Hospice Use and Outcomes in Nursing Home Residents with Advanced Dementia
Open accessAbstract
OBJECTIVES: To identify characteristics of nursing home (NH) residents with advanced dementia and their healthcare proxies (HCPs) associated with hospice referral and to examine the association between hospice use and the treatment of pain and dyspnea and unmet needs during the last 7 days of life. DESIGN: Prospective cohort study. SETTING: Twenty‐two Boston‐area NHs. PARTICIPANTS: Three hundred twenty‐three NH residents with advanced dementia and their HCPs. MEASUREMENTS: Data were collected at baseline and quarterly for up to 18 months. Hospice referral, frequency of pain and dyspnea, and treatment of these symptoms was ascertained. HCPs reported unmet needs during the last 7 days of the residents' lives for communication, information, emotional support, and help with personal care. RESULTS: Twenty‐two percent of residents were referred to hospice. After multivariable adjustment, factors associated with hospice referral were nonwhite race, eating problems, HCP's perception that the resident's had less than 6 months to live, and better HCP mental health. Residents in hospice were more likely to receive scheduled opioids for pain (adjusted odds ratio (AOR)=3.16; 95% confidence interval (95% CI)=1.57–6.36) and oxygen, morphine, scopolamine, or hyoscyamine for dyspnea (AOR=3.28, 95% CI=1.37–7.86). HCPs of residents in hospice reported fewer unmet needs in all domains during the last 7 days of the residents' life. CONCLUSION: A minority of NH residents with advanced dementia received hospice care. Hospice recipients were more likely to received scheduled opioids for pain and symptomatic treatment for dyspnea and had fewer unmet needs at the end of life.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Medicare beneficiaries with advanced dementia enrolled in hospice are more likely to receive regular treatment for pain.
“and more likely to receive regular treatment for pain.778”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [778]
The Results section reports that nursing-home residents with advanced dementia on hospice were more likely to receive scheduled opioids for pain than those not on hospice (48.3% versus 19.4%). That supports the point about regular pain treatment, but the study population was nursing-home residents; it does not establish the finding for Medicare beneficiaries with advanced dementia generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThose enrolled in hospice care are more likely to receive regular treatment for pain.
“and more likely to receive regular treatment for pain. 936”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [936]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
WARE, J. E., KOSINSKI, M., & KELLER, S. D. (1996) · Medical Care · doi:10.1097/00005650-199603000-00003 · Cited by 17,392 · see citing works
The Global Deterioration Scale for assessment of primary degenerative dementia
Reisberg, ., Ferris, S. H., de Leon, M. J., & Crook, T. H. (1982) · American Journal of Psychiatry · doi:10.1176/ajp.139.9.1136 · Cited by 4,982 · see citing works
Alzheimer Disease in the US Population: Prevalence Estimates Using the 2000 Census
Hebert, L. E., Scherr, P. A., Bienias, J. L., Bennett, D. A., & Evans, D. A. (2003) · Archives of Neurology · doi:10.1001/archneur.60.8.1119 · Cited by 2,168 · see citing works
The Clinical Course of Advanced Dementia.
Mitchell, S. L., Teno, J. M., Kiely, D. K., Shaffer, M. L., Jones, R. N., Prigerson, H. G., Volicer, L., Givens, J. L., & Hamel, M. B. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0902234 · Cited by 1,618 · see citing works
Self-citationFamily Perspectives on End-of-Life Care at the Last Place of Care
Teno, J. M. (2004) · JAMA · doi:10.1001/jama.291.1.88 · Cited by 1,492 · see citing works
Self-citationDying With Advanced Dementia in the Nursing Home
Mitchell, S. L., Kiely, D. K., & Hamel, M. B. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.3.321 · Cited by 570 · see citing works
Self-citationBarriers to excellent end-of-life care for patients with dementia
Sachs, G. A., Shega, J. W., & Cox‐Hayley, D. (2004) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2004.30329.x · Cited by 418 · see citing works
A National Study of the Location of Death for Older Persons with Dementia
Mitchell, S. L., Teno, J. M., Miller, S. C., & Mor, V. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53118.x · Cited by 371 · see citing works
Self-citationPatient-Focused, Family-Centered End-of-Life Medical Care
Teno, J. M., Casey, V. A., Welch, L. C., & Edgman‐Levitan, S. (2001) · Journal of Pain and Symptom Management · doi:10.1016/s0885-3924(01)00335-9 · Cited by 305 · see citing works
Self-citationComputing Distributions for Exact Logistic Regression
Hirji, K. F., Mehta, C. R., & Patel, N. R. (1987) · Journal of the American Statistical Association · doi:10.1080/01621459.1987.10478547 · Cited by 297 · see citing works
Validation of Toolkit After-Death Bereaved Family Member Interview
Teno, J. M., Clarridge, B. R., Casey, V. A., Edgman‐Levitan, S., & Fowler, J. R. (2001) · Journal of Pain and Symptom Management · doi:10.1016/s0885-3924(01)00331-1 · Cited by 287 · see citing works
Self-citationAlbert, M., & Cohen, C. (1992) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1992.tb02009.x · Cited by 262 · see citing works
Estimating Prognosis for Nursing Home Residents With Advanced Dementia
Mitchell, S. L. (2004) · JAMA · doi:10.1001/jama.291.22.2734 · Cited by 257 · see citing works
Self-citationScales for Evaluation of End-of-Life Care in Dementia
Volicer, L., Hurley, A. C., & Blasi, Z. V. (2001) · Alzheimer Disease & Associated Disorders · doi:10.1097/00002093-200110000-00005 · Cited by 239 · see citing works
Hospice enrollment and hospitalization of dying nursing home patients
Miller, S. C., Gozalo, P., & Mor, V. (2001) · The American Journal of Medicine · doi:10.1016/s0002-9343(01)00747-1 · Cited by 196 · see citing works
Smith, A. K., Earle, C. C., & McCarthy, E. P. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2008.02081.x · Cited by 192 · see citing works
Greiner, K. A., Perera, S., & Ahluwalia, J. S. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1365-2389.2003.51310.x · Cited by 190 · see citing works
Measurement of Severity in Advanced Alzheimer's Disease
Volicer, L., Hurley, A. C., Lathi, D., & Kowall, N. W. (1994) · Journal of Gerontology · doi:10.1093/geronj/49.5.m223 · Cited by 186 · see citing works
Hospice enrollment and pain assessment and management in nursing homes
Miller, S. C., Mor, V., & Teno, J. M. (2003) · Journal of Pain and Symptom Management · doi:10.1016/s0885-3924(03)00284-7 · Cited by 164 · see citing works
Self-citationTerminal Care for Persons with Advanced Dementia in the Nursing Home and Home Care Settings
Mitchell, S. L., Morris, J. N., Park, P. S., & Fries, B. E. (2004) · Journal of Palliative Medicine · doi:10.1089/jpm.2004.7.808 · Cited by 150 · see citing works
Self-citationPatients Dying with Dementia: Experience at the End of Life and Impact of Hospice Care
Shega, J. W., Hougham, G. W., Stocking, C. B., Cox-Hayley, D., & Sachs, G. A. (2008) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2007.06.011 · Cited by 142 · see citing works
The Validity and Reliability of Scales for the Evaluation of End-of-Life Care in Advanced Dementia
Kiely, D. K., Volicer, L., Teno, J. M., Jones, R. N., Prigerson, H. G., & Mitchell, S. L. (2006) · Alzheimer Disease & Associated Disorders · doi:10.1097/00002093-200607000-00009 · Cited by 126 · see citing works
Self-citationComparison of hospice use and demographics among European Americans, African Americans, and Latinos
Colón, M., & Lyke, J. A. (2003) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/104990910302000306 · Cited by 108 · see citing works
Advanced Dementia Research in the Nursing Home: The CASCADE Study
Mitchell, S. L., Kiely, D. K., Jones, R. N., Prigerson, H. G., Volicer, L., & Teno, J. M. (2006) · Alzheimer Disease & Associated Disorders · doi:10.1097/00002093-200607000-00008 · Cited by 106 · see citing works
Self-citationVirnig, B. A., McBean, A. M., Kind, S., & Dholakia, R. (2002) · Medical Care · doi:10.1097/00005650-200201000-00010 · Cited by 98 · see citing works
Hospice Care for Patients with Dementia
Mitchell, S. L., Kiely, D. K., Miller, S. C., Connor, S. R., Spence, C., & Teno, J. M. (2007) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2007.01.003 · Cited by 95 · see citing works
Self-citationCharacteristics of dementia end-of-life care across care settings
Volicer, L., Hurley, A. C., & Blasi, Z. V. (2003) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/104990910302000307 · Cited by 88 · see citing works
Racial and Ethnic Differences in Hospice Use Among Patients With Heart Failure
Givens, J. L. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.547 · Cited by 87 · see citing works
Self-citationSloane, P. D., Zimmerman, S. I., Hanson, L. C., Mitchell, C. M., Riedel‐Leo, C., & Buie, V. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51511.x · Cited by 78 · see citing works
Racial disparity in hospice use in the United States in 2002
Connor, S. R., Elwert, F., Spence, C., & Christakis, N. (2008) · Palliative Medicine · doi:10.1177/0269216308089305 · Cited by 65 · see citing works
Ethnic Variation in Site of Death of Older Adults Dually Eligible for Medicaid and Medicare
Enguidanos, S. M., Yip, J. Y., & Wilber, K. H. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53410.x · Cited by 59 · see citing works
Differences in Hospice Use Between Black and White Patients During the Period 1992 through 2000
Han, B., Remsburg, R. E., & Iwashyna, T. J. (2006) · Medical Care · doi:10.1097/01.mlr.0000215858.37118.65 · Cited by 35 · see citing works
Hospice Care in a Cohort of Elders with Dementia and Mild Cognitive Impairment
Bekelman, D. B., Black, B. S., Shore, A. D., Kasper, J. D., & Rabins, P. V. (2005) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2005.04.003 · Cited by 28 · see citing works
Predictors of Hospice Utilization among Acute Stroke Patients who Died within Thirty Days
DuPreez, A., Smith, M. A., Liou, J., Frytak, J. R., Finch, M. D., Cleary, J. F., & Kind, A. (2008) · Journal of Palliative Medicine · doi:10.1089/jpm.2008.0124 · Cited by 26 · see citing works
Hospice Care for Patients with Dementia: Does Volume Make a Difference?
Miller, S. C., Kiely, D. K., Teno, J. M., Connor, S. R., & Mitchell, S. L. (2008) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2007.12.001 · Cited by 13 · see citing works
Self-citationRacial Differences in the Growth of Noncancer Diagnoses Among Hospice Enrollees
Johnson, K. S., Kuchibhatla, M. N., Tanis, D., & Tulsky, J. A. (2007) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2006.11.010 · Cited by 13 · see citing works
(1992) · Rehabilitation Oncology · doi:10.1097/01893697-199210020-00022 · Cited by 5 · see citing works
Remsburg, R. E., Arispe, I. E., & Hing, E. (2002) · Medical Care · doi:10.1097/00005650-200212000-00017 · Cited by 3 · see citing works
Albert, M., & Cohen, C. (1992) · PsycTESTS Dataset · doi:10.1037/t28543-000 · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [12]NHPCO Facts and Figures: Hospice Care in American 2009 Edition: http://www.nhpco.org/i4a/pages/index.cfm?pageid=5994 January 15, 2010
Cited by
Sorted by citations
2023 Alzheimer's disease facts and figures
(2023) · Alzheimer's & Dementia · doi:10.1002/alz.13016 · Cited by 3,212 · see citing works
2024 Alzheimer's disease facts and figures
(2024) · Alzheimer's & Dementia · doi:10.1002/alz.13809 · Cited by 2,536 · see citing works
2019 Alzheimer’s disease facts and figures.
Alzheimer's Association (2019) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2019.01.010 · Cited by 2,461 · see citing works
2020 Alzheimer's disease facts and figures
(2020) · Alzheimer's & Dementia · doi:10.1002/alz.12068 · Cited by 2,353 · see citing works
2018 Alzheimer's disease facts and figures
Alzheimer's Association (2018) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2018.02.001 · Cited by 1,912 · see citing works
Lin, P.-J., Zhu, Y., Olchanski, N., Cohen, J. T., Neumann, P. J., Faul, J. D., Fillit, H. M., & Freund, K. M. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.16260 · Cited by 71 · see citing works
The effect of a comprehensive dementia care management program on end-of-life care
Jennings, L. A., Turner, M., Keebler, C., Burton, C. H., Romero, T., Wenger, N. S., & Reuben, D. B. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15769 · Cited by 59 · see citing works
Life-Sustaining Treatments Among Medicare Beneficiaries with and without Dementia at the End of Life
Zhu, Y., Olchanski, N., Cohen, J. T., Freund, K. M., Faul, J. D., Fillit, H. M., Neumann, P. J., & Lin, P.-J. (2023) · Journal of Alzheimer’s Disease · doi:10.3233/jad-230692 · Cited by 16 · see citing works
- Authors
- Kiely, D. K., Givens, J. L., Shaffer, M. L., Teno, J. M., & Mitchell, S. L.
- Affiliations
- Pennsylvania State University (US)
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2010-12
- Volume
- 58
- Issue
- 12
- Pages
- 2284-2291
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC3057929
- OpenAlex
- W1926099231
- Cited by
- 119
- References
- 40
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 8 · 2023: 6 · 2022: 16 · 2021: 6 · 2020: 8 · 2019: 8 · 2018: 7 · 2017: 5 · 2016: 6 · 2015: 9 · 2014: 13 · 2013: 7 · 2012: 10
- FWCI
- 5.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute on Aging (R01AG024091, K24AG033640)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- hospice care, advanced dementia, nursing home residents, health care proxy, hospice referral, pain management, palliative care, racial disparities, end-of-life care
- MeSH terms
- Aged, Aged, 80 and over, Analgesics, Opioid, Boston, Dementia, Dyspnea, Female, Homes for the Aged, Humans, Male, Nursing Homes, Pain, Prospective Studies, Referral and Consultation, Risk Factors, Cohort Studies, Geriatric Assessment, Confidence Intervals, Odds Ratio, Treatment Outcome, Hospice Care, Pain Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
