Language Preference Is Associated with Goals-of-Care Communication and End-of-Life Care in Dementia.

Abstract

People with dementia and preferred language other than English (PLOE) in the United States may face communication-related barriers to high-quality end-of-life care. Compare end-of-life care characteristics among people with dementia and PLOE versus those preferring English. Retrospective cohort study. Decedents with dementia (2011-2021). (1) Documentation of a goals-of-care discussion, (2) presence of advance care planning (ACP) documents, (3) hospital-based healthcare utilization, (3) palliative care consultation, (4) in-hospital death. Among 7777 decedents, 725 (9%) had PLOE and 7052 (91%) preferred English. The median age at death was 84 years and about half of patients were female. Those with PLOE were more likely to have a documented goals-of-care discussion in the 6 months preceding death compared to those preferring English (62% versus 45%, adjusted risk difference 0.08; 95% CI 0.04-0.13). In the last 30 days of life, those with PLOE were more likely to visit the Emergency Department (ED), be admitted to the hospital or intensive care unit, and die in-hospital (adjusted risk difference 0.09 95% CI 0.04-0.14, 0.06 95% CI 0.01-0.11, 0.06 95% CI 0.02-0.09, 0.11 95% CI 007-0.14 respectively). Differences in frequency of ACP documentation and palliative care consultation were not detected. Decedents with dementia and PLOE were more likely to have documented goals-of-care discussions and similarly likely to have ACP documents and palliative care consultation, yet had higher hospital-based healthcare utilization near end-of-life. Future studies should investigate whether high healthcare utilization is goal-discordant for this group. Future efforts to improve end-of-life care for those with PLOE might prioritize ED and hospital-based interventions, recognizing their critical safety-net functions, as well as ensure that people with dementia and PLOE and their families have sufficient cultural and linguistic support to engage in high-quality end-of-life communication with their healthcare providers.