A recent analysis conducted by Rutgers Health, based on millions of Medicare records, has unveiled nine trajectories that older Americans follow in their final three years of life. This groundbreaking study lays the foundation for enhancing end-of-life care by identifying the different paths individuals take and understanding the factors that influence their choices. The research, published in BMC Geriatrics, aims to design interventions that align with patients’ preferences and ensure they receive the care that is right for them.
To undertake the study, the research team examined the clinical records of 2 million randomly selected Medicare beneficiaries who passed away in 2018. By analyzing the level and location of care provided to each patient, the researchers identified three major clusters: home care, skilled home care, and institutional care. Within each cluster, three distinct trajectories emerged.
Approximately 59% of patients fell into the home care cluster, indicating that they spent most of their last three years at home, supported by family and friends when needed. These patients received minimal professional care, either at home or in nursing facilities, until the final year of life.
Around 27% of patients belonged to the skilled home care cluster, where nurses and other skilled professionals provided care in the patients’ homes with the assistance of family members. This care arrangement persisted for the majority of their last three years.
The remaining 14% of patients were categorized under the institutional care cluster, spending the majority of their last three years in hospitals or nursing homes, where paid professionals delivered the necessary care.
Using a group-based trajectory modeling approach, the researchers investigated the relationship between care trajectories and sociodemographic and health-related metrics. The findings revealed that patients in both the skilled home care and institutional care clusters were more likely to be female, Black, enrolled in Medicaid, or suffering from dementia. Skilled home care was more prevalent in Southern states, while institutional care was more common in Midwestern states.
Haiqun Lin, the lead author of the study and a professor of biostatistics at Rutgers, emphasized that the analysis not only identified different care patterns but also shed light on the clinical and policy factors that influence the location and timing of care delivery. Lin explained that understanding these patterns is essential for advance care planning and achieving the goals of improving care experiences, reducing costs, and enhancing quality.
This study is the first in a series planned by the researchers, who intend to explore the key factors that steer individuals towards each trajectory and develop interventions that align with their preferences. However, the researchers note that for most individuals, the preferred path is within the home care cluster.
Olga Jarrín, the corresponding author and the Hunterdon Professor of Nursing Research at Rutgers, explained that the goal is not to enforce a specific type of care but rather to assist individuals in planning and obtaining the care that suits their needs. While most people prefer to stay at home with minimal professional help, a significant minority seeks professional care to avoid burdening their loved ones.
By understanding these preferences and tailoring care plans accordingly, the aim is to provide end-of-life care that respects patients’ wishes and ensures their well-being. Through further analysis of Medicare data, the research team aims to make significant strides in improving end-of-life care for older Americans.
1. Source: Coherent Market Insights, Public sources, Desk research
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