Hospice use and outcomes in nursing home residents with advanced dementia

Dan K. Kiely, Jane L. Givens, Michele L. Shaffer, Joan Teno, Susan L. Mitchell

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Objectives: To identify characteristics of nursing home (NH) residents with advanced dementia and their healthcare proxies (HCPs) associated with hospice referral and to examine the association between hospice use and the treatment of pain and dyspnea and unmet needs during the last 7 days of life. Design: Prospective cohort study. Setting: Twenty-two Boston-area NHs. Participants: Three hundred twenty-three NH residents with advanced dementia and their HCPs. Measurements: Data were collected at baseline and quarterly for up to 18 months. Hospice referral, frequency of pain and dyspnea, and treatment of these symptoms was ascertained. HCPs reported unmet needs during the last 7 days of the residents' lives for communication, information, emotional support, and help with personal care. Results: Twenty-two percent of residents were referred to hospice. After multivariable adjustment, factors associated with hospice referral were nonwhite race, eating problems, HCP's perception that the resident's had less than 6 months to live, and better HCP mental health. Residents in hospice were more likely to receive scheduled opioids for pain (adjusted odds ratio (AOR)=3.16; 95% confidence interval (95% CI)=1.57-6.36) and oxygen, morphine, scopolamine, or hyoscyamine for dyspnea (AOR=3.28, 95% CI=1.37-7.86). HCPs of residents in hospice reported fewer unmet needs in all domains during the last 7 days of the residents' life. Conclusion: A minority of NH residents with advanced dementia received hospice care. Hospice recipients were more likely to received scheduled opioids for pain and symptomatic treatment for dyspnea and had fewer unmet needs at the end of life.

Original languageEnglish (US)
Pages (from-to)2284-2291
Number of pages8
JournalJournal of the American Geriatrics Society
Volume58
Issue number12
DOIs
StatePublished - Dec 1 2010
Externally publishedYes

Fingerprint

Hospices
Nursing Homes
Dementia
Proxy
Dyspnea
Delivery of Health Care
Pain
Referral and Consultation
Opioid Analgesics
Hyoscyamine
Odds Ratio
Confidence Intervals
Social Adjustment
Hospice Care
Scopolamine Hydrobromide
Morphine
Mental Health
Cohort Studies
Therapeutics
Eating

Keywords

  • Alzheimer's disease
  • dementia
  • hospice
  • nursing homes
  • palliative care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Hospice use and outcomes in nursing home residents with advanced dementia. / Kiely, Dan K.; Givens, Jane L.; Shaffer, Michele L.; Teno, Joan; Mitchell, Susan L.

In: Journal of the American Geriatrics Society, Vol. 58, No. 12, 01.12.2010, p. 2284-2291.

Research output: Contribution to journalArticle

Kiely, Dan K. ; Givens, Jane L. ; Shaffer, Michele L. ; Teno, Joan ; Mitchell, Susan L. / Hospice use and outcomes in nursing home residents with advanced dementia. In: Journal of the American Geriatrics Society. 2010 ; Vol. 58, No. 12. pp. 2284-2291.
@article{c24fe966df574803b499786a8e9fe55c,
title = "Hospice use and outcomes in nursing home residents with advanced dementia",
abstract = "Objectives: To identify characteristics of nursing home (NH) residents with advanced dementia and their healthcare proxies (HCPs) associated with hospice referral and to examine the association between hospice use and the treatment of pain and dyspnea and unmet needs during the last 7 days of life. Design: Prospective cohort study. Setting: Twenty-two Boston-area NHs. Participants: Three hundred twenty-three NH residents with advanced dementia and their HCPs. Measurements: Data were collected at baseline and quarterly for up to 18 months. Hospice referral, frequency of pain and dyspnea, and treatment of these symptoms was ascertained. HCPs reported unmet needs during the last 7 days of the residents' lives for communication, information, emotional support, and help with personal care. Results: Twenty-two percent of residents were referred to hospice. After multivariable adjustment, factors associated with hospice referral were nonwhite race, eating problems, HCP's perception that the resident's had less than 6 months to live, and better HCP mental health. Residents in hospice were more likely to receive scheduled opioids for pain (adjusted odds ratio (AOR)=3.16; 95{\%} confidence interval (95{\%} CI)=1.57-6.36) and oxygen, morphine, scopolamine, or hyoscyamine for dyspnea (AOR=3.28, 95{\%} CI=1.37-7.86). HCPs of residents in hospice reported fewer unmet needs in all domains during the last 7 days of the residents' life. Conclusion: A minority of NH residents with advanced dementia received hospice care. Hospice recipients were more likely to received scheduled opioids for pain and symptomatic treatment for dyspnea and had fewer unmet needs at the end of life.",
keywords = "Alzheimer's disease, dementia, hospice, nursing homes, palliative care",
author = "Kiely, {Dan K.} and Givens, {Jane L.} and Shaffer, {Michele L.} and Joan Teno and Mitchell, {Susan L.}",
year = "2010",
month = "12",
day = "1",
doi = "10.1111/j.1532-5415.2010.03185.x",
language = "English (US)",
volume = "58",
pages = "2284--2291",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - Hospice use and outcomes in nursing home residents with advanced dementia

AU - Kiely, Dan K.

AU - Givens, Jane L.

AU - Shaffer, Michele L.

AU - Teno, Joan

AU - Mitchell, Susan L.

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Objectives: To identify characteristics of nursing home (NH) residents with advanced dementia and their healthcare proxies (HCPs) associated with hospice referral and to examine the association between hospice use and the treatment of pain and dyspnea and unmet needs during the last 7 days of life. Design: Prospective cohort study. Setting: Twenty-two Boston-area NHs. Participants: Three hundred twenty-three NH residents with advanced dementia and their HCPs. Measurements: Data were collected at baseline and quarterly for up to 18 months. Hospice referral, frequency of pain and dyspnea, and treatment of these symptoms was ascertained. HCPs reported unmet needs during the last 7 days of the residents' lives for communication, information, emotional support, and help with personal care. Results: Twenty-two percent of residents were referred to hospice. After multivariable adjustment, factors associated with hospice referral were nonwhite race, eating problems, HCP's perception that the resident's had less than 6 months to live, and better HCP mental health. Residents in hospice were more likely to receive scheduled opioids for pain (adjusted odds ratio (AOR)=3.16; 95% confidence interval (95% CI)=1.57-6.36) and oxygen, morphine, scopolamine, or hyoscyamine for dyspnea (AOR=3.28, 95% CI=1.37-7.86). HCPs of residents in hospice reported fewer unmet needs in all domains during the last 7 days of the residents' life. Conclusion: A minority of NH residents with advanced dementia received hospice care. Hospice recipients were more likely to received scheduled opioids for pain and symptomatic treatment for dyspnea and had fewer unmet needs at the end of life.

AB - Objectives: To identify characteristics of nursing home (NH) residents with advanced dementia and their healthcare proxies (HCPs) associated with hospice referral and to examine the association between hospice use and the treatment of pain and dyspnea and unmet needs during the last 7 days of life. Design: Prospective cohort study. Setting: Twenty-two Boston-area NHs. Participants: Three hundred twenty-three NH residents with advanced dementia and their HCPs. Measurements: Data were collected at baseline and quarterly for up to 18 months. Hospice referral, frequency of pain and dyspnea, and treatment of these symptoms was ascertained. HCPs reported unmet needs during the last 7 days of the residents' lives for communication, information, emotional support, and help with personal care. Results: Twenty-two percent of residents were referred to hospice. After multivariable adjustment, factors associated with hospice referral were nonwhite race, eating problems, HCP's perception that the resident's had less than 6 months to live, and better HCP mental health. Residents in hospice were more likely to receive scheduled opioids for pain (adjusted odds ratio (AOR)=3.16; 95% confidence interval (95% CI)=1.57-6.36) and oxygen, morphine, scopolamine, or hyoscyamine for dyspnea (AOR=3.28, 95% CI=1.37-7.86). HCPs of residents in hospice reported fewer unmet needs in all domains during the last 7 days of the residents' life. Conclusion: A minority of NH residents with advanced dementia received hospice care. Hospice recipients were more likely to received scheduled opioids for pain and symptomatic treatment for dyspnea and had fewer unmet needs at the end of life.

KW - Alzheimer's disease

KW - dementia

KW - hospice

KW - nursing homes

KW - palliative care

UR - http://www.scopus.com/inward/record.url?scp=78650118171&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78650118171&partnerID=8YFLogxK

U2 - 10.1111/j.1532-5415.2010.03185.x

DO - 10.1111/j.1532-5415.2010.03185.x

M3 - Article

VL - 58

SP - 2284

EP - 2291

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 12

ER -