Survival in hospice patients with dementia: the effect of home hospice and nurse visits.
J Am Geriatr Soc
; 69(6): 1529-1538, 2021 06.
Article
en En
| MEDLINE
| ID: mdl-33608869
ABSTRACT
BACKGROUND:
Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospice, or experiences a live discharge or long length of stay.OBJECTIVE:
Examine how home hospice and nurse visit frequency relate to dying in hospice within the Medicare-intended 6-month period.DESIGN:
Retrospective cohort study.SETTING:
Non-profit hospice agency.PARTICIPANTS:
Three thousand eight hundred and thirty seven patients with dementia who received hospice services from 2013 to 2017.METHODS:
Multivariable survival analyses examined the effects of receiving home hospice (vs. nursing home) and timing of nurse visits on death within 6 months of hospice enrollment, compared to live discharge or long length of stay. Models adjust for relevant demographic and clinical factors.RESULTS:
Thirty-nine percent (39%) of patients experienced live discharge or long length of stay. Home hospice patients were more likely to experience live discharge or long length of stays (HR for death 0.77, 95%CI 0.69-0.86, p < 0.001). Frequency of nurse visits was inversely associated with live discharge and long lengths of stay (HR for death 2.87, 95%CI 2.47-3.33, p < 0.001).CONCLUSION:
Nearly 40% of patients with dementia in our study experienced live discharge or a long length of stay. Additional research is needed to understand why home hospice may result in live discharge or a long length of stay for patients with dementia. Nurse visits were associated with death, suggesting their responsiveness to deteriorating patient health. Hospice guidelines may need to permit longer stays so community-dwelling patients with dementia, a growing segment of hospice patients, can remain continuously enrolled in hospice and avoid burden and costs associated with live discharge.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Alta del Paciente
/
Cuidados Paliativos al Final de la Vida
/
Demencia
/
Servicios de Atención de Salud a Domicilio
Tipo de estudio:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged80
/
Female
/
Humans
/
Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Am Geriatr Soc
Año:
2021
Tipo del documento:
Article
País de afiliación:
Estados Unidos