2013-02-06-Hospice-care-rises-but-so-do-treatments-in-final-days-of-care_ST_U.xml
^$^Twice as many elderly people died in hospice as in a hospital or nursing home compared with a decade ago, but hospice is often treated as a last resort -- and used too late to benefit patients and their families, a study said Tuesday.
Researchers examined Medicare records for 840,000 people 66 or older who died in 2000, 2005 and 2009. They found intensive-care use, hospitalization and health care transitions increased in the last month of life before patients entered hospice.
Hospice aims to address the physical, emotional, social and spiritual needs of dying patients and their families and to control pain, says the study's lead author, Joan Teno, a palliative care physician and professor at Warren Alpert School of Medicine at Brown University in Providence.
But this study shows that "for many patients, hospice is an add-on to a very aggressive pattern of care during the last days of life," she says. "We suspect they and their families didn't get the support they needed."
More than a quarter of hospice use in 2009 was for three days or less; 40% of those late referrals followed an intensive-care stay.
The study is in The Journal of the American Medical Association.
An accompanying editorial calls for an end to aggressive treatment at the end of life by improving communication between patients and physicians and considering a "threshold of likely benefit and life expectancy for ICU admissions."
"We need to improve the care system so people are spending more than a day or two in hospice," says David Goodman, director of the Center for Health Policy Research at Dartmouth in Hanover, N.H. "Comfort, being in a familiar setting with family and pets is what it should be all about."
Other highlights of the study:
The percentage of dying seniors using hospice was 42.2% in 2009, up from 21.6% in 2000.
People dying of cancer were more likely than those with dementia or chronic obstructive pulmonary disease to use hospice.
The percentage of people with dementia who spent time in intensive care in their last month of life rose from 18.6% in 2000 to 21.8% in 2009. Days spent in intensive care also increased.
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