linked to Medicare claims to identify the differences between the type of care given to dementia patients in nursing homes and those who remain in the community. Cognitive impairment was common among seniors living in nursing homes and among those remaining in the community.

“We found that more than half of older adults living on their own or with family members in the last year of life were cognitively impaired. These patients were treated much more aggressively, than similar patients who lived in nursing homes, potentially because their memory impairment was not known to emergency healthcare providers and or their preferences for care were not known or clear to the family members, caregivers or surrogate decision makers,” said Lauren Hersch Nicholas, PhD, MPP, assistant professor of Health Policy and Management at the Bloomberg School and lead author of the study.

The findings are believed to be the first to estimate the prevalence of cognitive impairment and dementia at the end-of-life and examine the associated healthcare costs and utilization for community dwellers.

The research indicates there is an important difference in the relationship between advance directive use and end-of-life care between patients in the community compared to nursing home patients. Memory-impaired patients without advance directives received aggressive end-of-life care and potentially inappropriate care, especially if they did not reside in a healthcare facility.

“Dementia is often under-recognized as a terminal, progressive condition, which can result in end-of-life care that can be burdensome, painful, costly and unlikely to improve quality of life or survival. Like previous studies which focused only on nursing home residents, we found higher rates of life-sustaining treatment, ICU use, and in-hospital death among dementia patients living in the community than might be expected given their prognosis,” said Nicholas.

The study results suggest that advance directives may have a more important role on treatment decisions for patients living in the community with severe dementia, who likely lack the capacity to participate in medical decision-making, than for those living in nursing homes. Efforts to engage patients and family members in advance care planning when cognitive impairment is first diagnosed and patients are still living in the community can help to ensure that a surrogate decision-maker is identified and alerted to the patient’s preferences while these conversations are possible.

While additional research is needed to determine whether advance directives cause differences in end-of-life care for older adults with severe dementia, efforts to educate both patients and their families about dementia and its progression at initial diagnosis may be necessary to prompt all relevant family members, caregivers and surrogates to learn about a patient’s preferences, prognosis and end-of-life requests. 


Story Source:

The above story is based on materials provided by Johns Hopkins Bloomberg School of Public Health. Note: Materials may be edited for content and length.


Journal Reference:

  1. L. H. Nicholas, J. P. W. Bynum, T. J. Iwashyna, D. R. Weir, K. M. Langa. Advance Directives And Nursing Home Stays Associated With Less Aggressive End-Of-Life Care For Patients With Severe Dementia. Health Affairs, 2014; 33 (4): 667 DOI: 10.1377/hlthaff.2013.1258

Cite This Page:

Johns Hopkins Bloomberg School of Public Health. "Cognitive impairment common among community-dwelling, nursing-home resident elderly nearing end-of-life." ScienceDaily. ScienceDaily, 7 April 2014. <www.sciencedaily.com/releases/2014/04/140407164552.htm>.
Johns Hopkins Bloomberg School of Public Health. (2014, April 7). Cognitive impairment common among community-dwelling, nursing-home resident elderly nearing end-of-life. ScienceDaily. Retrieved March 28, 2015 from www.sciencedaily.com/releases/2014/04/140407164552.htm
Johns Hopkins Bloomberg School of Public Health. "Cognitive impairment common among community-dwelling, nursing-home resident elderly nearing end-of-life." ScienceDaily. www.sciencedaily.com/releases/2014/04/140407164552.htm (accessed March 28, 2015).

Share This


More From ScienceDaily



More Health & Medicine News

Saturday, March 28, 2015

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

S. Leone in New Anti-Ebola Lockdown

S. Leone in New Anti-Ebola Lockdown

AFP (Mar. 28, 2015) — Sierra Leone imposed a three-day nationwide lockdown Friday for the second time in six months in a bid to prevent a resurgence of the deadly Ebola virus. Duration: 01:17 Video provided by AFP
Powered by NewsLook.com
These Popular Antibiotics Can Cause Permanent Nerve Damage

These Popular Antibiotics Can Cause Permanent Nerve Damage

Newsy (Mar. 27, 2015) — A popular class of antibiotic can leave patients in severe pain and even result in permanent nerve damage. Video provided by Newsy
Powered by NewsLook.com
WH Plan to Fight Antibiotic-Resistant Germs

WH Plan to Fight Antibiotic-Resistant Germs

AP (Mar. 27, 2015) — The White House on Friday announced a five-year plan to fight the threat posed by antibiotic-resistant bacteria amid fears that once-treatable germs could become deadly. (March 27) Video provided by AP
Powered by NewsLook.com
House Ready to Pass Medicare Doc Bill

House Ready to Pass Medicare Doc Bill

AP (Mar. 26, 2015) — In rare bipartisan harmony, congressional leaders pushed a $214 billion bill permanently blocking physician Medicare cuts toward House passage Thursday, moving lawmakers closer to resolving a problem that has plagued them for years. (March 26) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins