Where the Oldest Die Now

By May 4, 2012Blogging

Where the Oldest Die Now


I recently discovered this article and wanted to share it with you.  As a home health care provider I found it quite interesting but also disturbing.  Yes, people are living longer but the question is, what is their quality of life experience during these later years.  I recently spoke with an older gentleman who was passionate about not being sent to a hospital if he had an emergency situation.  He was convinced that the hospital experience renders the visitor worse off when they leave.  I have heard time and time again, we go in for one complaint and leave with several complications.  It sure compromises the trust and reliance one should have in the healthcare system designed to foster trust and reliance. To quote Astronaut James Lovell, “Houston, we have a problem”.

Where the Oldest Die Now

Always alert for a bit of good news about the sorry way so many older Americans die, I noticed a recent report from the Centers for Disease Control and Prevention. The agency’s statisticians looked at the deaths of people over 85 — 700,000 of them in 2007 — and where they occurred, and pointed out some encouraging trends.
The proportion of those very old people who died as hospital patients dropped to 29 percent in 2007 from 40 percent in 1989. During the same time period, the proportion who died at home climbed to 19 percent from 12 percent.
The full C.D.C. report shows similar trends in the broader population over age 65: a steadily declining proportion of deaths in hospitals (just over one-third in 2007, down from nearly half in 1989) and a rising proportion of deaths at home (24 percent in 2007, up from 15 percent in 1989).
That’s still a very low percentage, given how many people say they want to die in their homes. But it shows improvement, doesn’t it?
Not so fast, said Dr. Joan Teno, professor of community health and medicine at the Brown Medical School. She pointed out to me that the rates of very old people dying in nursing homes and other long-term care facilities have also increased, reaching 40 percent of those over age 85. If they were actually residents of the nursing homes in which they died, that may not be unhappy news.

But if people are being shuttled from home to hospital to nursing home (and possibly around again) during their last days and weeks, that’s nothing to celebrate. “Site-of-death data only tells you where you are at time of death, but nothing about the transitions leading to that point,” Dr. Teno said.
In The New England Journal of Medicine last year, Dr. Teno and her colleagues published an analysis of seven years of Medicare data on nearly half a million nursing home residents with advanced dementia, a terminal disease. Almost one in five experienced what the authors called “burdensome transitions” in their final days: transfers in the last three days of life, multiple hospitalizations, or moves from nursing home to hospital to a different nursing home.
So Dr. Teno is glad that more people were dying in their homes instead of in intensive care units. “Years ago, we just kept them in the hospital,” she said. Still, she added, “I don’t want to look only at where they die, but at the kind of care they get” in their last days and weeks.
Duly noted. The percentage of very old people dying at home increased by more than 50 percent over nearly two decades, but many are still denied the peaceful passage in familiar surroundings that we hope for, or perhaps fantasize about. One and a half cheers.

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