 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Diane Dewar, PhD, Department of Health Policy, Management, and Behavior, School of Public Health--University at Albany, One University Place, Rensselaer, NY 12144-3456, 518-402-0290, ddewar@albany.edu and James Lambrinos, PhD, Graduate Managment Institute, Union College, Lamont House, Schenectady, NY 12308.
This paper determines whether elderly women in critical care settings are more likely to have social worker support, health care proxies and DNR orders than elderly men at the end of life, controlling for clinical risk factors and delivery system changes. Medical record data from a large regional hospital during 1995-1997 was collected for approximately 100 patients who died during the hospital episode. Data include detailed information concerning diagnostic patterns, treatment chronology, consultations, DNR orders and health care proxy indicators that are not available on statewide public use files. Qualitative information was also gathered concerning patients’ social support network, reasons for social worker consultations, and provider perceptions of care that could affect utilization. Logistic regression models were used to predict the likelihood of social worker intervention for these patients; as well as the likelihood of DNR orders or health care proxies, controlling for physician and clinical characteristics. Results show that although women have more utilization of social worker interventions, they are less likely to have DNR orders or health care proxies noted. This information identifies the roles of patient advocacy and social support variations on health care utilization as hospital resources become more restricted. These findings can be used to identify policies that can improve the coordination of end of life care for the elderly, particularly for those in high cost, critical care settings.
Learning Objectives:
Keywords: Aging, End-of-Life Care
Presenting author's disclosure statement:
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.