Disabilities decline for the elderly in U.S.
Significant reductions in disabilities among the elderly occurred between the early 1980s and early 2000s, likely due to advances in medical care and to socioeconomic gains.
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Medicare beneficiaries in rural areas and lung cancer survival rates — December 10, 2007
Lung cancer patients in rural areas do not have poorer survival rates than those in urban areas. However, rural beneficiaries were more likely to live in poorer areas and therefore have a smaller pool of health care providers. Read abstract More end of life care research
Quality of medical care increases when patients have multiple chronic illnesses
Patients with multiple illnesses received better, not worse, quality of care than patients with fewer illnesses. This may be in part because the former group either visits a doctor more often or visits specialists' yet some patients with multiple illnesses only visited their primary care physician while still seeing increased quality of care. News release Read abstract More quality of care research
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Older patients with multiple chronic conditions receive better care
Improved working conditions for nurses promote patient safety — May 31, 2007
Better working conditions for nurses contribute to better safety outcomes for elderly patients in intensive care units. Almost 16,000 patients were studied in this survey of over 1,000 nurses from 31 hospitals.
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Older patients with multiple chronic conditions receive better care — May 31, 2007
Older patients with multiple chronic conditions receive better quality of care than those with a single or no chronic illness. Combinations of eight common chronic conditions were analyzed in this study of 372 elderly participants.
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Cultural end-of-life values largely preserved for Japanese-Americans — May 01, 2007
Focus groups with 122 participants revealed that Japanese-Americans generally do not want to live in adverse health conditions and receive life-sustaining treatment. Fear of being a burden on loved ones is a major concern. These findings suggest that traditional Japanese end-of-life cultural values are preserved among Japanese-Americans.
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Medicare expenditures by colorectal cancer decedents show gender differences — April 18, 2007
This cross-sectional study of Medicare administrative and claims data examined age and gender differences in Medicare spending for colorectal cancer during the last year of life. Women tended to have higher inpatient expenditures, though older cohorts were less likely to use inpatient services at all, regardless of gender. The largest gender differences occurred among those aged 68-74.
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Short-term complications after sling surgery in women are higher among Medicare beneficiaries
— April 4, 2007
During the year after sling surgery among women, 65 and older, Medicare beneficiaries were found to have higher rates of complications than what has been reported in clinical literature. Data provided by the 1999-2001 Medicare Public Use Files provided information on 1,356 sling procedures. Patient race, age, and the presence of multiple diseases in the patient each had singnificant influences on outcomes.
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Few HIV-positive parents make formal guardianship arrangements for their children — Feb 12, 2007
A survey of a nationally representative sample of more than 200 unmarried parents who are HIV-infected examined the levels of guardianship they have planned for their children in the event of their death. Results also indicate that pediatricians may be key in providing referrals for guardianship planning.
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Chronically ill patients who receive higher quality care have better outcomes — Feb. 7, 2007
Better outpatient care has been linked to improved health outcomes among non-elderly adults with chronic illnesses, according to a recent study involving over 900 adults with conditions such as heart disease and diabetes. Patients who received even moderately better care showed improved quality in life. The study also found that the sickest patients were the most likely to receive recommended medical care, suggesting that doctors should increase the preventive care offered to chronically ill but stable patients.
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Ethnic variations in caregiving exists for minority elders with dementia — Dec. 19, 2006
Focus groups of caregivers from a variety of ethnicities reveal differing perspectives in caregiving and stigmas associated with dementia. Topics breeched included the benefits of caregiving, spirituality or religion to ease burdens, and language barriers. The proportion of minority elders with dementia in the U.S. is expected to rise in the coming years.
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Cataract surgery is found to be cost-effective for low-probability patients — 2006
Patients who have a low predicted probablity for improvement may still find cost-effective benefits from cataract surgery when compared against watchful waiting. This study monitored 250 patients who had a less than 30% probability of reporting improvements in post-operative visual function.
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Influenza outbreaks in nursing facilities is influenced by staff and resident immunizations — Nov 2006
Facilities having high percentages of staff and resident immunizations are less likely to have an influenza outbreak than counterpart facilities with lower immunization percentages. However, once an outbreak occurs, vaccination does not seem to reduce the negative effects of influenza.
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Research on improving care for heart failure rarely reforms services — Mar. 2006
Many patients suffering from chronic heart failure do not benefit from research demonstrating how to improve their care because the research rarely finds its way into routine clinical practice in the United States.
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Trajectory of end-stage heart failure — Mar. 2006
The authors explain the trajectory of patients with heart failure, illustrate the importance of advance care planning for these patients, discuss the impact of choices to use or forgo new technologies, and suggest ways to improve the care system.
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Improving end-of-life care — Jan. 2005
The U.S. health care system is ill-equiped to address the needs of a growing population with eventually fatal chronic illness. New models of care are needed.
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Related document
When to deactivate implantable cardioverter defibrillators — Dec. 2004
Implantable defibrillators can prevent premature death, but they can also unnecessarily prolong the process of dying. However, clinicians rarely discuss deactivating the defibrillator with patients.
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Hospice care tailored to ethnically diverse populations lags — Aug. 2004
Many hospices are making efforts to accommodate ethnically diverse patients, but a substantial number are not. Culturally appropriate care and outreach should be addressed in efforts to improve the acceptability and experience of hospice care among minorities.
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Sick to death and not going to take it anymore! — Aug. 2004
Many Americans will face prolonged illness and disability before death. This "owner's manual for the health care system," lays out facts, concepts, strategies, and plans for genuine reform and gives the reader new ways to imagine innovative possibilities and take steps to implement them.
Order book at ucpress.edu More research on end-of-life care
Integrating cancer therapy and palliative care — Jul. 2004
The artificial division between cancer therapy and palliative care is perhaps the most significant barrier to quality care at the end of life.
Journal abstract at jco.org More research on end-of-life care
Palliative care as a barrier to hospice admission — Apr. 2004
A study of admission policies among California hospices found that many factors, including receiving complex forms of palliative care such as parenteral nutrition therapy and refusal to forgo hospitalization, prevented admission to hospices. To improve access to hospice care, policy makers should consider more closely incorporating palliative care with other health care services.
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Hospice care raises Medicare cost for last year of life — Feb. 2004
Patients who choose hospice care cost the federal Medicare system more than patients who use only traditional medical care, a finding that is contrary to traditional views that hospice care is less costly to provide.
News release More research on end-of-life care
The mismatch of law, custom, and resuscitation decisions — Oct. 2003
This editorial in the Journal of American Geriatric Society argues that it's time to rethink how to evaluate resuscitation since the procedure was not developed for use with people in frail health at the end of life.
Journal abstract at blackwell-synergy.com More research on end-of-life care
Educating families of nursing home residents — Jun. 2003
In this pilot study, families of nursing home residents helped to design a computer system to educate family members about dementia, agitation/aggression, and caregiver strategies. Users' knowledge significantly increased, and they found the system easy to use. A complete curriculum of education is now under development.
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Better planning would reduce end-of-life suffering — Jun. 2003
Hospitals,
hospices, and emergency teams seldom coordinate to comply with patients'
decisions about end-of-life care. A new RAND study offers practical advice for both patients and clinicians on advance care planning.
Journal abstract at annals.org Related research brief More research on end-of-life care
Patterns of functional decline at the end of life — May 2003
This study examined how functional decline differs among 4 types of illness trajectories: sudden death, cancer death, death from organ failure, and frailty. The researchers found that trajectories of decline varied significantly. For example, individuals who died of cancer were highly functional early in the final year but more disabled 3 months before death; organ failure decedents experienced fluctuating decline.
Journal abstract at jama.org 
Journal reprint at jama.org More research on end-of-life care
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