GENDER DIFFERENCES IN HEALTH CARE AT THE END OF LIFE

老年女性和男性在哪里死亡，哪些因素与他们在生命末期和死亡地点的医疗保健利用有关？在他们最近的报告中，老龄化研究联盟（1998:7）呼吁使用1993年全国死亡率跟踪调查（NMFS）“询问老年妇女和男子关于临终经历的重要未解问题，并确定临终者未满足的需求。”本研究拟使用1993年的NMFS来达到以下目的：(1)描述临终关怀的性别差异，包括生命最后一年在医院的时间长短，生命最后一年在疗养院居住的时间长短和死亡地点；(2)评估与男性和女性在生命最后一年使用卫生服务的类型和数量、临终关怀的使用和死亡地点相关的因素；(3)确定卫生服务利用和死亡地点的性别差异是否因社会经济地位、种族/民族、婚姻状况、其他家庭关系特征以及是否有家庭成员作为照顾者而不同。拟议研究的优势在于其成本效益，能够同时评估死亡地点（例如，家庭、养老院或医院）的决定因素，并测试与性别和其他人口特征相关的相互作用效应。来自NMFS的数据提供了一个前所未有的机会来研究与老年男性和女性随机样本的护理模式和死亡地点相关的因素。这个具有全国代表性的大样本的额外好处是它的黑人样本和关于死者病史的丰富数据，包括疾病和残疾，以及死者是否有生前遗嘱。本回顾性队列研究将为男性和女性临终关怀的前瞻性研究奠定基础。这一研究议程有望为旨在改善临终关怀的社会干预提供新的可能性。

Where do older women and men die, and what factors are associated with their healthcare utilization at the end-of-life and site of death? In their recent report, the Alliance for Aging Research (1998:7) calls for the use of the 1993 National Mortality Followback Survey (NMFS) "to ask important unanswered questions about end-of-life experiences for older women and men and to determine unmet needs of dying people." The proposed study uses the 1993 NMFS to accomplish the following aims: (1) to describe gender differences in end-of-life care including length of time in a hospital in the last year of life, length of time residing in a nursing home in the last year of life, and site of death; (2) to assess factors associated with the type and amount of health service use for men and women in the last year of life, use of hospice care, and of site of death; (3) to determine whether gender differences in health service utilization and site of death vary by socioeconomic status, race/ethnicity, marital status, characteristics of other family ties, and the availability of a family member as a caregiver. The strengths of the proposed study are its cost effectiveness, the ability to simultaneously assess the determinants of site of death (e.g., home, nursing home, or hospital) and to test for interaction effects associated with gender and other demographic characteristics. Data from the (NMFS) provide an unprecedented opportunity to study factors associated with patterns of care and site of death for a random sample of older men and women. Additional benefits of this large nationally-representative sample are its oversample of Blacks and the wealth of data on the decedent's medical history including diseases and disability and whether the decedent had a living will. This retrospective cohort study will set the stage for a prospective study of men's and women's end-of-life care. This research agenda promises to raise new possibilities for social interventions designed to improve end- of-life care.