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End-of-life care in nursing home settings: Do race or age matter?

  • Kimberly S. Reynolds (a1) (a2), Laura C. Hanson (a2), Martha Henderson (a3) and Karen E. Steinhauser (a4) (a5)
  • DOI: http://dx.doi.org/10.1017/S1478951508000047
  • Published online: 01 February 2008
Abstract
ABSTRACTObjective:

One-quarter of all U.S. chronic-disease deaths occur in nursing homes, yet few studies examine palliative care quality in these settings. This study tests whether racial and/or age-based differences in end-of-life care exist in these institutional settings.

Methods:

We abstracted residents' charts (N = 1133) in 12 nursing homes. Researchers collected data on indicators of palliative care in two domains of care—advance care planning and pain management—and on residents' demographic and health status variables. Analyses tested for differences by race and age.

Results:

White residents were more likely than minorities to have DNR orders (69.5% vs. 37.3%), living wills (39% vs. 5%), and health care proxies (36.2% vs. 11.8%; p < .001 for each). Advance directives were highly and positively correlated with age. In-depth advance care planning discussions between residents, families, and health care providers were rare for all residents, irrespective of demographic characteristics. Nursing staff considered older residents to have milder and less frequent pain than younger residents. We found no disparities in pain management based on race.

Significance of results:

To the extent that advance care planning improves care at the end of life, racial minorities in nursing homes are disadvantaged compared to their white fellow residents. Focusing on in-depth discussions of values and goals of care can improve palliative care for all residents and may help to ameliorate racial disparities in end-of-life care. Staff should consider residents of all ages as appropriate recipients of advance care planning efforts and should be cognizant of the fact that individuals of all ages can experience pain. Nursing homes may do a better job than other health care institutions in eliminating racial disparities in pain management.

Copyright
Corresponding author
Address correspondences and reprint requests to: Kimberly S. Reynolds, UNC Project-Malawi, Private Bag A-104, Lilongwe, Malawi. E-mail: kreynolds@unclilongwe.org.mw
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

N. Allcock , J. McGarry , & R. Elkan (2002). Management of pain in older people within the nursing home: A preliminary study. Health & Social Care in the Community, 10, 464471.

K.O. Anderson , T.R. Mendoza , V. Valero , (2000). Minority cancer patients and their providers: Pain management attitudes and practice. Cancer, 88, 1929–1938.

R.R. Baier , D.R Gifford ., G. Patry , (2004). Ameliorating pain in nursing homes: A collaborative quality-improvement project. Journal of the American Geriatrics Society, 52, 1988–1995.

J.T. Berger (1998). Culture and ethnicity in clinical care. Archives of Internal Medicine, 158, 20852090.

L. Crawley , R. Payne , J. Bolden , (2000). Palliative and end-of-life care in the African American community. JAMA, 284, 25182521.

H.B. Degenholtz , R.A. Arnold , A. Meisel , & J.R. Lave (2002). Persistence of racial disparities in advance care plan documents among nursing home residents. Journal of the American Geriatrics Society, 50, 378381.

V.F. Engle , E. Fox-Hill , & M.J. Graney (1998). The experience of living-dying in a nursing home: Self-reports of black and white older adults. Journal of the American Geriatrics Society, 46, 10911096.

B.A. Ferrell (1993). The assessment and control of pain in the nursing home. In Improving Care in the Nursing Home: Comprehensive Reviews of Clinical Research, L.Z. Rubenstein (ed.), pp. 241250. Thousand Oaks, CA: Sage Publications.

B.A. Ferrell (1995). Pain evaluation and management in the nursing home. Annals of Internal Medicine, 123, 681687.

L.C. Hanson , K.S. Reynolds , M. Henderson , (2005). A quality improvement intervention to increase palliative care in nursing homes. Journal of Palliative Medicine, 8, 576584.

M.B. Happ , E. Capezuti , N.E. Strumpf , (2002). Advance care planning and end-of-life care for hospitalized nursing home residents. Journal of the American Geriatrics Society, 50, 829835.

F.P. Hopp (2000). Preferences for surrogate decision makers, informal communication, and advance directives among community-dwelling elders: Results from a national study. Gerontologist, 40, 449457.

F.P. Hopp & S.A. Duffy (2000). Racial variations in end-of-life care. Journal of the American Geriatrics Society, 48, 658663.

M. Kagawa Singer & L.J. Blackhall (2001). Negotiating cross-cultural issues at the end of life: “You got to go where he lives”. JAMA, 286, 29933001.

D.K. Kiely , S.L. Mitchell , A. Marlow , K.M. Murphy , & J.N. Morris (2001). Racial and state differences in the designation of advance directives in nursing home residents. Journal of the American Geriatrics Society, 49, 13461352.

C.R. Kovach , D.E. Weissman , J. Griffie , (1999). Assessment and treatment of discomfort for people with late-stage dementia. Journal of Pain & Symptom Management, 18, 412419.

N. Lurie , A.M. Pheley , S.H. Miles , (1992). Attitudes toward discussing life-sustaining treatments in extended care facility patients. Journal of the American Geriatrics Society, 40, 12051208.

D.H. Mark , J. Bahr , E.H. Duthie , (1995). Characteristics of residents with do-not-resuscitate orders in nursing homes. Archives of Family Medicine, 4, 463467.

S.C. Miller & V. Mor (2004). The opportunity for collaborative care provision: The presence of nursing home/hospice collaborations in the U.S. Journal of Pain and Symptom Management, 28, 537547.

S.L. Mitchell , D.K. Kiely , & M.B. Hamel (2004). Dying with advanced dementia in the nursing home. Archives of Internal Medicine, 164, 321326.

R.S. Morrison , L.H. Zayas , M. Mulvihill , (1998). Barriers to completion of health care proxies: An examination of ethnic differences. Archives of Internal Medicine, 158, 24932497.

L.A. O'Brien , J.A. Grisso , G. Maislin , (1995). Nursing home residents' preferences for life-sustaining treatments. JAMA, 274, 17751779.

D.P. Oliver , D. Porock , & S. Zweig (2005). End-of-life care in US nursing homes: A review of the evidence. Journal of the American Medical Directors Association, 6(Suppl.), S20S30.

E. Phipps , G. True , D. Harris , (2003). Approaching the end of life: Attitudes, preferences, and behaviors of African-American and white patients and their family caregivers. Journal of Clinical Oncology, 21, 549554.

K.S. Reynolds , M. Henderson , A. Schulman , & L.C. Hanson (2002). Needs of the dying in nursing homes. Journal of Palliative Medicine, 5, 895901.

P.A. Singer , D.K. Martin , & M. Kelner (1999). Quality end-of-life care: Patients' perspectives. JAMA, 281, 163168.

W.M. Stein (2001). Pain in the nursing home. Clinics in Geriatric Medicine, 17, 575594.

K.E. Steinhauser , N.A. Christakis , E.C. Clipp , (2000). Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA, 284, 24762482.

J.M. Teno (2004). Do-not-resuscitate orders and hospitalization of nursing home residents: Trumping, neglect, or shared decision-making at the eleventh hour. Journal of the American Geriatrics Society, 52, 159160.

J.M. Teno , S. Weitzen , T. Wetle , (2001). Persistent pain in nursing home residents. JAMA, 285, 2081.

M. Terry & S. Zweig (1994). Prevalence of advance directives and do-not-resuscitate orders in community nursing facilities. Archives of Family Medicine, 3, 141145.

A. Won , K. Lapane , G. Gambassi , (1999). Correlates and management of nonmalignant pain in the nursing home. Journal of the American Geriatrics Society, 47, 936942.

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Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
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