• Kathryn A Frahm, Lisa M Brown, and Kathryn Hyer.
• School of Aging Studies, College of Behavioral and Community Sciences University of South Florida, Tampa, FL 33612, USA. kfrahm@usf.edu
• J Am Med Dir Assoc. 2012 Nov 1;13(9):819.e7-11.

ObjectiveThis study examined the relationship between race and advance directives, hospice services, and hospitalization at the end of life among deceased nursing home residents.DesignSecondary data analysis using the 2007 Minimum Data Set (MDS) was used to identify nursing home residents who died during the year, as well as to explore relationships between race and the study variables of interest.SettingUS nursing homes certified for Medicare or Medicaid reimbursement were included in the study.ParticipantsNursing home residents 65 years of age and older who had a completed MDS full assessment and one quarterly assessment, and died while residing in the facility during 2007.MeasurementsMDS documentation of advance directive measures, hospice use, and hospitalizations were assessed for white, black, Hispanic, and Asian residents with linear regression models fitted to each dependent variable (outcome) with "race" as the main predictor.ResultsAcross different types of advance directives, black, Hispanic, and Asian nursing home residents were significantly less likely to have these documented in their files. Compared with white residents, Asian residents were also significantly less likely to receive hospice services during their last year of life, whereas Hispanic residents were more likely to receive services. Finally, all racial groups were more likely to experience hospitalization within 90 days before death, regardless of whether they had documentation of a do not hospitalize order.ConclusionAs the racial profile of nursing home residents becomes more diverse, recognizing differences in end-of-life planning and treatment preferences, as well as the implementation of tailored programs for specific groups, will continue to increase in importance.Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

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