QUALITY OF LIFE PREDICTS END-OF-LIFE CARE TRANSITIONS AMONG PERSONS WITH DEMENTIA OVER NINE YEARS

Abstract

Abstract Physical, financial, and emotional burdens are profound and affect the quality-of-life of persons with dementia (PWD) and their caregivers, particularly as cognitive decline accelerates and death approaches, which leads to burdensome, non-beneficial transitions in care that can lead to further decline of PWD. Measures of quality-of-life for PWD and their caregivers include important physical, psychological/cognitive, existential, caregiving burden, and socio-demographic factors that may be useful for predicting and preventing these end-of-life transitions. This secondary data analysis of the National Health and Aging and Trends Study (NHATS) linked to the National Study of Caregiving (NSOC) investigates the relationship between quality-of-life factors and end-of-life care transition (overnight hospitalization, hospice use, and place of death) over nine years (2011-2019) among caregiver/PWD dyads using multivariable logistic regression for hospice and place of death and multivariable logistic regression with generalized estimating equations for longitudinal overnight hospitalizations. Overnight hospitalizations are predicted by overall health (p=0.048), pain (p=0.016), and having a regular doctor (p=0.012). Predictors of hospice include health prevents enjoying life (p=0.0002) and receiving food stamps (p=0.008). Place of death is predicted by PWD needing >30 mins to fall asleep (p=0.007), dementia status (p=0.015), health preventing enjoying life (p=0.0005), race (p=0.033), and census division (p=0.012). End-of-life care transitions can be predicted far in advance by quality-of-life and socio-demographic factors of PWD and their caregivers. With this knowledge it may be possible to develop upstream interventions to facilitate appropriate transitions and improve end-of-life quality-of-life far in advance of avoidable care transitions of PWD.