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Original Study| Volume 21, ISSUE 6, P858-863.e1, June 2020

The Trend of Aggressive Treatments in End-of-Life Care for Older People With Dementia After a Policy Change in Taiwan

  • Ying Hsin Hsu
    Affiliations
    Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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  • Ming Yueh Chou
    Affiliations
    Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Aging and Health Research Center, National Yang Ming University Taipei, Taiwan

    Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
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  • Hsiu-Min Chen
    Affiliations
    Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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  • Wei-Cheng Chang
    Affiliations
    Division of Metabolism and Endocrinology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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  • Che Sheng Chu
    Affiliations
    Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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  • Yu-Chun Wang
    Affiliations
    Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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  • Chiao-Lin Hsu
    Affiliations
    Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Meiho University, Pingtung, Taiwan
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  • Chih-Kuang Liang
    Correspondence
    Address correspondence to Chih-Kuang Liang, MD, Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying Dist., Kaohsiung City 81362, Taiwan (R.O.C.).
    Affiliations
    Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Aging and Health Research Center, National Yang Ming University Taipei, Taiwan

    Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
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  • Ching-Chih Lee
    Affiliations
    Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
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  • Yu Te Lin
    Affiliations
    Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
    Search for articles by this author

      Abstract

      Objectives

      We evaluated the trend of end-of-life healthcare utilization and life-sustaining interventions for older adults with dementia 3 to 4 years after the change in hospice policy.

      Design

      Population-based retrospective cohort study.

      Setting and participants

      We used the National Health Insurance Research database of enrolled patients ≥65 years of age diagnosed with dementia who died in 2010-2013 (n = 2062).

      Methods

      Aggressive treatments, including healthcare utilization and life-sustaining interventions, were recorded within 6 months of death. Aggressive healthcare utilization included ≥1 emergency department visits, ≥1 hospitalizations, >14 days of hospitalization, intensive care unit admission, and death in an acute care hospital. Life-sustaining interventions were enteral tube, artificial nutrition, blood transfusion, hemodialysis, invasive ventilation, and cardiopulmonary resuscitation.

      Results

      Compared with 2010‒2012, 2013 rates significantly decreased for all measures (P < .001). Composite scores of healthcare utilization and life-sustaining treatments in 2013 were significantly lower than for 2010‒2012, after controlling for confounding variables (both P < .001).

      Conclusions and implications

      Older patients with dementia had a trend of reduced healthcare utilization and fewer life-sustaining treatments near the end of life from 2010 to 2013 after a policy change.

      Keywords

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