Race/ethnic differences in end-of-life care: Podcast with Rashmi Sharma and Zhi Jia
We have made remarkable progress in reducing the use of feeding tubes for patients with advanced dementia.\xa0 This has been due to the leadership of people like Susan Mitchell and Joan Teno, among others.\xa0 One might hope that this reduction in use of feeding tubes has been in part due to advance care planning discussions that helped align care and treatment with patients goals.\xa0\xa0
How then, do we explain the concerning findings in a pair of recent papers demonstrating high rates of mechanical ventilation among patients with dementia?\xa0 In today\u2019s podcast, we talk with Rashmi Sharma, who in JAGS found that rates of mechanical ventilation rose from 4% to 12% among whites with advanced dementia and 9% to 22% among blacks between 2001 and 2014.\xa0 One in five blacks with advanced dementia admitted from a nursing home received mechanical ventilation.\xa0 That\u2019s startling.\xa0\xa0
And Zhi Jia found in a Medicare sample that Asians were more likely to receive mechanical ventilation than whites, and disparities were higher for older Asians with dementia compared to cancer.\xa0\xa0
We have made progress, due to the leadership of GeriPal superstars.\xa0 But even as we make progress in feeding tubes, it doesn\u2019t seem to have translated across the board to mechanical ventilation, a burdensome and potentially non-beneficial treatment for patients with dementia.\xa0 The fact that rates are highest among older blacks and Asians is particularly concerning. Though the reasons behind this are complex, it\u2019s likely that structural racism plays a major role in these growing inequalities.\xa0\xa0
We have more work to do.
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