A team of researchers from Yale University has studied how soon older adults who were experiencing distressing symptoms and disability were admitted to hospice near the end of their lives . Their study was published in the Journal of the American Geriatrics Society.
The researchers examined information from a study of 562 people, aged 70 and older, who were not disabled when the study began. Of these people, 244 (43.4 percent) were admitted to hospice during the last year of life. These people were slightly older and more likely to have cognitive impairments (problems thinking and making decisions) than those individuals who weren't admitted to hospice.
The most common condition leading to death was frailty (the medical term for physical weakness or an increasing likelihood for poor health), followed by organ failure (the term for certain parts of our body no longer working as they should), advanced dementia, and cancer.
The researchers found that cancer and advanced dementia were the conditions that most often resulted in being admitted for hospice care. Older adults who were frail were least likely to be admitted to hospice.
The duration of hospice care was less than 13 days for half of the study participants. The short duration of hospice suggests that healthcare providers might need to consider discussing referrals to hospice sooner with people who are approaching the end of their lives. Alternatively, we may need to develop and test other ways to reduce the high burden of distressing symptoms and disability at the end of life, said the researchers.
The researchers suggest that referral to hospice at the end of life should be based on an older adult's burden of pain and other distressing symptoms.
What do you think? Share your thoughts in the comments section below.
I am an OB nurse and have taken a leave to help care for my mother with terminal cancer. She is on hospice care at home and have been told she can only be admitted if there is 2 weeks left of life or for a 5 day respit for family. None of us know the hour or the day when our life will be over- hard to know when 2 weeks are left. It is very hard physically mentally and emotionally to care for your mother at end of life- at times I just want to be her daughter and be at her bedside to help her along this journey – not the caregiver with all the responsibility and making sure it is done right. There are people trained to care for those at end of life and their families – they should be utilized and all the restrictions of when to be admitted lifted. Would help to make the transition from this life to the next easier on all. No nurse can work a 24-48hr shift.
I work Long Term Care. The facility I work has residents who are on hospice care. Some are just starting their final journies; some are in the middle; some are nearing the the end. The residents who started on hospice care always seem to do better than the ones whose families decide (or, sometimes don’t) “at the last minute”. They are more prepared; more at ease; and, less likely to fight death at the very end. The doctors at the facility are pro-hospice when our residents are starting to show signs and symptoms of needing hospice care.
I am hoping that Medicre pays attention to the study and changes their restrictions.
Sadly we still live in a culture that does not deal with death comfortably and realistically. I think we are trying. It can be uncomfortable for family and healthcare workers alike. I think most mds take lead from family and patients and vice a versa. So when patients go on or into hospice it often late in the process. I love the idea that one nurse said that if a patient does not want to return to hospital then hospice was a good choice. It’s unfortunate that people think hospice is giving when it really is reclaiming yourself.and taking control. Maybe if working on a hospice unit or community hospice was basic part of medical and all health professionals education true change would happen.
I am a hospice nurse and agree with all the others. In my opinion, palliative care should be part of the hospice agency requiring more strict guidelines for palliative vs. hospice. Then move patient’s into hospice at the appropriate time. To me, that seems like a more seamless and natural transition.
It’s hard on us nurses too b/c we admit, and have no time to care for the patient when they die the next day. The system is difficult, especially on Friday afternoons;/
Healthcare and hospice is a 24/7 service. We are expected to admit quickly once referred. It can be challenging to meet the dying person’s needs as promptly as we would like, and what the patient deserves.
Transport at the very end-of-life should be avoided for the well being of the patient and family to provide comfort in the final days. Maybe acute care should start having floors for this….?? Hire hospice nurses and other practitioners that specialize in end-of-life;)
Thank you for the platform;)
I agree, elder care needs to be more focused on assisting these patients to access the programs they need sooner rather than later. Comfort & pain contol should be a priority.
As a hospice nurse, I see far to many patients come to us in a pre-active – active phase of dying. When this happens, we are unable to provide all the life enriching benefits of hospice care that patients and families require and deserve.
I agree with your assessment regarding physicians need for hospice education. Unfortunately, the biggest hurdles are Medicare Hospice Eligibility Guidelines. In a nutshell, we are no longer able to admit patients with a primary diagnosis of debility or non- Alzheimer’s Disease dementia. If you read the Eligibility Guidelines, they basically state a patient must be wel) on their way to dying before we can admit them, and still receive reimbursement.
In terms of non Alzheimer’s Disease dementia and debiliy our patients must be very near the end of life before they can be admitted, often days to a couple weeks. If a patient has cancer, they can come on service much earlier than Dementia or debility patients.
It’s hard to reconcile the 6 month prognosis rule and the Eligibility Guidelines that requires patients to be at deaths door (days to weeks) in order to recieve the Medicare hospice benefits that they have paid into most of their lives.
Thanks so much for your work in this area.
I agree, it shouldn’t be based on the diagnosis per say because Medicare has removed failure to thrive which an older frail adult fits into. The name Hospice still scares people as it’s human nature to fight until you just can’t anymore. That is why medical doctors need to be educated in end of life and how to have those discussions with there patients when they see the myriad of hospitalizations. I like the approach the following; If there were a way for nursing staff and doctors to take care of you at home without having to come back to the hospital would that be something you would like? Most people would.
I am a hospice nurse and we are getting patients admitted and with in hours or days they are gone. Doctors are keeping patients and not telling families that they are declining. Families are not getting time to prepare for what doctors know is going to happen if disease process continues.
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