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Factors associated with high intensity of end‐of‐life care for decedents with dementia in a Medicare Advantage plan
Huong Q. Nguyen, Lewei Duan, Janet Lee, Susan E. Wang, Anthony C Hou, Tarah Browne, Jarrod Athen Carrol, Soo Borson. Alzheimer s & Dementia, 2022-12-01
Topic: Risk, prevention and care in population studies
Abstract Background There are limited data on end‐of‐life care (EOL) for decedents with dementia enrolled in Medicare Advantage plans. The purpose of this descriptive analysis is to compare socio‐demographic and clinical characteristics and patterns of healthcare utilization for decedents who were hospitalized in the last 30 days of life versus those who were not. Methods Data were extracted from electronic health records (EHR) of individuals aged 65+ who had at least one coded ADRD diagnosis and died in 2018‐2019. Decedents with one or more hospital stays in the last 30 days of life were categorized as receiving high‐intensity EOL care (n = 6299, 45%); those with no hospitalizations were classified as receiving low‐intensity EOL care (n = 7571, 55%). We compared socio‐demographic and clinical characteristics and healthcare utilization, including life care planning (LCP) and palliative and hospice care between the two cohorts. Results The high‐intensity cohort was minimally younger (85±7.6 vs. 86.6±7.6) and included more men (48% vs. 41%) and people of color (47% vs. 38%) compared to the low‐intensity cohort. Co‐morbidities were also higher in this group (Elixhauser: 11.5±3.6 vs. 9.9±3.7) and dementia was more often first documented in the EHR very “late” [median: 586 (IQR:85.0, 1521.0) vs. 1062 (IQR:391.0, 2012.0) days prior to death]. The high‐intensity group used more outpatient (primary care and specialty visits, 10.3 vs. 6.5), emergency visits (2.7±3.0 vs. 1.8±2.3), and inpatient (1.6±2.2 vs. 1.1±1.5) care in the prior year. Moreover, the first LCP conversation occurred much closer to death in the high‐ vs. low‐intensity group [median: 35 (IQR:10.0, 139.0) vs. 105 (IQR:45.0, 234.0) days from first conversation to death]; an advance directive or POLST were less likely to be completed (71% vs. 81%) as was receipt of home palliative care or hospice (62% vs. 82%) than in the low‐intensity cohort. All comparisons between the two cohorts were significant, p<.01. Conclusions We found notable differences in socio‐demographic and clinical characteristics, and utilization patterns in the year prior to death between decedents with dementia who were hospitalized in the last 30 days of life vs. those who were not. Further analyses will assess key, potentially modifiable drivers of high‐intensity EOL care.
Key findings
- The purpose of this descriptive analysis is to compare socio‐demographic and clinical characteristics and patterns of healthcare utilization for decedents who were hospitalized in the last 30 days of life versus those who were not.
- Results The high‐intensity cohort was minimally younger (85±7.6 vs. 86.6±7.6) and included more men (48% vs. 41%) and people of color (47% vs. 38%) compared to the low‐intensity cohort.
- All comparisons between the two cohorts were significant, p<.01.
- Conclusions We found notable differences in socio‐demographic and clinical characteristics, and utilization patterns in the year prior to death between decedents with dementia who were hospitalized in the last 30 days of life vs. those who were not.
Why it matters
This study described characteristics of Medicare Advantage plan members with dementia who received high-intensity end-of-life care. It found those hospitalized in the last 30 days of life were slightly younger and more likely to be men and people of color, which concerns end-of-life care patterns rather than treating or curing dementia.
Study details
- Participants6,299
- Evidence strengthModerate
How this study scored 39/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer s & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2022 — within 6 year(s) of the newest study here |
| Sample size | 3 / 4 | 6,299 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 6 year(s) since 2022 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Soo Borson: h-index 56 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | University of Washington: institution h-index 3,540 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 39 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Nguyen, H. Q., Duan, L., Lee, J., Wang, S. E., Hou, A. C., Browne, T., et al. (2022). Factors associated with high intensity of end‐of‐life care for decedents with dementia in a Medicare Advantage plan. Alzheimer s & Dementia. https://doi.org/10.1002/alz.067755
Vancouver
Nguyen HQ, Duan L, Lee J, Wang SE, Hou AC, Browne T, et al. Factors associated with high intensity of end‐of‐life care for decedents with dementia in a Medicare Advantage plan. Alzheimer s & Dementia. 2022. doi:10.1002/alz.067755.
BibTeX
@article{nguyen2022-b84a5d05,
author = {Nguyen, Huong Q. and Duan, Lewei and Lee, Janet and Wang, Susan E. and Hou, Anthony C and Browne, Tarah and Carrol, Jarrod Athen and Borson, Soo},
title = {{Factors associated with high intensity of end‐of‐life care for decedents with dementia in a Medicare Advantage plan}},
journal = {Alzheimer s \& Dementia},
year = {2022},
doi = {10.1002/alz.067755},
url = {https://doi.org/10.1002/alz.067755}
}
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