Higher Rates of End-of-Life Health Care Utilization Among OAs With Limited English Proficiency

Higher rates of end-of-life health care utilization were reported among older adults (OAs) with limited English proficiency and serious illness.

With inadequate information available on palliative care use and end-of-life health care utilization among OAs with limited English proficiency and serious illness, researchers conducted a retrospective analysis that included seriously ill adults aged 65 years and older.

The OAs included in the analysis came from a large health system, were with and without limited English proficiency, and died between 2010 and 2018.

Study authors reported primary outcomes as measures of health care utilization in the last 30 and 180 days of life: emergency department (ED) visits, intensive care unit admission, hospitalization, and 30-day readmission. Advance care planning documents and palliative care consultation were secondary outcomes.

The study included 18,490 decedents of which 1363 had limited English proficiency, who were older at the time of death (median age 80 vs 77 years), more likely to be female (48% vs 44%), of Asian descent (64% vs 4%), of Hispanic ethnicity (10% vs 2%), with <12th grade education (38% vs 9%), and covered by Medicaid (36% vs 6%).

Findings showed patients with limited English proficiency experienced higher odds of ED  visits  (33% vs 20%; aOR 1.41, 95% CI 1.26-1.72; P < .001), readmission (12% vs 8%; aOR 1.64, 95% CI 1.30-2.07; P < .001), and in-hospital death (45% vs 37%; aOR 1.24, 95% CI 1.07-1.44; P = .005) in the last 30 days of life when compared to patients without limited English proficiency.

In patients’ last 180-days of life, findings were similar. In the last month of life only 14% of patients with limited English proficiency and 10% of those without received palliative care consultation.

Furthermore, when compared to patients without limited English proficiency, patients with limited English proficiency were less likely to have advance care planning documents (36% vs 40%; aOR 0.68, 95% CI 0.50-0.80; P < .001).

“Additional research is needed to identify drivers of these differences and inform linguistically- and culturally-appropriate interventions to improve end-of-life care in this population,” concluded study authors.

Reference:
Abedini NC, Downey L, Engelberg RA, Curtis R, Sharma RK. End-of-life health care utilization and palliative care use among older adults with limited English proficiency. J Am Geriatr Soc. Published online June 7, 2022. doi:10.1111/jgs.17913