Language Preference Is Associated with Goals-of-Care Communication and End-of-Life Care in Dementia

Area of Science:

• Gerontology
• Public Health
• Health Services Research

Background:

• Communication barriers can impede high-quality end-of-life care for dementia patients with preferred languages other than English (PLOE) in the US.
• Understanding end-of-life care disparities is crucial for equitable healthcare delivery.

Purpose of the Study:

• To compare end-of-life care characteristics between dementia patients with PLOE and those preferring English.
• To identify potential disparities in care planning and utilization.

Main Methods:

• Retrospective cohort study of decedents with dementia from 2011-2021.
• Key measures included goals-of-care discussions, advance care planning (ACP) documents, hospital-based healthcare utilization, palliative care consultation, and place of death.
• Analysis compared outcomes for PLOE patients versus English-preferring patients.

Main Results:

• Among 7777 decedents, 9% had PLOE. PLOE patients were more likely to have documented goals-of-care discussions (62% vs. 45%).
• PLOE patients showed higher utilization of Emergency Department (ED) visits, hospital admissions, and intensive care unit (ICU) stays in the last 30 days of life.
• No significant differences were found in advance care planning (ACP) documentation or palliative care consultation frequency.

Conclusions:

• Dementia patients with PLOE experienced more documented goals-of-care discussions but higher hospital-based healthcare utilization near end-of-life.
• Further investigation is needed to determine if this high utilization is goal-discordant.
• Future interventions should focus on improving cultural and linguistic support for PLOE patients and their families to enhance end-of-life communication and care.