Daniel E Lage1, Clark DuMontier2,3, Yoojin Lee4,5, Ryan D Nipp1, Susan L Mitchell3, Jennifer S Temel1, Areej El-Jawahri1, Sarah D Berry3. 1. Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts. 2. Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 3. Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, Massachusetts. 4. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island. 5. Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island.
Abstract
BACKGROUND: This study examined factors associated with potentially burdensome end-of-life (EOL) transitions between care settings among older adults with advanced cancer in nursing homes (NHs). METHODS: A retrospective analysis of deceased older NH residents with poor-prognosis solid tumors was conducted with Medicare claims and the Minimum Data Set. A potentially burdensome transition was defined as 2 or more hospitalizations or an intensive care unit admission in the last 90 days of life. RESULTS: Among 34,670 subjects, many had moderate to severe cognitive impairment (53.8%), full dependence in activities of daily living (ADLs; 66.5%), and comorbidities such as congestive heart failure (CHF; 29.3%) and chronic obstructive pulmonary disease (34.1%). Only 56.3% of the patients used hospice at any time in the 90 days before death; 36.0% of the patients experienced a potentially burdensome EOL transition, and this was higher among patients who did not receive hospice (45.4% vs 28.7%; P < .01). In multivariable analyses, full dependence in ADLs (odds ratio [OR], 1.70; P < .01), CHF (OR, 1.48; P < .01), and chronic obstructive pulmonary disease (OR, 1.28; P < .01) were associated with a higher risk of burdensome EOL transitions. Those with do-not-resuscitate directives (OR, 0.60; P < .01) and impaired cognition (OR, 0.89; P < .01) had lower odds of burdensome EOL transitions. CONCLUSIONS: NH residents with advanced cancer have substantial comorbidities and functional impairment, yet more than a third experience potentially burdensome EOL transitions. These findings help to identify a population at risk for poor EOL outcomes in order to target interventions, and they point to the importance of advanced care planning in this population.
BACKGROUND: This study examined factors associated with potentially burdensome end-of-life (EOL) transitions between care settings among older adults with advanced cancer in nursing homes (NHs). METHODS: A retrospective analysis of deceased older NH residents with poor-prognosis solid tumors was conducted with Medicare claims and the Minimum Data Set. A potentially burdensome transition was defined as 2 or more hospitalizations or an intensive care unit admission in the last 90 days of life. RESULTS: Among 34,670 subjects, many had moderate to severe cognitive impairment (53.8%), full dependence in activities of daily living (ADLs; 66.5%), and comorbidities such as congestive heart failure (CHF; 29.3%) and chronic obstructive pulmonary disease (34.1%). Only 56.3% of the patients used hospice at any time in the 90 days before death; 36.0% of the patients experienced a potentially burdensome EOL transition, and this was higher among patients who did not receive hospice (45.4% vs 28.7%; P < .01). In multivariable analyses, full dependence in ADLs (odds ratio [OR], 1.70; P < .01), CHF (OR, 1.48; P < .01), and chronic obstructive pulmonary disease (OR, 1.28; P < .01) were associated with a higher risk of burdensome EOL transitions. Those with do-not-resuscitate directives (OR, 0.60; P < .01) and impaired cognition (OR, 0.89; P < .01) had lower odds of burdensome EOL transitions. CONCLUSIONS:NH residents with advanced cancer have substantial comorbidities and functional impairment, yet more than a third experience potentially burdensome EOL transitions. These findings help to identify a population at risk for poor EOL outcomes in order to target interventions, and they point to the importance of advanced care planning in this population.
Authors: Daniel E Lage; Daryl J Caudry; D Clay Ackerly; Nancy L Keating; David C Grabowski Journal: Ann Intern Med Date: 2018-02-13 Impact factor: 25.391
Authors: Joan M Teno; Pedro L Gozalo; Julie P W Bynum; Natalie E Leland; Susan C Miller; Nancy E Morden; Thomas Scupp; David C Goodman; Vincent Mor Journal: JAMA Date: 2013-02-06 Impact factor: 56.272
Authors: C Falandry; B Weber; A-M Savoye; F Tinquaut; O Tredan; E Sevin; L Stefani; F Savinelli; M Atlassi; J Salvat; E Pujade-Lauraine; G Freyer Journal: Ann Oncol Date: 2013-09-22 Impact factor: 32.976
Authors: Gabriel A Brooks; Ling Li; Hajime Uno; Michael J Hassett; Bruce E Landon; Deborah Schrag Journal: Health Aff (Millwood) Date: 2014-10 Impact factor: 6.301
Authors: Djin L Tay; Katherine A Ornstein; Huong Meeks; Rebecca L Utz; Ken R Smith; Caroline Stephens; Mia Hashibe; Lee Ellington Journal: J Palliat Med Date: 2021-08-27 Impact factor: 2.947
Authors: Stephanie Nothelle; Amy S Kelley; Talan Zhang; David L Roth; Jennifer L Wolff; Cynthia Boyd Journal: J Am Geriatr Soc Date: 2022-04-30 Impact factor: 7.538