Social Connectedness Among Nursing Home Residents with Dementia by Hospice Enrollment

Nursing home residents with dementia are at risk for social isolation, particularly in the time period preceding death. Whether hospice enrollment affects social connectedness in this vulnerable population is unclear.

Among nursing home residents with dementia, to describe the prevalence of social connectedness up to 3 months prior to death and to characterize the association of hospice enrollment with social connectedness.

Decedent cohort study of nursing home residents with dementia in the United States who died in 2018. Data sources include the Minimum Data Set 3.0, the Medicare Master Beneficiary Summary File and Hospice files.

Main outcome measure is the Social Connectedness Index, a validated measure of social connection in the nursing home based on behavioral symptoms, wandering and receipt of care (range 0-5; 5=socially connected). Multivariable logistic regression characterizes the association of hospice enrollment with social connectedness.

Of 212,253 nursing home decedents with dementia in 2018, 80.4% (n=170,566) were socially connected (SCI=5). In adjusted analysis, relative to not being enrolled in hospice, enrollment in hospice with an admitting diagnosis of dementia was associated with increased odds of being socially connected (adjusted odds ratio (AOR) 1.20; 95% confidence interval (95%CI) 1.16-1.23) but being in hospice for a primary diagnosis other than dementia was associated with decreased odds of social connectedness (AOR 0.92; 95% CI 0.89-0.94).

Social connectedness differed among nursing home decedents with dementia by hospice enrollment. Hospice enrollment plays an important role in quality of life for nursing home residents.