Place of death among racial minority older adults with Alzheimer’s disease and related dementias

Abstract

AbstractBackgroundAlzheimer’s and Related Dementias (ADRD) affects close to half of older adults before death. The age‐adjusted rate of ADRD is disproportionately higher in racial/ethnic minority populations. There are also disparities in end‐of‐life care for racial minority older adults with ADRD, including the type of care, place of care, and place of death. Place of death is associated with the quality, type, and cost of care that patients may receive. Place of death is increasingly being recognized as an indicator of end‐of‐life care quality. In surveys of the U.S. population, older adults, including racial minority older adults, increasingly state a preference for death at home compared to a hospital or nursing home setting. In this study, we investigated factors associated with place of death among older adults with ADRD.MethodWe conducted a secondary analysis of a national dataset, the Health and Retirement Study (HRS), using HRS Exit interviews related to deceased participants’ data from 2002‐2019.ResultOf the 7,214 decedents, 13% had a diagnosis of ADRD, 30% had cognitive impairment suggesting undiagnosed ADRD, and 57% were cognitively intact. Among the 3,102 participants with ADRD, Black participants were 80% more likely to die in the hospital and 46% less likely to die in a nursing home compared to white participants. We did not observe any significant effect of race on hospice use. Additionally, married participants were 89% more likely to die at home compared to unmarried participants. For every 1‐year age increase, participants were 1.6% less likely to die in the hospital, 3.8% less likely to die at home, and 6% more likely to die in nursing homes.ConclusionOur findings indicate that race, marital status, and age are significant predictors of place of death among older adults living with ADRD. Black participants with ADRD were less likely to die at home compared to their white counterparts. There are considerable racial differences in which patients with ADRD die at home or in institutions. There is a need for further research to understand the reasons for these variations in the efficiency and type of end‐of‐life care delivered to racial minorities.