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Family Caregiving at the End of Life and Hospice Use: A National Study of Medicare Beneficiaries
Kumar V, Ankuda CK, Aldridge MD, Husain M, Ornstein KA.. Journal of the American Geriatrics Society, 2020-06-30
Topic: Risk, prevention and care in population studies
Background/objectives Hospice care confers well-documented benefits to patients and their families, but it is underutilized. One potential reason is inadequate family support to make end-of-life decisions and care for older adults on hospice at home. We assessed the association between amount of family support and hospice use among a population of decedents and among specific illness types. Design Prospective cohort study using the National Health and Aging Trends Study waves 2011 to 2017, linked to Medicare claims data. Setting Contiguous United States. Participants A total of 1,868 NHATS decedents. Measurements Outcome variable was 1 day or longer of hospice. Family caregiving intensity was measured by self-reported hours of care per week and number of caregivers. Covariates included probable dementia status and other demographic, clinical, and functional characteristics. Results At the end of life, hours of family caregiving and numbers of helpers vary widely with individuals with dementia receiving the most hours of unpaid care (mean = 64.5 hours per week) and having 2.4 unpaid caregivers on average. In an adjusted analysis, older adults with cancer receiving 40 hours and more of unpaid care/week as compared with fewer than 6 hours per week were twice as likely to receive hospice care at the end of life (odds ratio = 2.0; 95% confidence interval = 1.0-4.1). This association was not seen among those with dementia or among decedents in general. No significant association was found between number of caregivers and hospice use at the end of life. Conclusion Older adults at the end of life receive a high number of hours of help at the end of life, many from more than one caregiver, which may shape hospice access. Better understanding of disparities in hospice use can facilitate timely access to care for older adults with a serious illness. J Am Geriatr Soc 68:2288-2296, 2020.
Key findings
- Results At the end of life, hours of family caregiving and numbers of helpers vary widely with individuals with dementia receiving the most hours of unpaid care (mean = 64.5 hours per week) and having 2.4 unpaid caregivers on average.
- In an adjusted analysis, older adults with cancer receiving 40 hours and more of unpaid care/week as compared with fewer than 6 hours per week were twice as likely to receive hospice care at the end of life (odds ratio = 2.0; 95% confidence interval = 1.0-4.1).
- No significant association was found between number of caregivers and hospice use at the end of life.
Study details
- Study designcohort study
- Participants1,868
- Evidence strengthModerate
How this study scored 64/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for effect reported and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 37 of the 58 points we could judge it on, which is 64 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A cohort study following people over time |
| 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 | 2 / 5 | 2020 — within 10 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,868 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 | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 32602571) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 37 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 37 of the 58 points we could judge it on is 64 out of 100. |
| Total | 64 / 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
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APA 7th
Kumar, V., Ankuda, C. K., Aldridge, M. D., Husain, M., & Ornstein, K. A. (2020). Family Caregiving at the End of Life and Hospice Use: A National Study of Medicare Beneficiaries. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.16648
Vancouver
Kumar V, Ankuda CK, Aldridge MD, Husain M, Ornstein KA. Family Caregiving at the End of Life and Hospice Use: A National Study of Medicare Beneficiaries. Journal of the American Geriatrics Society. 2020. doi:10.1111/jgs.16648. PMID: 32602571.
BibTeX
@article{kumar2020-32602571,
author = {Kumar, V. and Ankuda, C. K. and Aldridge, M. D. and Husain, M. and Ornstein, K. A.},
title = {{Family Caregiving at the End of Life and Hospice Use: A National Study of Medicare Beneficiaries}},
journal = {Journal of the American Geriatrics Society},
year = {2020},
doi = {10.1111/jgs.16648},
pmid = {32602571},
url = {https://doi.org/10.1111/jgs.16648}
}
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