Knowing the trajectories of death can help in better planning end of life care.
A research analysis of Medicare records in the US has revealed that almost all older Americans follow one of nine trajectories in their last three years of life. Will you spend your final years at home, in a nursing home, or elsewhere?
“Identifying which paths people actually take is essential for identifying the factors that guide them, and designing interventions that lead more people down the right path for them,” said Olga Jarrín, the Hunterdon Professor of Nursing Research at Rutgers and the study’s corresponding author published in BMC Geriatrics.
The study examined the clinical records of 2 million Medicare beneficiaries who died in 2018. The analysis revealed three major care clusters: home, skilled home care, and institutional care, each containing three distinct trajectories.
Approximately 59% of patients fell into the “home” cluster, receiving minimal professional care until the last year of life and relying on friends and family for assistance. Another 27% received “skilled home care,” with the help of nurses and skilled professionals, while the final 14% were in “institutional care” and spent most of their final three years in hospitals or nursing homes.
The study also found that various sociodemographic and health-related metrics were associated with different care trajectories, highlighting disparities based on gender, race, and geographic location.
The study’s authors plan to base future research on their analysis, looking for the key factors that direct people down each trajectory and interventions that will help more people adhere to their preferred path.
According to Jarrín, most people prefer to stay at home with minimal professional help, while a minority seeks professional care to avoid being a burden on family and friends. “Our goal isn’t forcing people towards any particular type of care. It’s helping them to plan for and get the care that’s right for them,” she said.
