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Rural-urban differences in medical care for nursing home residents with severe dementia at the end of life.
- Source :
-
Journal of the American Geriatrics Society [J Am Geriatr Soc] 2006 Aug; Vol. 54 (8), pp. 1199-205. - Publication Year :
- 2006
-
Abstract
- Objectives: To identify factors associated with the use of selected medical services near the end of life in cognitively impaired residents of rural and urban nursing homes.<br />Design: Retrospective cohort study using Centers for Medicare and Medicaid Services administrative data for 1998 through 2002.<br />Setting: Minnesota and Texas nursing homes.<br />Participants: Nursing home residents aged 65 and older with severe cognitive impairment who subsequently died during 2000/01.<br />Measurements: Minimum Data Set and Medicare Provider Analysis and Review, Hospice, and Denominator files were used to identify subjects and to assess medical service use. U.S. Department of Agriculture metro-nonmetro continuum county codes defined rural (codes 6-9) and urban (codes 0-2) nursing homes. Nursing home residents with hospice or health maintenance organization benefits were excluded. Use of hospital services at the end of life was adjusted for use of corresponding services before the last year of life. Outcome variables were feeding tube use, any hospitalization, more than 10 days of hospitalization, and intensive care unit (ICU) admission.<br />Results: The population included 3,710 subjects (1,886 rural, 1,824 urban). In multivariable logistic regression analyses (all P<.05), feeding tube use was more common in urban nursing home residents, whereas rural nursing home residents were at greater risk for hospitalization.<br />Conclusion: Rural residence was also associated with lower risk of more than 10 days of hospitalization and ICU admission. Nonwhite race and stroke were associated with higher use of all services. Rural nursing home residence is associated with lower likelihood of use of the most-intensive medical services at the end of life.
- Subjects :
- Aged
Aged, 80 and over
Dementia epidemiology
Female
Follow-Up Studies
Humans
Incidence
Male
Minnesota epidemiology
Retrospective Studies
Rural Population
Severity of Illness Index
Texas epidemiology
Urban Population
Dementia therapy
Nursing Homes statistics & numerical data
Rural Health Services
Terminal Care methods
Urban Health Services
Subjects
Details
- Language :
- English
- ISSN :
- 0002-8614
- Volume :
- 54
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of the American Geriatrics Society
- Publication Type :
- Academic Journal
- Accession number :
- 16913985
- Full Text :
- https://doi.org/10.1111/j.1532-5415.2006.00824.x