1. Caregiver support and place of death among older adults.
- Author
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Lei L, Gerlach LB, Powell VD, and Maust DT
- Subjects
- Adult Children psychology, Adult Children statistics & numerical data, Aged, Aged, 80 and over, Caregiver Burden epidemiology, Caregiver Burden psychology, Caregivers psychology, Cross-Sectional Studies, Family Characteristics, Female, Humans, Male, Odds Ratio, Terminal Care psychology, United States epidemiology, Caregivers statistics & numerical data, Home Care Services statistics & numerical data, Hospices statistics & numerical data, Hospitals statistics & numerical data, Terminal Care statistics & numerical data
- Abstract
Background/objectives: As home becomes the most common place of death in the United States, information about caregiver support and place of death is critical to improve patient and caregiver experiences at end of life. We seek to examine (1) the association between family care availability and place of death; and (2) caregiving intensity associated with place of death., Design: 2017 National Health and Aging Trends Study and National Study of Caregiving; nationally representative cross-sectional study of deceased older adults and last-month-of-life (LML) caregivers., Setting: United States; all places of deaths., Participants: Three-hundred and seventy-five decedents and 267 LML caregivers., Measurements: Place of death (home, hospital, and nursing or hospice facility), family care availability (spouse/partner, household size, number of daughters and sons), caregiving intensity (hours of help provided at LML and a binary indicator for high care-related emotional difficulty)., Results: 38.9% of older adults died at home, followed by hospital (33.1%), and nursing or hospice facility (28.0%). In an adjusted multinomial logistic regression, decedents with larger household size (odds ratio [OR]: 0.441; 95% confidence interval [CI]: 0.269-0.724) and more daughters (OR: 0.743 [95% CI: 0.575-0.958]) had lower odds of dying in nursing or hospice facility relative to dying at home. For older adults who died at home, caregivers provided 209.8 h of help at LML. In contrast, when death occurred in nursing or hospice facility, caregivers provided 91.6 fewer hours of help, adjusted for decedent and caregiver characteristics. Dying in hospital was associated with higher odds of caregiver emotional difficulty relative to home deaths (OR: 4.093 [95% CI: 1.623-10.323])., Conclusions: Household size and number of daughters are important determinants of place of death. Despite dying at home being associated with more hours of direct caregiving; caregiver emotional strain was experienced as higher for hospital deaths. Better support services for end-of-life caregivers might improve patient and caregiver experiences for home and hospital deaths., (© 2021 The American Geriatrics Society.)
- Published
- 2021
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