Address correspondence to Samuel S. Richardson, B.A., VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA 94025. Samuel S. Richardson, B.A., Ariel Hill, A.B, and Wei Yu, Ph.D., are with the Health Economics Resource Center of Health Services Research and Development Service, U.S. Department of Veterans Affairs, Menlo Park, CA. Ariel Hill, A.B., is currently with Northwest Permanente, PC, Portland, OR. Greer Sullivan, M.D., M.S.P.H., is with the South Central Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, Little Rock, AR, and with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR.
Use of Aggressive Medical Treatments Near the End of Life: Differences between Patients with and without Dementia
Version of Record online: 17 AUG 2006
Health Services Research
Volume 42, Issue 1p1, pages 183–200, February 2007
How to Cite
Richardson, S. S., Sullivan, G., Hill, A. and Yu, W. (2007), Use of Aggressive Medical Treatments Near the End of Life: Differences between Patients with and without Dementia. Health Services Research, 42: 183–200. doi: 10.1111/j.1475-6773.2006.00608.x
- Issue online: 17 AUG 2006
- Version of Record online: 17 AUG 2006
- Acute inpatient care;
- end-of-life decisions;
- VA health care system;
- administrative data uses
Objective. To analyze whether acute care patients with dementia are more or less likely to receive each of five aggressive medical services near the end of life, compared with patients without dementia.
Data Sources. Two years of Veterans Affairs (VA) and Medicare utilization data for all 169,036 VA users nationwide age 67 and older who died between October 1, 1999 and September 30, 2001.
Study Design. We performed a retrospective analysis of acute care stays discharged in the final 30 days of life. The main outcome measure was the patient's likelihood of receiving each of five aggressive services (intensive care unit [ICU] admission, ventilator, cardiac catheterization, pulmonary artery monitor, and dialysis), controlling for demographic and clinical factors in probit regressions.
Principal Findings. There were 122,740 acute-stay discharges during the final 30 days of life, representing 94,100 unique patients (31,654 with dementia). In probit models comparing acute care patients with and without dementia, patients with dementia were 7.5 percentage points less likely to be admitted to the ICU (95 percent confidence interval [CI], 6.9–8.1; percent of stays with ICU admission=36.8 percent), 5.4 percentage points less likely to be placed on a ventilator (95 percent CI, 5.0–5.9; percent of stays with ventilator use=17.1 percent), 0.7 percentage points less likely to receive cardiac catheterization (95 percent CI, 0.6–0.8; percent of stays with cardiac catheterization=2.7 percent), 1.4 percentage points less likely to receive pulmonary artery monitoring (95 percent CI, 1.2–1.5; percent of stays with pulmonary artery monitoring=2.6 percent), and 0.6 percentage points less likely to receive dialysis (95 percent CI, 0.4–0.8; percent of stays with dialysis=4.6 percent).
Conclusions. During the final 30 days of life, acute care patients with dementia are treated substantially less aggressively than patients without dementia. Further research is warranted to determine the causes and appropriateness of these patterns of care.