Family Structure and Location Shape End-of-Life Acute Care Use in Nursing Homes

Area of Science:

• Gerontology and Palliative Care
• Health Services Research
• Rural Health Disparities

Background:

• End-of-life (EOL) care in nursing homes (NHs) exhibits persistent gaps, with significant rural-urban disparities.
• Family availability and structure vary across settings, potentially influencing care utilization for NH residents.

Purpose of the Study:

• To examine how rural versus urban settings and first-degree family structure relate to EOL acute care utilization.
• To assess NH residents who died in NHs, focusing on hospitalization and emergency department (ED) use.

Main Methods:

• Retrospective cohort study of 42,806 individuals aged 65+ who died in rural or urban NHs.
• Linked NH residents to 122,655 first-degree family members.
• Used regression models to estimate inpatient hospitalization and ED use in the last 1 and 6 months of life, analyzing location and family structure as predictors.

Main Results:

• Rural residents showed higher ED utilization (1 and 6 months) and 1-month hospitalization compared to urban residents.
• Family structure, particularly the presence of a spouse or spouse with children, correlated with higher hospitalization rates.
• Family structure moderated rural-urban differences, with lower hospitalization for residents with only children in rural facilities.

Conclusions:

• End-of-life (EOL) acute care utilization among nursing home residents is influenced by geographic location and family structure.
• Tailoring EOL care to specific family and geographic contexts is crucial for improving care quality.
• Leveraging telehealth for palliative care and family engagement may reduce burdensome utilization and warrants further research.