Life-Sustaining Treatments Among Medicare Beneficiaries with and without Dementia at the End of Life
Open accessAbstract
Background: Older adults with dementia including Alzheimer’s disease may have difficulty communicating their treatment preferences and thus may receive intensive end-of-life (EOL) care that confers limited benefits. Objective: This study compared the use of life-sustaining interventions during the last 90 days of life among Medicare beneficiaries with and without dementia. Methods: This cohort study utilized population-based national survey data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims. Our sample included Medicare fee-for-service beneficiaries aged 65 years or older deceased between 2000 and 2016. The main outcome was receipt of any life-sustaining interventions during the last 90 days of life, including mechanical ventilation, tracheostomy, tube feeding, and cardiopulmonary resuscitation. We used logistic regression, stratified by nursing home use, to examine dementia status (no dementia, non-advanced dementia, advanced dementia) and patient characteristics associated with receiving those interventions. Results: Community dwellers with dementia were more likely than those without dementia to receive life-sustaining treatments in their last 90 days of life (advanced dementia: OR = 1.83 [1.42–2.35]; non-advanced dementia: OR = 1.16 [1.01–1.32]). Advance care planning was associated with lower odds of receiving life-sustaining treatments in the community (OR = 0.84 [0.74–0.96]) and in nursing homes (OR = 0.68 [0.53–0.86]). More beneficiaries with advanced dementia received interventions discordant with their EOL treatment preferences. Conclusions: Community dwellers with advanced dementia were more likely to receive life-sustaining treatments at the end of life and such treatments may be discordant with their EOL wishes. Enhancing advance care planning and patient-physician communication may improve EOL care quality for persons with dementia.
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Individuals with advanced dementia are significantly more likely to receive tube feeding in the last three months of life compared with those without dementia.
“However, individuals with advanced dementia are significantly more likely to receive tube feeding in the last three months of life compared with those without dementia. 941”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [941]
The Methods define the end-of-life window as the last 90 days, and the Results report more tube feeding among beneficiaries with advanced dementia than among those without dementia in both community and nursing-home settings. The Discussion says it was twice as common overall. Our copy does not report a statistical significance test for the tube-feeding comparison specifically, so it does not establish the claim’s “significantly” qualifier. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMedicare beneficiaries with advanced dementia who lived in the community were 1.8 times as likely to receive life-sustaining treatments in the last three months of life, compared with individuals without dementia living in the community.
“One group of researchers found that Medicare beneficiaries with advanced dementia who lived in the community were 1.8 times as likely to receive life‐sustaining treatments in the last three months of life, compared with individuals without dementia living in the community. 941”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [941]
The Results report that community-dwelling beneficiaries with advanced dementia had higher adjusted odds of receiving life-sustaining treatments in the last 90 days than those without dementia (OR = 1.83). The claim calls this “1.8 times as likely,” but 1.83 is an odds ratio, not a likelihood ratio; the reported proportions are 28% versus 20%. (LLM, conf=0.88)
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- Authors
- Zhu, Y., Olchanski, N., Cohen, J. T., Freund, K. M., Faul, J. D., Fillit, H. M., Neumann, P. J., & Lin, P.-J.
- Affiliations
- Tufts Medical Center (US)
- Tufts University (US)
- University of Michigan (US)
- Alzheimer's Drug Discovery Foundation (US)
- Corresponding author
- Zhu, Yingying
- ORCID
- Venue
- Journal of Alzheimer’s Disease
- Publisher
- SAGE Publications
- Published
- 2023-11-06
- Volume
- 96
- Issue
- 3
- Pages
- 1183-1193
- ISSN
- 1387-2877 (ISSN-L)
- 1875-8908
- PMC
- PMC10777481
- OpenAlex
- W4388452306
- Cited by
- 16
- References
- 62
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 6
- FWCI
- 4.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Alzheimer s Disease (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Tufts Medical Center
- National Institutes of Health
- National Institute on Aging (R01AG060165, U01AG009740)
- 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 › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- dementia, end-of-life care
- MeSH terms
- Aged, Alzheimer Disease, Death, Medicare, Humans, Terminal Care, United States, Cohort Studies
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