Despite stress on United States healthcare systems during the early pandemic, overall end-of-life care quality remained comparable to prepandemic care for patients with and without dementia, a new study of Medicare data has found. But the findings highlight disparities in spiritual care, investigators said.
The study included 1,050 proxies for deceased participants in the National Health and Aging Trends Study. Participants had died between 2019 and 2021. End-of-life care quality was assessed using interviews with the bereaved caregivers, including their ratings of 13 care quality measures from the following categories: pain and symptom management, communication and decision-making, emotional support and overall quality.
Overall ratings of care deemed “not excellent” were more common among people who died during the pandemic than among those who died before the pandemic began. And people with dementia appeared to be more likely to have unmet spiritual needs at the end of life.
Otherwise, dementia and the pandemic were not found to have a significant impact on the study indicators and caregivers’ overall rating of care quality, the researchers found.
Hospice care helped
“Most end-of-life care indicators preserved the level of quality, regardless of dementia and the COVID-19 pandemic,” the authors wrote. This result may be attributed in part to a relatively higher use of hospice by people with dementia in the study, they theorized.
However, “disparities in spiritual care may exist across people with and without dementia,” they added. Spiritual care tends to receive less attention than advance care planning and psychological aspects of care, the researchers noted.
“Our results support the existing need for spiritual care for people with dementia regardless of a healthcare crisis and restrictions,” they concluded.
Full findings were published in JAMDA.
