196844 End-of life care for older adults: Hospital deaths, bedside decisions, and lessons learned from a mixed methods approach

Wednesday, November 11, 2009: 12:45 PM

Brenda Ohta, PhD, MSG, MSW , Care Management, New York University Medical Center, New York, NY
Jennie Jacobs Kronenfeld, PhD , Sociology Program, School of Social and Family Dynamics, Arizona State University, Tempe, AZ
Purpose: Problems encountered regarding consistency/quality of care at the end of life are often multidimensional and multidisciplinary, necessitating a research design that is broad and integrative. This study, therefore, employed a mixed methods approach to explore both the determinants and processes impacting care for older adults at the end of life. Design and Methods: Within Maricopa County, Arizona, hospital utilization data were obtained for inpatient deaths (n=3,409) for individuals 65 and older in 2006. In addition, for this timeframe/ region, an ethnographic study was conducted at one major acute care hospital to provide an in-depth evaluation of processes related to end-of-life decision-making. The results were triangulated to validate/corroborate the statistical trends with the qualitative themes and vice versa. Triangulation further served to foster a broader, deeper interpretation of results. Results: Triangulated findings indicate that age, race/ethnicity, health insurance type, and hospital capacity were significantly related to levels of acute care utilization at the end of life, as well as to the processes affecting decision-making at the patient bedside. Implications: Advanced age, race/ethnicity, insurance, and hospital capacity play a significant role regarding intensity of care delivered, regardless of patient diagnosis or prognosis. Dynamics at the patient bedside reveal contention among and between families and health providers as negotiations ensue to foster decisions regarding withdrawal/withholding of life sustaining measures. These findings, possible via a mixed methods approach, yield implications related to cultural competence, evidence based practice, continuity/consistency in service delivery, and the impact of consumerism on decisions at the end of life.

Learning Objectives:
1. Articulate the impact of multi-level variables (from patient level to system level) on end-of-life hospital utilization in a Southwestern U.S. population. 2. Explain the dynamic of contention and how it may contribute to variation in care and delays related to decision-making during a terminal hospital admission. 3. Evaluate the benefits of a mixed methods research approach to evaluating care at the end-of-life, especially as relates to age, race/ ethnicity, hospital capacity, and insurance status.

Keywords: End-of-Life Care, Decision-Making

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted the original research, as well as have substantial applied and academic training and experience in this content area.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: End of Life Issues
See more of: Gerontological Health