Hospice Care Is Short and May Start Later Than Needed

Older adults are admitted to hospice for short duration despite experiencing symptoms months prior to the end of life, according to a Yale-led study. The finding highlights the need for earlier hospice admission or other strategies to address increasing symptoms and disability at the end of life, the researchers say.

The study was published on September 12 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 but died over the following 16 years. Of these individuals, 244 (43.4%) were admitted to hospice during the last year of life. They were slightly older and more likely to have cognitive impairments (problems thinking and making decisions) than older adults who weren't admitted to hospice.

The researchers found that cancer and advanced dementia were the conditions that most often resulted in hospice admission. Older adults who were frail were least likely to be admitted to hospice. The most common condition leading to death was frailty, followed by organ failure, advanced dementia, and cancer.

The study also found that the duration of hospice care was less than 13 days for one-half of the study participants. This short duration suggests that health care providers might need to consider discussing referrals to hospice sooner with people who are approaching the end of their lives. Alternatively, providers may need to develop and test other ways to reduce the high burden of distressing symptoms and disability at the end of life, the researchers says.

"Failing or delaying to refer older persons to hospice at the end of life can place a high burden on caregivers and result in patient suffering," says Thomas Gill, MD, the Humana Foundation Professor of Medicine and the study's first author.

Referral to hospice at the end of life should be based on an older adult's burden of pain and other distressing symptoms, the researchers suggest. Those symptoms include fatigue, nausea, depression, anxiety, difficulty sleeping, and difficulty with memory, among others.

Study authors are Thomas M. Gill, MD; Ling Han, MD; Linda Leo-Summers; Evelyne A. Gahbauer, MD; and Heather G. Allore.

The work for this report was funded by grants from the National Institute on Aging. The study was conducted at the Yale Claude D. Pepper Older Americans Independence Center.

Source: Journal of the American Geriatrics Society