TORONTO — A study of nursing home residents with advanced dementia found that men were more likely to be hospitalized, physically restrained and receive invasive treatment than women in the last 30 days of life.
The study was conducted by Ontario non-profit research institute ICES and found that men were also more likely to die in an acute-care facility, instead of their nursing home.
Researchers say it points to gender biases that are known to occur more broadly in health care, in which men are often offered more aggressive treatment than women with similar conditions. intravenously and mechanical ventilation
Lead author Dr. Nathan Stall says that while such interventions might be welcome earlier in life, they are often avoidable and distressing later in life and may not provide comfort if the patient is near death.
Senior author Dr. Paula Rochon says the findings also highlight the need for people to discuss their end-of-life wishes with loved ones and caregivers.
The study looked at the experiences of 27,243 nursing home residents with advanced dementia who died between June 1, 2010, and March 31, 2015. It was published in medical journal JAMA Network Open on Friday.
While people with milder stages of dementia can be quite functional, Stall said those in the advanced stages may have profound memory impairment and generally need help with most, if not all, of the basic activities of daily living — including grooming, bathing, dressing and eating.
“The care should generally be focused at this stage on maximizing quality of life,” Stall said Friday.
“But what was really striking about our findings were that compared to women, men were much more likely to experience any of these burdensome interventions and to die in acute care.”
He noted that men were 41 per cent more likely to be transferred to an emergency department or hospital, and had 33 per cent increased odds of receiving antibiotics.
While many factors are likely at play, researchers point to gender biases that are known to pervade health care generally.
The study cited another paper on people who complained about osteoarthritis, finding that even when presenting similar symptoms, men were more likely to be offered a joint replacement, while women were more likely to be offered physical therapy and supportive therapy.
Stall said another issue is that many people may not necessarily perceive advanced dementia as a terminal condition. As a result, many with advanced dementia do not receive optimal palliative care.
In Canada, approximately 564,000 people were living with dementia in 2016, a number that is expected to increase to 937,000 by 2031.
Most people with dementia are older adults, two-thirds of whom are women.
Cassandra Szklarski, The Canadian Press