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Rural nursing home residents with dementia are less likely than their urban counterparts to undergo intensive end-of-life care

Extraordinary lifesaving measures instead of comfort care at the end of life are not always in the best interests of frail elderly patients and their families. Yet a new study found that 40 percent of elderly nursing home residents with severe dementia were hospitalized in the last 90 days of life and 9 percent were admitted to an intensive care unit (ICU). Rural residents were less likely than their urban counterparts to undergo the most intensive medical services at the end of life, according to the study supported by the Agency for Healthcare Research and Quality (HS13022).

For example, urban residents were nearly twice as likely as rural residents to have tube feeding, over twice as likely to be admitted to an ICU, and 41 percent more likely to be hospitalized for more than 10 days. Yet urban residents were 22 percent less likely than rural residents to be hospitalized during the last 90 days of life. This may have been due in part to fewer staff at rural nursing homes to care for failing residents who, as a result, had to be hospitalized, suggests Charles E. Gessert, M.D., M.P.H., of the SMDC Health System in Duluth, Minnesota.

Dr. Gessert and colleagues examined the use of intensive medical services by analyzing Medicare and Medicaid data from 1998 through 2002 for 3,710 Minnesota and Texas elderly nursing home residents with severe cognitive impairment who died during 2000 and 2001. Race other than white and having a stroke were associated with higher use of all intensive medical services. Medicaid was associated with lower likelihood of any hospitalization and hospitalization for more than 10 days, but was not associated with feeding tube or ICU use by rural or urban residents. Finally, both rural and urban residents who had completed advance directives were less likely than others to undergo most of the intensive medical services at the end of life.

See "Rural-urban differences in medical care for nursing home residents with severe dementia at the end of life," by Dr. Gessert, Irina V. Haller, Ph.D., M.S., Robert L. Kane, M.D., and Howard Degenholtz, Ph.D., in the August 2006 Journal of the American Geriatric Society 54, pp. 1199-1205.

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