• J Am Geriatr Soc · Jun 2021

    Survival in hospice patients with dementia: the effect of home hospice and nurse visits.

    • Elizabeth A Luth, David J Russell, Jiehui Cici Xu, Bonnie Lauder, Miriam B Ryvicker, Ritchell R Dignam, Rosemary Baughn, Kathryn H Bowles, and Holly G Prigerson.
    • Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
    • J Am Geriatr Soc. 2021 Jun 1; 69 (6): 1529-1538.

    BackgroundHospice 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.ObjectiveExamine how home hospice and nurse visit frequency relate to dying in hospice within the Medicare-intended 6-month period.DesignRetrospective cohort study.SettingNon-profit hospice agency.ParticipantsThree thousand eight hundred and thirty seven patients with dementia who received hospice services from 2013 to 2017.MethodsMultivariable 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.ResultsThirty-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).ConclusionNearly 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.© 2021 The American Geriatrics Society.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…