Differences in survival and healthcare utilization amongst nursing home residents with advanced dementia and frailty compared to other end-of-life conditions: a retrospective cohort study

Many nursing home residents suffer from advanced dementia and frailty. Describing their survival patterns and healthcare utilisation while under palliative care enables planning of palliative care services around their needs. We aimed to determine survival differences between nursing home residents with advanced dementia and frailty, incurable cancer and end-stage organ failure, as well as differences in healthcare utilisation in the last 6 months of life. A retrospective cohort study of 535 nursing home residents with end-of-life conditions enrolled in a palliative care programme between March 2022 to February 2024 and followed up until February 2025, using Kaplan-Meier survival curve analysis and Cox proportional hazards regression to determine survival and Chi-square test and one way Analysis of Variance (ANOVA) to examine differences in healthcare utilisation. There were 361 deaths. Median survival was longer for residents with advanced dementia and frailty (16.5 months, 95%CI:13.5–19.5 months, P < 0.001) compared to incurable cancer (8.1 months, 95%CI:5.1–11.1 months, P < 0.001) and end-stage organ failure (7.7 months, 95%CI:3.0-12.4 months, P < 0.001). Residents with incurable cancer (HR 1.62, 95%CI:1.18–2.22, P = 0.003) and end-stage organ failure (HR 1.63, 95%CI:1.15–2.33, P = 0.006) were more likely to die during follow-up. Residents with advanced dementia and frailty had fewer in-person reviews (2.4, P < 0.001) compared to those with incurable cancer (4.5, P < 0.001) and end-stage organ failure (3.2, P < 0.001). Hospitalisations and emergency department visits were similar across groups. Nursing home residents with advanced dementia and frailty live longer and receive fewer in-person reviews at the last 6 months of life than those with other end-of-life conditions. Providers of palliative care would need to adjust service planning and resource allocation for the longer follow-up period required for this group.