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138. Quality of Dementia End-of-Life Care Across Care Settings
L Volicer, EN Rogers Memorial Veterans Hospital, Bedford, MA; AC Hurley, E.N. Rogers Memorial Veterans Hospital, Bedford, MA; ZV Blasi, Education Development Center, Watertown, MA
Objectives: To identify factors affecting end-of-life care outcomes (satisfaction with care, symptom control, and comfort during dying) for persons with dementia during the last 90 days of life in different care settings.
Methods: Retrospective survey including national sample of 154 familycaregivers whose care recipient died during the last year.
Results: Twenty four (15.6%) of care recipients spent the entire 90 days at home (Group H), 53 (34.4%) spent some time at home and some time in an institution (Group HI), and 77 (50%) spent the entire 90 days in an institution (Group I). The care recipients were similar except that Group I care recipients were slightly more impaired. Care recipients in Group H had the least severe physical and emotional symptoms. Care recipients receiving hospice care and pain control stayed at home longer and were more likely to die at home. Group HI caregivers were least satisfied with care. Caregiver burdens were similar in all 3 groups except for Time Dependence Burden, which was highest in Group H. Caregiver burden was higher if behavioral symptoms of dementia were present and was not affected by informal assistance. Behavioral symptoms of dementia were the most common reason for admission to an institution and care recipients receiving psychiatric care at home were able to stay at home longer. Presence of advance directives decreased the number of days spent in a hospital and increased the likelihood of dying in a nursing home instead of in a hospital. Most care recipients died in a nursing home (49%), followed by home (22%), hospital (21%), assisted living (5%), and free standing hospice (3%). Care recipients dying at home had fewer symptoms and less discomfort than care recipients dying in other settings.
Conclusions: Symptom control in patients with advanced dementia being cared for at home was at least as good or better than symptom control in patients being cared for in an institution. The ability of persons with advanced or terminal dementia to remain and die at home was supported by involvement in hospice programs, effective pain control, and provision of psychiatric care. These results indicate that home care is a satisfactory option for end of life in dementia and suggest which programs need to be in place to make optimal home care possible.
Impact: Results of this study suggest areas in which improvement of care for patients with advanced dementia is required. Improvement of care would increase the length of stay at home and would decrease use of health care resources needed for care of individuals with advanced dementia.