A Rutgers Health analysis of millions of Medicare records has laid the groundwork for improving end-of-life care by demonstrating that nearly all older Americans follow one of nine trajectories in their last three years of life.

“Identifying which paths people actually take is a necessary precursor to identifying which factors send different people down different paths and designing interventions that send more people down whatever path is right for them,” said Olga Jarrín (PhD, RN, FAAN), the Hunterdon Professor of Nursing Research at Rutgers School of Nursing and corresponding author of the study published in BMC Geriatrics.

“Our study not only identifies different patterns of care but also sheds light on the clinical and policy factors that dictate where and when patients receive care,” said School of Nursing Professor Haiqun Lin (PhD), the study’s lead author.

The team pulled the final three years of clinical records from a randomly selected 10 percent of all 2 million Medicare beneficiaries who died in 2018. Analysis of how much personal care each patient received and where they received care revealed three major care clusters – home, skilled home care, and institutional care. Each cluster contains three distinct trajectories.