Associations between race and dementia status and the quality of end-of-life care

Elizabeth A. Luth, Holly G. Prigerson

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Non-Hispanic black and dementia patients receive more invasive and futile treatment at end of life (EOL) relative to others. Little is known about the relationship between race/ethnicity, dementia, and EOL care quality. Objective: Identify the relationship between race/ethnicity, dementia, and proxy reporters' evaluation of EOL care quality in older adults. Design: Latent class analysis (LCA) of national survey data. Setting: 1588 deceased Medicare beneficiaries age 65 and older from the National Health and Aging Trends Study (2011-2016). Measurements: LCA identified three types of quality EOL care using nine measures of symptom management, quality of healthcare encounters, and dignified treatment. Race and dementia were primary predictors of EOL care quality type. Adjusted models controlled for decedent education, sex, marital status, age, number of illnesses, number of hospitalizations, self-rated health, place of death, hospice involvement, and proxy relationship to decedent and familiarity with care. Results: Over 20% of proxies report that dying individuals experienced suboptimal EOL care quality, characterized by pain, sadness, poor communication, and inattention to personal care needs. In adjusted analyses, proxies for non-Hispanic black decedents were less likely to provide negative care assessments than proxies for non-Hispanic white decedents (adjusted odds ratio [AOR]: 0.58; 95% confidence interval [CI]: 0.40-0.86). Proxies for decedents with dementia were less likely to provide negative assessments than proxies for decedents without dementia (AOR: 0.70; 95% CI: 0.51-0.97). Implications: Efforts to improve EOL care quality are needed. More positive EOL care quality assessments for non-Hispanic Black and dementia decedents appear counterintuitive given research demonstrating that these groups of individuals are likely to have received suboptimal EOL care. Because caregiver expectations for care may differ by decedent race and dementia status, research is needed to explore the role of caregiver expectations for EOL care to explain these paradoxical findings.

Original languageEnglish (US)
Pages (from-to)970-977
Number of pages8
JournalJournal of palliative medicine
Issue number7
StatePublished - Jul 2018
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • General Nursing
  • Anesthesiology and Pain Medicine


  • care quality
  • dementia
  • proxy report
  • race/ethnicity


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