Changes in Site of Death Among Older Adults Without a COVID-19 Diagnosis During the COVID-19 Pandemic.
J Gen Intern Med
; 39(4): 619-625, 2024 Mar.
Article
em En
| MEDLINE
| ID: mdl-37946020
ABSTRACT
BACKGROUND:
Understanding how the coronavirus disease 2019 (COVID-19) pandemic affected site of death-an important patient-centered outcome related to end-of-life care-would inform healthcare system resiliency in future public health emergencies.OBJECTIVE:
To evaluate the changes in site of death during the COVID-19 pandemic among older adults without a COVID-19 diagnosis.DESIGN:
Using a quasi-experimental difference-in-differences method, we estimated net changes in site of death during the pandemic period (March-December 2020) from the pre-pandemic period (January-February 2020), using data on the same months in prior years (2016-2019) as the control.PARTICIPANTS:
A 20% sample of Medicare Fee-for-Service beneficiaries aged 66 years and older who died in 2016-2020. We excluded beneficiaries with a hospital diagnosis of COVID-19. MAINMEASURES:
We assessed each of the following sites of death separately (1) home or community; (2) acute care hospital; and (3) nursing home. KEYRESULTS:
We included 1,133,273 beneficiaries without a hospital diagnosis of COVID-19. We found that the proportion of Medicare beneficiaries who died at home or in the community setting increased (difference-in-differences [DID] estimate, + 3.1 percentage points [pp]; 95% CI, + 2.6 to + 3.6 pp; P < 0.001) and the proportion of beneficiaries who died (without COVID-19 diagnosis) in an acute care hospital decreased (- 0.8 pp; 95% CI, - 1.2 to - 0.4 pp; P < 0.001) during the pandemic. We found no evidence that the proportion of deaths in nursing homes changed during the pandemic.CONCLUSIONS:
Using national data on older adults without a COVID-19 diagnosis, we found that site of death shifted toward home or community settings during the COVID-19 pandemic. Our findings may inform clinicians and policymakers in supporting end-of-life care during future public health emergencies.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Medicare
/
COVID-19
Limite:
Aged
/
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Gen Intern Med
Assunto da revista:
MEDICINA INTERNA
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Estados Unidos