Geographic and temporal variations in the place of death of dementia patients in the United States

Authors: Wei Xu*, University of Wisconsin Madison, Changshan Wu, University of Wisconsin Milwaukee, Jason Fletcher, University of Wisconsin Madison
Topics: Health and Medical, Medical and Health Geography
Keywords: Dementia, Place of death, End-of-life care
Session Type: Virtual Paper
Day: 4/7/2021
Start / End Time: 1:30 PM / 2:45 PM
Room: Virtual 28
Presentation File: No File Uploaded


Previous research suggests that place of death may be an indicator of quality of end-of-life care. This study aims to examine the geographical variations and temporal trends in place of death of dementia decedents in the US and the relationships between place of death of dementia decedents and broad structural determinants. Using nationwide death certificates between 2000 and 2014, we described the changes in place of death of dementia decedents across states and over time. State fixed effects models were estimated to assess the relationships between the proportion of dementia decedents at difference places and state-level factors, particularly availability of care facility resources and public health insurance expenditures. Dementia decedents were more likely to die at home and other places and less likely to die at institutional settings over the study period. There was wide inter-state and temporal variability in the proportions of deaths at different places. Among state-level factors, availability of nursing home beds was positively associated with rates of nursing home/long term care deaths and negatively associated with rates of home deaths. Medicaid expenditure on institutional long term supports and services was positively associated with rates of nursing home/long term care deaths and negatively associated with rates of home deaths. There was a persistent shift in the place of death of dementia decedents from institutions to homes and communities. Increased investments in home and community based health services may help dementia patients to die at their homes.

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