End-of-life care in U.S. nursing homes: a review of the evidence

J Am Med Dir Assoc. 2004 May-Jun;5(3):147-55. doi: 10.1097/01.JAM.0000123063.79715.8E.


Objectives: The purpose of this study was to systematically review the empiric evidence on end-of-life care in nursing homes in the United States The guiding research question for this review was what is the state of research evidence in end-of-life care in long-term care?

Design: We conducted a systematic review of the literature.

Data: The review was limited to published and indexed research in peer-reviewed journals in five major databases between 1995 and October 2002.

Results: The initial search yielded a total of 395 articles. The search was narrowed, focusing on nursing homes in the United States and empiric research. The result was 43 articles related to research in end-of-life care in American nursing homes. It was categorized into eight foci: prognosis, pain, hospice, hospitalization, advanced care planning, communication, family perceptions, and miscellaneous.

Conclusion: There is a dearth of research published in end-of-life care in the nursing home setting. What is available is primarily descriptive. The empiric research only documents poor end-of-life care in U.S. nursing homes. Empiric evidence has grown in this area, but there is now a need for research of creative and innovative solutions aimed at improving the quality of end-of-life care in this setting.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Advance Directives
  • Aged
  • Aged, 80 and over
  • Health Services Research
  • Homes for the Aged / standards*
  • Hospice Care / standards*
  • Humans
  • Long-Term Care / standards
  • Nursing Evaluation Research
  • Nursing Homes / standards*
  • Outcome Assessment, Health Care
  • Palliative Care / standards*
  • Quality Assurance, Health Care
  • Quality of Life
  • Terminal Care / standards*
  • United States