TY - JOUR
T1 - Patterns of functional decline in hospice
T2 - What can individuals and their families expect?
AU - Harris, Pamela
AU - Wong, Esther
AU - Farrington, Sue
AU - Craig, Teresa R.
AU - Harrold, Joan K.
AU - Oldanie, Betty
AU - Teno, Joan M.
AU - Casarett, David J.
PY - 2013/3
Y1 - 2013/3
N2 - Objectives To describe the trajectory of functional decline after an individual is referred to hospice. Design Electronic health record-based retrospective cohort study. Setting Three hospice programs in the U.S. southeast, northeast, and midwest. Participants Individuals in hospice. Main outcome measures Palliative Performance Scale (PPS) scores measured at intervals between hospice enrollment and death, on a scale from 10 to 100. Results In 8,669 decedents, there was an average 13.8-point decline in PPS score. After adjusting for baseline PPS score and length of stay in hospice, three distinct trajectories were identified, each of which consisted of two diagnoses whose rates of decline had 95% confidence intervals (CIs) that overlapped. The most rapid decline was observed for individuals with cancer (adjusted decline 8.44 points/wk; 95% CI = 8.03-8.82) and stroke (adjusted decline 7.67 points/wk, 95% CI = 7.08-8.29). A significantly slower decline was observed in individuals with pulmonary disease (adjusted decline 5.02 points/wk, 95% CI = 4.24-5.75) and cardiac disease (adjusted decline 4.53 points/wk, 95% CI = 4.05-5.05). Individuals with debility (adjusted decline 1.86 points/wk, 95% CI = 0.95-2.78) and dementia (adjusted decline 1.98 points/wk, 95% CI = 1.01-2.89) had the slowest decline. In an inverse probability-weighted sample of individuals who had a PPS score recorded in the last day of life (n = 1,959, 22.6%), 35.9% had a PPS score of at least 40, indicating some oral intake, variable mental status, limited self-care, and an ability to get out of bed for at least part of the day. Conclusion Although functional status generally declines in individuals in hospice, this decline is heterogeneous. Some individuals retain some physical and cognitive function until the last day of life.
AB - Objectives To describe the trajectory of functional decline after an individual is referred to hospice. Design Electronic health record-based retrospective cohort study. Setting Three hospice programs in the U.S. southeast, northeast, and midwest. Participants Individuals in hospice. Main outcome measures Palliative Performance Scale (PPS) scores measured at intervals between hospice enrollment and death, on a scale from 10 to 100. Results In 8,669 decedents, there was an average 13.8-point decline in PPS score. After adjusting for baseline PPS score and length of stay in hospice, three distinct trajectories were identified, each of which consisted of two diagnoses whose rates of decline had 95% confidence intervals (CIs) that overlapped. The most rapid decline was observed for individuals with cancer (adjusted decline 8.44 points/wk; 95% CI = 8.03-8.82) and stroke (adjusted decline 7.67 points/wk, 95% CI = 7.08-8.29). A significantly slower decline was observed in individuals with pulmonary disease (adjusted decline 5.02 points/wk, 95% CI = 4.24-5.75) and cardiac disease (adjusted decline 4.53 points/wk, 95% CI = 4.05-5.05). Individuals with debility (adjusted decline 1.86 points/wk, 95% CI = 0.95-2.78) and dementia (adjusted decline 1.98 points/wk, 95% CI = 1.01-2.89) had the slowest decline. In an inverse probability-weighted sample of individuals who had a PPS score recorded in the last day of life (n = 1,959, 22.6%), 35.9% had a PPS score of at least 40, indicating some oral intake, variable mental status, limited self-care, and an ability to get out of bed for at least part of the day. Conclusion Although functional status generally declines in individuals in hospice, this decline is heterogeneous. Some individuals retain some physical and cognitive function until the last day of life.
KW - functional status
KW - hospice
KW - prognosis
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U2 - 10.1111/jgs.12144
DO - 10.1111/jgs.12144
M3 - Article
C2 - 23347201
AN - SCOPUS:84875209863
SN - 0002-8614
VL - 61
SP - 413
EP - 417
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 3
ER -