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Do Community and Caregiver Factors Influence Hospice Use at the End of Life Among Older Adults With Alzheimer Disease?

Karikari-Martin, Pauline MPH, MSN, RN; McCann, Judith J. PhD, RN; Hebert, Liesi E. ScD; Haffer, Samuel C. PhD; Phillips, Marcia PhD, RN

Journal of Hospice & Palliative Nursing: May 2012 - Volume 14 - Issue 3 - p 225–237
doi: 10.1097/NJH.0b013e3182433a15
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Hospice is an underused service among people with Alzheimer disease. This study used the Hospice Use Model to examine community, care recipient, and caregiver characteristics associated with hospice use before death among 145 community-dwelling care recipients with Alzheimer disease and their caregivers. Secondary analysis using logistic regression modeling indicated that older age, male gender, black race, and better functional health of care recipients with Alzheimer disease were associated with a decreased likelihood of using hospice (model χ25 = 23.5, P = .0003). Moreover, care recipients recruited from an Alzheimer clinic were more likely to use hospice than those recruited from adult day-care centers. Caregiver factors were not independent predictors of hospice use. However, there was a significant interaction between hours of care provided each week and recruitment site. Among care recipients from the Alzheimer clinic, the probability of hospice use increased as caregiving intensity increased. This relationship was reversed in care recipients from day-care centers. Results suggest that adult day-care centers need to partner with hospice programs in the community. In conclusion, care recipient and community service factors influence hospice use in individuals with Alzheimer disease.

Pauline Karikari-Martin, MPH, MSN, RN, is Doctoral Student, College of Nursing, Rush University Medical Center, Chicago, Illinois; US Public Health Service, Rockville, Maryland; Centers for Medicare & Medicaid Services, Baltimore, Maryland.

Judith J. McCann, PhD, RN, is Professor, College of Nursing, Rush Institute for Healthy Aging, Rush UniversityMedical Center, Chicago, Illinois.

Liesi E. Hebert, ScD, is Assistant Professor, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois.

Samuel C. Haffer, PhD, is Senior Statistician and Program Manager, Centers for Medicare & Medicaid Services, Baltimore, Maryland.

Marcia Phillips, PhD, RN, is Assistant Professor, College of Nursing, Rush University Medical Center, Chicago, Illinois.

Address correspondence to Pauline Karikari-Martin, MPH, MSN, RN,College of Nursing, Rush University, 6152 Camelback Ln, Columbia, MD 21045 (pauline_karikari-martin@Rush.edu; pauline.karikarimartin@cms.hhs.gov).

The authors have no conflict of interest to disclose.

This study was supported by the Longitudinal Study of Day Care in Alzheimer’s Disease (R01 AG10315).

This article was accomplished by authors Ms Karikari-Martin’s and Dr Haffer’s personal capacity. The opinions expressed in this article are the authors’ own and do not reflect the views of the Centers for Medicare & Medicaid Services, the Department of Health and Human Services, the US Government, College of Nursing, Rush University Medical Center, Chicago, IL, or Rush Institute for Healthy Aging.

© 2012 The Hospice and Palliative Nurses Association