End-of-life care in nursing home settings: do race or age matter?
ABSTRACT One-quarter of all U.S. chronic-disease deaths occur in nursing homes, yet few studies examine palliative care quality in these settings. This study tests whether racial and/or age-based differences in end-of-life care exist in these institutional settings.
We abstracted residents' charts (N = 1133) in 12 nursing homes. Researchers collected data on indicators of palliative care in two domains of care--advance care planning and pain management--and on residents' demographic and health status variables. Analyses tested for differences by race and age.
White residents were more likely than minorities to have DNR orders (69.5% vs. 37.3%), living wills (39% vs. 5%), and health care proxies (36.2% vs. 11.8%; p < .001 for each). Advance directives were highly and positively correlated with age. In-depth advance care planning discussions between residents, families, and health care providers were rare for all residents, irrespective of demographic characteristics. Nursing staff considered older residents to have milder and less frequent pain than younger residents. We found no disparities in pain management based on race.
To the extent that advance care planning improves care at the end of life, racial minorities in nursing homes are disadvantaged compared to their white fellow residents. Focusing on in-depth discussions of values and goals of care can improve palliative care for all residents and may help to ameliorate racial disparities in end-of-life care. Staff should consider residents of all ages as appropriate recipients of advance care planning efforts and should be cognizant of the fact that individuals of all ages can experience pain. Nursing homes may do a better job than other health care institutions in eliminating racial disparities in pain management.
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ABSTRACT: EnglishDying in old age has become the majority dying of the developed world, yet older people are routinely denied palliative care, their dying characterized by failure to facilitate choice and recognize their needs. Social workers in all settings should embrace their contribution to quality end-of-life care for older people.FrenchMourir à un âge avancé est devenu la ‘forme majoritaire de la mort’ dans le monde développé, bien que l’on dénie couramment aux personnes âgées l’accès aux soins palliatifs, leur décès étant socialement caractérisé par l’incapacité à faciliter leurs choix et à reconnaître leurs besoins. Les travailleurs sociaux dans tous les dispositifs devraient apporter leur contribution à la qualité des soins de fin de vie pour les personnes âgées.SpanishMorirse de viejo se ha convertido en la forma mayoritaria de morir en el mundo desarrollado, sin embargo, a los ancianos se les niega sistemáticamente el cuidado paliativo. Sus muertes se caracterizan por el fallo de no ofrecer a los ancianos opciones y reconocer sus necesidades. Los trabajadores sociales de todas partes deben contribuir a la calidad del cuidado al final de la vida de los ancianos.International Social Work 10/2009; 52(6):713-725. DOI:10.1177/0020872809342640 · 0.48 Impact Factor