What Do We Know About Hospice Enrollment for Nursing Home Residents with Cognitive Disabilities? A Systematic Review.
Victoria M Winogora, Patricia W Stone, Kimberlee Grier et al.
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In 30 seconds
This systematic review examined hospice enrollment among US nursing home residents with cognitive disabilities. The authors searched four databases for peer-reviewed English-language studies published before February 28, 2025, and included 12 studies. In seven studies, a substantial proportion of nursing home decedents with cognitive disabilities had not enrolled in hospice. Across studies, enrollment varied but was consistently lower for decedents with cognitive disabilities than for those without. Factors associated with greater enrollment included female sex, White race, a terminal diagnosis other than cognitive disability, and higher dementia prevalence in the nursing home.
Key findings
- Twelve studies met the review’s inclusion criteria.
- In seven of the 12 studies, a substantial proportion of nursing home decedents with cognitive disabilities were not enrolled in hospice.
- Hospice enrollment was consistently lower among nursing home decedents with cognitive disabilities than among those without, although it varied across studies.
- Greater enrollment was associated with female sex, White race, a terminal diagnosis other than cognitive disability, and higher nursing-home dementia prevalence.
Why it matters
The findings indicate a potential disparity in access to hospice for nursing home residents with cognitive disabilities, a population for whom end-of-life care needs may be difficult to identify and address. Recognizing differences in enrollment and the factors associated with it can help frame research into barriers and inform efforts to improve equitable access to symptom-focused, quality-of-life care.
What to keep in mind
The review included only 12 studies, and enrollment varied across them; the abstract does not report pooled estimates.