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End-of-Life Experience at Nursing Homes Differs With Race, Ethnicity

January 20, 2021

A systematic review identified racial/ethnic disparities in end-of-life care at nursing homes in areas such as advance care planning, hospitalization, and pain management. Researchers published their findings online in the Journal of the American Medical Directors Association. 

“To help reduce end-of-life disparities, language services and cultural competency training for staff should be available in nursing homes with higher proportions of racial/ethnic minorities,” advised researchers from the Columbia University School of Nursing. 

The systematic review spanned 18 articles, 16 of which were considered good quality and 15 of which contained data through 2010. 

Residents with terminal illness or approaching the end of life were not as likely to complete advance directives if they were from a racial/ethnic minority, researchers reported. Black residents were less likely to receive hospice care before death, while end-of-life hospitalizations were more likely among residents who were Hispanic or Black compared with non-Hispanic White.  

Moreover, pain and symptom management at the end of life was worse for residents from racial/ethnic minority groups, according to the study. End-of-life care differences were most apparent at facilities with higher proportions of Black residents.  

Study authors advised continued investigation into the subject. 

“Research is needed,” they wrote, “that uses recent data reflective of current nursing home demographic trends.” 

Jolynn Tumolo


Estrada LV, Agarwal M, Stone PW. Racial/Ethnic Disparities in Nursing Home End-of-Life Care: A Systematic Review [published online ahead of print, 2021 Jan 8]. J Am Med Dir Assoc. 2021;S1525-8610(20)31054-9. doi:10.1016/j.jamda.2020.12.005

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