Kenji Sekiguchi1, Christina L Bell, Kamal H Masaki, Daniel J Fischberg. 1. 1 The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii , Honolulu, Hawaii.
Abstract
BACKGROUND: Despite palliative care implementation, most deaths still occur in hospitals. OBJECTIVES: To identify factors associated with in-hospital death among elderly patients receiving palliative care, by site of consultation. DESIGN: Prospective observational study. SETTING/ SUBJECTS: All inpatients aged 65 years and older receiving pain and palliative care consultations in a 533-bed acute tertiary care hospital in Honolulu, Hawaii, from January 2005 through December 2009. MEASUREMENTS: During consultation, demographics, diagnoses, consultation site (intensive care unit [ICU], non-ICU medical, non-ICU surgical, and rehabilitation floors), consultation indication (assistance with establishing goals of care versus pain and/or symptom management), Karnofsky scores, length of stay (LOS), discharge disposition, and in-hospital death were collected. Multiple logistic regression analyses examined factors associated with in-hospital death. RESULTS: Of 1630 elderly inpatients receiving palliative care, 305 (19%) died in-hospital. In-hospital death among non-ICU medical patients was associated with needing consultation to assist with plan of care (odds ratio [OR]=1.89, 95% confidence interval [CI]=1.27-2.80). Likelihood of in-hospital death increased 2% for each additional hospital day before consultation (OR=1.02, 95% CI=1.01-1.03). Among elderly ICU patients, likelihood of in-hospital death increased 8% for each additional hospital day before consultation (OR=1.08, 95% CI=1.01-1.16). CONCLUSION: Among elderly non-ICU medical patients receiving palliative care consultations, the need for a consultation to assist with plan of care was associated with in-hospital death, while length of stay prior to consultation was important among both elderly ICU and non-ICU medical patients. Elderly hospitalized patients may benefit from earlier identification and palliative care consultation for assistance with plan of care to avoid in-hospital death.
BACKGROUND: Despite palliative care implementation, most deaths still occur in hospitals. OBJECTIVES: To identify factors associated with in-hospital death among elderly patients receiving palliative care, by site of consultation. DESIGN: Prospective observational study. SETTING/ SUBJECTS: All inpatients aged 65 years and older receiving pain and palliative care consultations in a 533-bed acute tertiary care hospital in Honolulu, Hawaii, from January 2005 through December 2009. MEASUREMENTS: During consultation, demographics, diagnoses, consultation site (intensive care unit [ICU], non-ICU medical, non-ICU surgical, and rehabilitation floors), consultation indication (assistance with establishing goals of care versus pain and/or symptom management), Karnofsky scores, length of stay (LOS), discharge disposition, and in-hospital death were collected. Multiple logistic regression analyses examined factors associated with in-hospital death. RESULTS: Of 1630 elderly inpatients receiving palliative care, 305 (19%) died in-hospital. In-hospital death among non-ICU medical patients was associated with needing consultation to assist with plan of care (odds ratio [OR]=1.89, 95% confidence interval [CI]=1.27-2.80). Likelihood of in-hospital death increased 2% for each additional hospital day before consultation (OR=1.02, 95% CI=1.01-1.03). Among elderly ICU patients, likelihood of in-hospital death increased 8% for each additional hospital day before consultation (OR=1.08, 95% CI=1.01-1.16). CONCLUSION: Among elderly non-ICU medical patients receiving palliative care consultations, the need for a consultation to assist with plan of care was associated with in-hospital death, while length of stay prior to consultation was important among both elderly ICU and non-ICU medical patients. Elderly hospitalized patients may benefit from earlier identification and palliative care consultation for assistance with plan of care to avoid in-hospital death.
Authors: B Taylor Thompson; Peter N Cox; Massimo Antonelli; Jean M Carlet; Joan Cassell; Nicholas S Hill; Charles J Hinds; Jorge M Pimentel; Konrad Reinhart; Lambertus G Thijs Journal: Crit Care Med Date: 2004-08 Impact factor: 7.598
Authors: Sofía García-Sanjuán; Manuel Fernández-Alcántara; Violeta Clement-Carbonell; Concepción Petra Campos-Calderón; Núria Orts-Beneito; María José Cabañero-Martínez Journal: Front Psychol Date: 2022-01-13