Resource Use During the Last 6 Months of Life of Individuals Dying with and of Alzheimer's Disease

OBJECTIVES: To compare resource use during the last 6 months of life of individuals diagnosed with Alzheimer's disease (AD) but for whom AD was not formally identified as the underlying cause of death (dying with AD) with that of those who had AD as underlying cause of death (dying of AD).

DESIGN: Full-population retrospective analysis.

SETTING: Belgium.

PARTICIPANTS: All Belgian decedents in 2012.

MEASUREMENTS: We linked participants' healthcare, population, and death certificate data. Those who died of AD were selected based on underlying cause of death. Those who died with AD were selected using a validated algorithm.

RESULTS: Individuals who died of AD had less hospital use than those who died with AD; were less often admitted to a palliative care unit but received palliative home care services slightly more often; and had use of physiotherapy, noninvasive ventilation, medical imaging, sedatives, oxygen, and opioids comparable with that of those who died with AD.

CONCLUSION: During the last 6 months of life, individuals dying of AD used fewer intensive resources such as intensive care unit, cardiopulmonary resuscitation, and invasive ventilation than those dying with AD, which suggests the effect of recognition of an end-of-life phase. Overall, individuals with AD rarely used palliative care services, suggesting a need for more efforts to encourage use of palliative care in individuals with AD.