Cited by 54Palliative Care and End-of-Life IssuesPalliative and Oncologic CareGeriatric Care and Nursing Homes

Family Caregiving at the End of Life and Hospice Use: A National Study of Medicare Beneficiaries

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Kumar, Vedika, Ankuda, Claire K., Aldridge, Melissa D., Husain, Mohammed, Ornstein, Katherine A.·2020·Journal of the American Geriatrics Society

Abstract

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.

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  • In the last 12 months of life, people with dementia relied on more hours of family care (64.5 hours per week) than people with cancer (39.3 hours per week).

    “In the last 12 months of life, people with dementia relied on more hours of family care (64.5 hours per week) than people with cancer (39.3 hours per week).504”

    From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [504]

  • In the last 12 months of life, people with dementia relied on more hours of family care (64.5 hours per week) than people with cancer (39.3 hours per week).

    “In the last 12 months of life, people with dementia relied on more hours of family care (64.5 hours per week) than people with cancer (39.3 hours per week). 550”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [550]

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  1. [23]Jarosek S, Shippee TP and Virnig B. RACIAL DISPARITIES IN THE USE OF THE MEDICARE HOSPICE BENEFIT OVER TIME in Gerontologist. 2015 OXFORD UNIV PRESS INC JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA.

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Authors
Kumar, V., Ankuda, C. K., Aldridge, M. D., Husain, M., & Ornstein, K. A.
Affiliations
Icahn School of Medicine at Mount Sinai (US)
Corresponding author
Kumar, Vedika
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2020-06-30
Volume
68
Issue
10
Pages
2288-2296
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
OpenAlex
W3039178198
Cited by
54
References
42
Citations by year
2026: 11 · 2025: 10 · 2024: 8 · 2023: 8 · 2022: 12 · 2021: 5
FWCI
4.67
Type
journal article
Language
en
Open access
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Aging (K01AG047923, R01 AG060967, U01AG32947)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
Keywords
family caregiving, hospice care, end-of-life care, hospice use, informal caregivers, caregiver hours, dementia, cancer, older adults, Medicare beneficiaries, National Health and Aging Trends Study, access to end-of-life care
MeSH terms
Aged, Aged, 80 and over, Female, Medicare, Health Services Accessibility, Humans, Male, Patient Acceptance of Health Care, Terminal Care, Time Factors, United States, Odds Ratio, Caregivers, Hospice Care, Healthcare Disparities

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