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.

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 July 23, 2014 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 July 23, 2014).

Share This




More Health & Medicine News

Wednesday, July 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Courts Conflicted Over Healthcare Law

Courts Conflicted Over Healthcare Law

AP (July 22, 2014) Two federal appeals courts issued conflicting rulings Tuesday on the legality of the federally-run healthcare exchange that operates in 36 states. (July 22) Video provided by AP
Powered by NewsLook.com
Why Do People Believe We Only Use 10 Percent Of Our Brains?

Why Do People Believe We Only Use 10 Percent Of Our Brains?

Newsy (July 22, 2014) The new sci-fi thriller "Lucy" is making people question whether we really use all our brainpower. But, as scientists have insisted for years, we do. Video provided by Newsy
Powered by NewsLook.com
Scientists Find New Way To Make Human Platelets

Scientists Find New Way To Make Human Platelets

Newsy (July 22, 2014) Boston scientists have discovered a new way to create fully functioning human platelets using a bioreactor and human stem cells. Video provided by Newsy
Powered by NewsLook.com
Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

TheStreet (July 21, 2014) New research shows Gilead Science's drug Sovaldi helps in curing hepatitis C in those who suffer from HIV. In a medical study, the combination of Gilead's Hep C drug with anti-viral drug Ribavirin cured 76% of HIV-positive patients suffering from the most common hepatitis C strain. Hepatitis C and related complications have been a top cause of death in HIV-positive patients. Typical medication used to treat the disease, including interferon proteins, tended to react badly with HIV drugs. However, Sovaldi's %1,000-a-pill price tag could limit the number of patients able to access the treatment. TheStreet's Keris Lahiff reports from New York. Video provided by TheStreet
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:
from the past week

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