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Trends and Factors Associated with Place of Death for Individuals with Dementia in the United States
Cross SH, Kaufman BG, Taylor DH, Kamal AH, Warraich HJ.. Journal of the American Geriatrics Society, 2019-10-14
Topic: Risk, prevention and care in population studies
Objectives To assess trends and factors associated with place of death among individuals with Alzheimer's disease-related dementias (ADRD). Design Cross-sectional analysis. Setting Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research, 2003-2017. Participants Natural deaths occurring between 2003 and 2017 for which ADRD was determined to be the underlying cause. Measurements Place of death was categorized as hospital, home, nursing facility, hospice facility, and other. Aggregate data included age, race, Hispanic ethnicity, sex, urbanization, and census division. Individual-level predictors included age, race, Hispanic ethnicity, sex, marital status, and education. Results From 2003 to 2017, nursing facility and hospital deaths declined from 65.7% and 12.7% to 55.0% and 8.0% while home and hospice facility deaths increased from 13.6% and .2% to 21.9% and 6.2%, respectively. Odds of hospital and hospice facility deaths declined with age while odds of nursing facility deaths increased with age. Male sex was associated with higher odds of hospital or hospice facility death and lower odds of home or nursing facility death. Nonwhite race, Hispanic ethnicity, and being married were associated with increased odds of hospital or home death and reduced odds of nursing facility death. More education was associated with higher odds of home or in a hospice facility death and reduced odds of death in a nursing facility or hospital. Significant disparities in place of death by urban-rural status were also noted. Conclusion As ADRD deaths at home increase, the need for caregiver support and home-based palliative care may become more critical. Further research should examine the care preferences and experiences of ADRD patients and caregivers, the financial impact of home death on families and insurers, and explore factors that may contribute to differences in actual and preferred place of death. J Am Geriatr Soc 68:250-255, 2020.
Key findings
- Objectives To assess trends and factors associated with place of death among individuals with Alzheimer's disease-related dementias (ADRD).
- Results From 2003 to 2017, nursing facility and hospital deaths declined from 65.7% and 12.7% to 55.0% and 8.0% while home and hospice facility deaths increased from 13.6% and .2% to 21.9% and 6.2%, respectively.
- Male sex was associated with higher odds of hospital or hospice facility death and lower odds of home or nursing facility death.
- Nonwhite race, Hispanic ethnicity, and being married were associated with increased odds of hospital or home death and reduced odds of nursing facility death.
- More education was associated with higher odds of home or in a hospice facility death and reduced odds of death in a nursing facility or hospital.
Why it matters
Across US deaths from dementia between 2003 and 2017, the share at home rose from 13.6% to 21.9% and in hospice facilities from 0.2% to 6.2%, while nursing-facility deaths fell from 65.7% to 55.0% and hospital deaths from 12.7% to 8.0%. Where people died differed by age, sex, race, Hispanic ethnicity, marital status, education and urban-rural setting. The authors conclude that as more of these deaths happen at home, "the need for caregiver support and home-based palliative care may become more critical." It describes patterns only: it does not show which place of death is better or what patients wanted.
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Study details
- Study designcross-sectional
- Effect size65.7%; 12.7% to 55.0%; 8.0%
- Evidence strengthLow
How this study scored 53/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time. Scored zero for sample size, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | 3 / 4 | Journal of the American Geriatrics Society: journal h-index 344 (OpenAlex, 2026-10-29) |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 1 / 5 | Rated “low” 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 | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 75 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 9.4 citations a year over 8 year(s) since 2020 |
| Impact for its field and year | 3 / 6 | Cited 6.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 10 other studies in this library |
| Still being cited | 2 / 4 | Cited 32 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Haider Javed Warraich: h-index 40 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Harvard University: institution h-index 3,235 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 31609481) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 53 / 100 | — |
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
Cross, S. H., Kaufman, B. G., Taylor, D. H., Kamal, A. H., & Warraich, H. J. (2020). Trends and Factors Associated with Place of Death for Individuals with Dementia in the United States. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.16200
Vancouver
Cross SH, Kaufman BG, Taylor DH, Kamal AH, Warraich HJ. Trends and Factors Associated with Place of Death for Individuals with Dementia in the United States. Journal of the American Geriatrics Society. 2020. doi:10.1111/jgs.16200. PMID: 31609481.
BibTeX
@article{cross2020-31609481,
author = {Cross, S. H. and Kaufman, B. G. and Taylor, D. H. and Kamal, A. H. and Warraich, H. J.},
title = {{Trends and Factors Associated with Place of Death for Individuals with Dementia in the United States}},
journal = {Journal of the American Geriatrics Society},
year = {2020},
doi = {10.1111/jgs.16200},
pmid = {31609481},
url = {https://doi.org/10.1111/jgs.16200}
}
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