Persistent disparities exist in end-of-life hospitalizations both within nursing homes and between nursing homes for residents with dementia, according to a new study from the University of Rochester School of Medicine and Dentistry, Rochester, NY.
Investigators sought to find whether severe cognitive impairment was tied to residents’ place of death. In an observational study in almost 14,600 facilities, the researchers analyzed federal data on long‐stay residents with Alzheimer’s disease or related dementia who had died in a nursing home or in a hospital within eight days of discharge.
When compared with whites, Black residents had nearly an 8% higher risk of end-of-life hospitalization. Among those with severe cognitive impairment, whites showed a 6% lower risk of hospitalizations. But end-of-life hospitalization risk among Blacks with severe cognitive impairment was still significantly elevated, reported corresponding author Helena Temkin‐Greener, Ph.D.
Further analysis showed statistically significant hospitalization risk by the deceased resident’s race both within and across facilities, she and her colleagues wrote.
The within‐facility disparities may be due to residents’ preferences and/or nursing home practices that contribute to differential treatment, the researchers said. The across-facility differences, meanwhile, “point to the overall quality of care disparities in homes with a higher prevalence of black residents,” Temkin-Greener wrote.
“Persistence of such systemic disparities among the most vulnerable individuals is extremely troubling,” the authors concluded.
Data were gleaned from the national‐level Minimum Data Set, Medicare patient records, Medicare Provider Analysis and Review, and Nursing Home Compare.
The study was published on Monday in the Journal of the American Geriatrics Society.
