For the 5.3 million older Americans with Alzheimer’s disease and related dementias (ADRD), end-of-life-care is increasingly marked by intensive medical treatments that are goal-discordant, confer no benefit, and likely cause harm. Compared to a decade ago, older adults with advanced dementia in the United States (US) are twice as likely to receive mechanical ventilation and be admitted to the ICU without substantial improvement in survival. There is a lack of research describing the systemic and cultural drivers of burdensome care, which I define as ICU admission, ICU level treatments such as vasopressors or mechanical ventilation, and resuscitation amongst older adults with ADRD near the end of life.
Comparisons between the US, France, and the United Kingdom (UK), countries that have lower rates of aggressive end of life care in comparison to the US, are useful in determining modifiable drivers of burdensome care. By identifying practices that are common or accepted in one country, but not in the other, we can bring a different perspective onto typical practices and identify innovative practices that exist in one country that could be introduced in other national contexts to modify the culture of burdensome care.
The long-term goal is to design, pilot, and implement hospital systems-level interventions that successfully shift institutional culture to mitigate burdensome treatments for older adults with ADRD near the end of life. The objective of this project is to identify factors at the institutional level that contribute to burdensome treatments in older adults with ADRD near the end of life in the US, UK, and France.