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A comprehensive study conducted by Rutgers Health, analyzing millions of Medicare records, has uncovered vital insights into the end-of-life trajectories of older Americans. The research, based on clinical records from a randomly selected 10 percent of the 2 million Medicare beneficiaries who passed away in 2018, has identified nine distinct trajectories that individuals follow in their last three years of life.
Published in BMC Geriatrics, the study aims to pave the way for improved end-of-life care by understanding and categorizing the diverse paths older Americans take in their final years. The research outlines three major care clusters – home, skilled home care, and institutional care – each containing three distinct trajectories.
Approximately 59 percent of patients fell into the “home” cluster, spending the majority of their last three years at home with support from friends and family. These patients received minimal professional care until the final year of life.
Another 27 percent of patients were in the “skilled home care” cluster, where nurses and skilled professionals provided assistance within their homes for most of their final three years.
The final 14 percent of patients were in the “institutional care” cluster, spending most of their last three years in hospitals or nursing homes, receiving essential care from paid professionals.
The researchers utilized a group-based trajectory modeling approach, examining associations between care trajectories and sociodemographic and health-related metrics. Patients in the skilled home care and institutional care clusters were more likely to be female, Black, enrolled in Medicaid, or suffering from dementia. Regional variations were also noted, with extensive use of skilled home care more prevalent in Southern states and institutional care more common in Midwestern states.
Haiqun Lin, lead author of the study and a professor of biostatistics at Rutgers, highlighted the importance of understanding these care patterns for advance care planning. Lin stated, “Understanding these patterns is crucial for advance care planning and ultimately for achieving the triple aim of improving care experiences, reducing care costs, and improving care quality.”
The study, the first in a series planned by the researchers, aims to delve deeper into the factors influencing care trajectories and develop interventions to help individuals follow their preferred path. The ultimate goal is not to dictate a particular type of care but to assist individuals in planning and receiving the care that aligns with their preferences.
Dr. Olga Jarrín, corresponding author of the study and Hunterdon Professor of Nursing Research at Rutgers, emphasized, “Our goal isn’t forcing people toward any particular type of care. It’s helping them to plan for and get the care that’s right for them.”
The research was supported by the National Institutes of Health’s National Institute on Aging, through grants R33AG068931 and R01AG066139.
