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.
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).
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.
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.
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- World Population Ageing 2019: Highlights.2019 (Available at:)https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf(Accessed January 16, 2020)
- Age-related neurodegenerative disease research needs aging models.Front Aging Neurosci. 2015; 7: 168
- A nationwide survey of mild cognitive impairment and dementia, including very mild dementia, in Taiwan.PloS One. 2014; 9: e100303
- Effectiveness of cholinesterase inhibitors and memantine for treating dementia: Evidence review for a clinical practice guideline.Ann Intern Med. 2008; 148: 379-397
- The clinical course of advanced dementia.N Engl J Med. 2009; 361: 1529-1538
- Nursing home residents dying with dementia in Flanders, Belgium: A nationwide postmortem study on clinical characteristics and quality of dying.J Am Med Dir Assoc. 2013; 14: 485-492
- Burdensome transitions at the end of life among long-term care residents with dementia.J Am Med Dir Assoc. 2014; 15: 643-648
- Comparison of healthcare utilization and life-sustaining interventions between elderly patients with dementia and those with cancer near the end of life: A nationwide, population-based study in Taiwan.Geriatr Gerontol Int. 2017; 17: 2545-2551
- Care needs and clinical outcomes of older people with dementia: A population-based propensity score-matched cohort study.PloS One. 2015; 10: e0124973
- Hospice palliative care policy in Taiwan: Past developments and future perspectives.Hu Li Za Zhi. 2015; 62: 13
- Trends of do-not-resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014: A Hospital-based observational study.Medicine. 2016; 95: e5394
- Trends in specialized palliative care for noncancer patients in Germany—Data from the national hospice and palliative care evaluation (hope).Eur J Intern Med. 2014; 25: 187-192
- Differences in do-not-resuscitate orders, hospice care utilization, and late referral to hospice care between cancer and noncancer decedents in a tertiary Hospital in Taiwan between 2010 and 2015: A hospital-based observational study.BMC Palliative Care. 2018; 17: 18
- Evolution of Taiwan's health care system.Health Economics Policy Law. 2011; 6: 85‒107
- Data resource profile: The National Health Insurance Research Database (NHIRD).Epidemiol Health. 2018; 40: e2018062
- International classification of diseases—Ninth Revision (ICD-9). Week Epidemiol Record.Relevé épidémiologique hebdomadaire. 1988; 63: 343-344
- Validation of acute myocardial infarction cases in the national health insurance research database in Taiwan.J Epidemiol. 2014; 24: 500-507
- Association of daily aspirin therapy with risk of hepatocellular carcinoma in patients with chronic hepatitis B.JAMA Intern Med. 2019; 179: 633-640
- Accuracy of diabetes diagnosis in health insurance claims data in Taiwan.J Formosan Med Assoc. 2005; 104: 157-163
- Trends in the aggressiveness of cancer care near the end of life.J Clin Oncol. 2004; 22: 315-321
- Identifying potential indicators of the quality of end-of-life cancer care from administrative data.J Clin Oncol. 2003; 21: 1133-1138
- Aggressiveness of end-of-life care for hospitalized individuals with cancer with and without dementia: A nationwide matched-cohort study in France.J Am Geriatr Soc. 2016; 64: 1851-1857
- The combined effect of individual and neighborhood socioeconomic status on cancer survival rates.PloS One. 2012; 7: e44325
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol. 1992; 45: 613-619
- Methodological quality and reporting of generalized linear mixed models in clinical medicine (2000–2012): A systematic review.PloS one. 2014; 9: e112653
- Palliative medicine and the hospice movement in Taiwan.Support Care Cancer. 1997; 5: 348-350
- Use of aggressive medical treatments near the end of life: Differences between patients with and without dementia.Health Serv Res. 2007; 42: 183-200
- Place of death of older persons with dementia. A study in five European countries.J Am Geriatr Soc. 2010; 58: 751-756
- End-of-life transitions among nursing home residents with cognitive issues.N Engl J Med. 2011; 365: 1212-1221
- Quality of end-of-life care in patients with dementia compared to patients with cancer: A population-based register study.PloS One. 2018; 13: e0201051
- Predictors of emergency department attendance by people with dementia in their last year of life: Retrospective cohort study using linked clinical and administrative data.Alzheimer's Dementia. 2018; 14: 20-27
- Increased healthcare service utilizations for patients with dementia: A population-based study.PLoS One. 2014; 9: e105789
- Association between palliative care and life-sustaining treatments for patients with dementia: A nationwide 5-year cohort study.Palliative Med. 2018; 32: 622-630
- Predictors of survival following in-hospital adult cardiopulmonary resuscitation.CMAJ. 2002; 167: 343-348
- Dying with advanced dementia in the nursing home.Arch Intern Med. 2004; 164: 321-326
- Enteral feeding in end-stage dementia: A comparison of religious, ethnic, and national differences in Canada and Israel.J Gerontol Ser A Biol Sci Med Sci. 2006; 61: 621-627
- Dying with advanced dementia in long-term care geriatric institutions: A retrospective study.J Palliat Med. 2008; 11: 1023-1028
- Physicians' attitudes about artificial feeding in older patients with severe cognitive impairment in Japan: A qualitative study.BMC Geriatr. 2007; 7: 22
- An evaluation of nutrition support for terminal cancer patients at teaching hospitals in Korea.Cancer Res Treatment. 2006; 38: 214
- The attitudes of Chinese family caregivers of older people with dementia towards life sustaining treatments.J Adv Nurs. 2007; 58: 256-262
- A cross cultural review of the ethical issues in dementia care in Kerala, India and The Netherlands.Int J Geriatr Psychiatry. 2009; 24: 329-334
- Feeding the hungry ghosts.Am J Kidney Dis. 2010; 55: A33-A34
- Clinical dementia rating (CDR), Chinese version.Acta Neurologica Taiwanica. 2003; 12: 154-165
- Translation and cross-cultural adaptation of a family booklet on comfort care in dementia: Sensitive topics revised before implementation.J Med Ethics. 2013; 39: 104-109
- Families' experiences with end-of-life care in nursing homes and associations with dying peacefully with dementia.J Am Med Dir Assoc. 2019; 20: 268-272
Published online: June 02, 2020
The study was approved by the ethics committee of Kaohsiung Veterans General Hospital and supported by department of medical education and research, Kaohsiung Veterans General Hospital. This work was supported by the Veteran Affairs Commission, Executive Yuan, Taiwan, Republic of China.
The authors declare no conflicts of interest.
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.