A national study of the location of death for older persons with dementia

Susan L. Mitchell, Joan Teno, Susan C. Miller, Vincent Mor

Research output: Contribution to journalArticle

251 Citations (Scopus)

Abstract

OBJECTIVES: To describe where older Americans with dementia die and to compare the state health system factors related to the location of dementia-related deaths with those of cancer and all other conditions in this population. DESIGN: Cross-sectional study. SETTING: United States in 2001. PARTICIPANTS: All persons aged 65 and older who died from nontraumatic causes in the United States during 2001. The underlying cause of death, as determined by the National Center for Health Statistics from death certificate data, was used to categorize subjects into three decedent groups: dementia (n = 88,523, 5.1%), cancer (n = 389,754, 22.4%), and all other conditions (n = 1,256,873, 72.5%). MEASUREMENTS: Site of death was identified as the hospital, home, nursing home, or another location as recorded on the death certificate. In each state, the proportion of hospital deaths in the three decedent groups was categorized as high, medium, and low based on terciles of the national distribution. Using multivariate analyses, associations between state-level variables and the proportion of deaths occurring in the hospital in each state were examined. RESULTS: The majority of dementia-related deaths in the United States occurred in nursing homes (66.9%). In contrast, most older persons with cancer died at home (37.8%) or in the hospital (35.4%). The hospital was the most common site of death for all other conditions (52.2%). The state-specific proportion of dementia-related deaths occurring in hospitals varied from 5.0% to 37.0% across the nation and was in the highest tercile in 18 states. Hospital death rates related to cancer and all other conditions were in the highest tercile in 14 of these 18 states. After multivariate adjustment, states with a greater number of hospital beds per 1,000 persons and a lower percentage of decedents aged 85 and older were more likely to have a higher proportion of hospital deaths in all three decedent groups. Additionally, in the dementia cohort, states with fewer nursing home beds had a greater proportion of hospital deaths. CONCLUSION: The majority of older Americans whose underlying cause of death is attributable to dementia on their death certificate die in nursing homes. State-level factors, including the availability of hospital and nursing home beds and the age of decedents in the population, explain, in part, the wide state-to-state variability in the proportion of dementia-related deaths occurring in the hospital.

Original languageEnglish (US)
Pages (from-to)299-305
Number of pages7
JournalJournal of the American Geriatrics Society
Volume53
Issue number2
DOIs
StatePublished - Feb 1 2005
Externally publishedYes

Fingerprint

Dementia
Nursing Homes
Death Certificates
Cause of Death
Neoplasms
National Center for Health Statistics (U.S.)
Home Nursing
Social Adjustment
Population
Multivariate Analysis
Cross-Sectional Studies
Mortality
Health

Keywords

  • Dementia
  • Location of death
  • Nursing home

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

A national study of the location of death for older persons with dementia. / Mitchell, Susan L.; Teno, Joan; Miller, Susan C.; Mor, Vincent.

In: Journal of the American Geriatrics Society, Vol. 53, No. 2, 01.02.2005, p. 299-305.

Research output: Contribution to journalArticle

Mitchell, Susan L. ; Teno, Joan ; Miller, Susan C. ; Mor, Vincent. / A national study of the location of death for older persons with dementia. In: Journal of the American Geriatrics Society. 2005 ; Vol. 53, No. 2. pp. 299-305.
@article{41201597a1434f938ea41d442a0fd248,
title = "A national study of the location of death for older persons with dementia",
abstract = "OBJECTIVES: To describe where older Americans with dementia die and to compare the state health system factors related to the location of dementia-related deaths with those of cancer and all other conditions in this population. DESIGN: Cross-sectional study. SETTING: United States in 2001. PARTICIPANTS: All persons aged 65 and older who died from nontraumatic causes in the United States during 2001. The underlying cause of death, as determined by the National Center for Health Statistics from death certificate data, was used to categorize subjects into three decedent groups: dementia (n = 88,523, 5.1{\%}), cancer (n = 389,754, 22.4{\%}), and all other conditions (n = 1,256,873, 72.5{\%}). MEASUREMENTS: Site of death was identified as the hospital, home, nursing home, or another location as recorded on the death certificate. In each state, the proportion of hospital deaths in the three decedent groups was categorized as high, medium, and low based on terciles of the national distribution. Using multivariate analyses, associations between state-level variables and the proportion of deaths occurring in the hospital in each state were examined. RESULTS: The majority of dementia-related deaths in the United States occurred in nursing homes (66.9{\%}). In contrast, most older persons with cancer died at home (37.8{\%}) or in the hospital (35.4{\%}). The hospital was the most common site of death for all other conditions (52.2{\%}). The state-specific proportion of dementia-related deaths occurring in hospitals varied from 5.0{\%} to 37.0{\%} across the nation and was in the highest tercile in 18 states. Hospital death rates related to cancer and all other conditions were in the highest tercile in 14 of these 18 states. After multivariate adjustment, states with a greater number of hospital beds per 1,000 persons and a lower percentage of decedents aged 85 and older were more likely to have a higher proportion of hospital deaths in all three decedent groups. Additionally, in the dementia cohort, states with fewer nursing home beds had a greater proportion of hospital deaths. CONCLUSION: The majority of older Americans whose underlying cause of death is attributable to dementia on their death certificate die in nursing homes. State-level factors, including the availability of hospital and nursing home beds and the age of decedents in the population, explain, in part, the wide state-to-state variability in the proportion of dementia-related deaths occurring in the hospital.",
keywords = "Dementia, Location of death, Nursing home",
author = "Mitchell, {Susan L.} and Joan Teno and Miller, {Susan C.} and Vincent Mor",
year = "2005",
month = "2",
day = "1",
doi = "10.1111/j.1532-5415.2005.53118.x",
language = "English (US)",
volume = "53",
pages = "299--305",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - A national study of the location of death for older persons with dementia

AU - Mitchell, Susan L.

AU - Teno, Joan

AU - Miller, Susan C.

AU - Mor, Vincent

PY - 2005/2/1

Y1 - 2005/2/1

N2 - OBJECTIVES: To describe where older Americans with dementia die and to compare the state health system factors related to the location of dementia-related deaths with those of cancer and all other conditions in this population. DESIGN: Cross-sectional study. SETTING: United States in 2001. PARTICIPANTS: All persons aged 65 and older who died from nontraumatic causes in the United States during 2001. The underlying cause of death, as determined by the National Center for Health Statistics from death certificate data, was used to categorize subjects into three decedent groups: dementia (n = 88,523, 5.1%), cancer (n = 389,754, 22.4%), and all other conditions (n = 1,256,873, 72.5%). MEASUREMENTS: Site of death was identified as the hospital, home, nursing home, or another location as recorded on the death certificate. In each state, the proportion of hospital deaths in the three decedent groups was categorized as high, medium, and low based on terciles of the national distribution. Using multivariate analyses, associations between state-level variables and the proportion of deaths occurring in the hospital in each state were examined. RESULTS: The majority of dementia-related deaths in the United States occurred in nursing homes (66.9%). In contrast, most older persons with cancer died at home (37.8%) or in the hospital (35.4%). The hospital was the most common site of death for all other conditions (52.2%). The state-specific proportion of dementia-related deaths occurring in hospitals varied from 5.0% to 37.0% across the nation and was in the highest tercile in 18 states. Hospital death rates related to cancer and all other conditions were in the highest tercile in 14 of these 18 states. After multivariate adjustment, states with a greater number of hospital beds per 1,000 persons and a lower percentage of decedents aged 85 and older were more likely to have a higher proportion of hospital deaths in all three decedent groups. Additionally, in the dementia cohort, states with fewer nursing home beds had a greater proportion of hospital deaths. CONCLUSION: The majority of older Americans whose underlying cause of death is attributable to dementia on their death certificate die in nursing homes. State-level factors, including the availability of hospital and nursing home beds and the age of decedents in the population, explain, in part, the wide state-to-state variability in the proportion of dementia-related deaths occurring in the hospital.

AB - OBJECTIVES: To describe where older Americans with dementia die and to compare the state health system factors related to the location of dementia-related deaths with those of cancer and all other conditions in this population. DESIGN: Cross-sectional study. SETTING: United States in 2001. PARTICIPANTS: All persons aged 65 and older who died from nontraumatic causes in the United States during 2001. The underlying cause of death, as determined by the National Center for Health Statistics from death certificate data, was used to categorize subjects into three decedent groups: dementia (n = 88,523, 5.1%), cancer (n = 389,754, 22.4%), and all other conditions (n = 1,256,873, 72.5%). MEASUREMENTS: Site of death was identified as the hospital, home, nursing home, or another location as recorded on the death certificate. In each state, the proportion of hospital deaths in the three decedent groups was categorized as high, medium, and low based on terciles of the national distribution. Using multivariate analyses, associations between state-level variables and the proportion of deaths occurring in the hospital in each state were examined. RESULTS: The majority of dementia-related deaths in the United States occurred in nursing homes (66.9%). In contrast, most older persons with cancer died at home (37.8%) or in the hospital (35.4%). The hospital was the most common site of death for all other conditions (52.2%). The state-specific proportion of dementia-related deaths occurring in hospitals varied from 5.0% to 37.0% across the nation and was in the highest tercile in 18 states. Hospital death rates related to cancer and all other conditions were in the highest tercile in 14 of these 18 states. After multivariate adjustment, states with a greater number of hospital beds per 1,000 persons and a lower percentage of decedents aged 85 and older were more likely to have a higher proportion of hospital deaths in all three decedent groups. Additionally, in the dementia cohort, states with fewer nursing home beds had a greater proportion of hospital deaths. CONCLUSION: The majority of older Americans whose underlying cause of death is attributable to dementia on their death certificate die in nursing homes. State-level factors, including the availability of hospital and nursing home beds and the age of decedents in the population, explain, in part, the wide state-to-state variability in the proportion of dementia-related deaths occurring in the hospital.

KW - Dementia

KW - Location of death

KW - Nursing home

UR - http://www.scopus.com/inward/record.url?scp=15044359033&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=15044359033&partnerID=8YFLogxK

U2 - 10.1111/j.1532-5415.2005.53118.x

DO - 10.1111/j.1532-5415.2005.53118.x

M3 - Article

VL - 53

SP - 299

EP - 305

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 2

ER -