Profiles of older medicare decedents

J Am Geriatr Soc. 2002 Jun;50(6):1108-12. doi: 10.1046/j.1532-5415.2002.50268.x.


Objectives: To evaluate the usefulness of a clinical scheme to classify older decedents to better understand the issues associated with healthcare use and costs in the last year of life.

Design: We analyzed Medicare claims data for a random sample of 0.1% of all Medicare beneficiaries with expenditures between 1993 and 1998. This sample yielded 7,966 deaths.

Setting: Medicare claims data.

Participants: Medicare beneficiaries.

Measurements: We classified decedents into groups representing four trajectories at the end of life: sudden death, terminal illness, organ failure, and frailty.

Results: Ninety-two percent of decedents were captured by the profiling strategy. The four trajectory groups had distinct patterns of demographics, care delivery, and Medicare expenditures. Frailty was a dominant pattern, with 47% of all decedents, whereas sudden death claimed only 7%; cancer claimed 22%, and organ system failure, 16%.

Conclusions: The clinical scheme to classify decedents appears to fit most decedents and to form groups with substantial clinical differences. Acknowledging the differences among these groups may be a fruitful way to evaluate expenditures and develop strategies to improve care at the end of life.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cause of Death
  • Death, Sudden / epidemiology
  • Female
  • Frail Elderly / statistics & numerical data
  • Health Expenditures
  • Humans
  • Male
  • Medicare / economics*
  • Terminal Care / economics*
  • Terminal Care / statistics & numerical data
  • Terminally Ill / statistics & numerical data*
  • United States