In a study of elderly Americans who moved to a nursing home for their final months or years of life, 80 percent died there within one year, according to an investigation by researchers at the San Francisco VA Medical Center (SFVAMC) and the University of California, San Francisco.
Researchers found that length of stay before death in a nursing home was associated with differences in gender, net worth and marital status. Men had shorter lengths of stay before death than women, residents with higher net worth had shorter lengths of stay than those with lower net worth, and residents who were married or otherwise partnered had shorter lengths of stay before death than those who were single.
For the study, the authors analyzed data on 1,817 nursing home residents who died between 1992 and 2006. The residents were participants in the Health and Retirement Study, an ongoing nationally representative longitudinal study of health, retirement and aging sponsored by the National Institute on Aging. The average age of participants when they moved to a nursing home was about 83. The average length of stay before death was 13.7 months, while the median was five months. Fifty-three percent of nursing home residents in the study died within six months.
Men died after a median stay of three months, while women died after a median stay of eight months. Married participants died a median four months sooner than those who were unmarried. Participants in the highest quartile of net worth died a median six months sooner than those in the lowest quartile. The differences in length of stay remained after the researchers adjusted for age, gender, marital status, health status and other factors.
According to senior author Alexander K. Smith, M.D., M.S., M.P.H., a palliative medicine physician at SFVAMC and an assistant professor of medicine in the Division of Geriatrics at the University of California, San Francisco, the association between social support and length of stay before death has broad social implications. “One quarter of all deaths in the United States occur in nursing homes, and that figure is expected to rise to 40 percent by the year 2020,” says Dr. Smith. “At the same time, we know that nursing home care is incredibly expensive. This study suggests that if we can provide greater social support for patients who are less wealthy and have less caregiver support at home, we may be able to keep them out of nursing homes longer, which would probably have an impact on costs of care at the end-of-life.” Dr. Smith describes the average and median length of stay before death as “surprisingly brief.” The implication, he says, is that “we need to engage nursing home residents in planning conversations about end-of-life care and treatment preferences soon after they are admitted. We have only a brief amount of time to address their concerns before they become seriously ill.”
Source: University of California, San Francisco, August 24, 2010
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