Background: Efforts to improve end-of-life care have increased during the last decade. The goals of these efforts include increasing patient autonomy, and reduction or more selective use of intensive medical interventions near the end of life. In this light, community to community variation in end-of-life practices is of great interest. Methods: We examined the use of feeding tubes among Kansas nursing home residents over the age of 65 between 1/1/94 and 6/30/98 (n=78,895), using the Minimum Data Set. Residents with very severe, persistent and irreversible cognitive impairment, as defined by Cognitive Performance Scale level 6 (n=4,847), were included in the study population. The location of nursing homes in urban, mid-sized, and rural counties was an independent variable. Results: Feeding tubes were used in 19.3% of the urban nursing home residents, 8.0% of the residents in mid-size counties, and 6.4% of the rural residents. The rate of feeding tube use was significantly higher in urban counties for most subpopulations, including men and women, whites and non-whites, and those eligible and ineligible for Medicaid. Discussion: Our findings suggest that there are important regional variations in end-of-life practices. The observed rural-urban differences in feeding tube use near the end of life may be associated with differences in access to surgical and/or nursing services, to differences in the relationships between providers and consumers of care in different communities, or to differences in rural and urban cultures. Qualitative research may be useful in clarifying the roles of each of these factors.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to: (1) contrast feeding tube use in rural, mid-size, and urban communities (2) list factors that may be associated with rural end-of-life care practices (3) identify three rural-urban differences in end-of-life care that need further research
Keywords: End-of-Life Care, Rural Health Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: none
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.