End-of-Life Transitions among Nursing Home Residents with Cognitive Issues

Among nursing home residents with cognitive impairment, burdensome transitions between the nursing home and the hospital or hospice during the last months of life were common, varied according to state, and were associated with a poor quality of care. Health care transitions, such as the hospitalization of nursing home residents, have the potential for fragmentation of care, changes in the management of chronic diseases, duplication of diagnostic workups, and medical errors. 1 – 7 Few previous reports have described health care transitions among nursing home residents who had advanced cognitive impairment. These patients and their family members are especially vulnerable to the adverse consequences resulting from transitions, particularly during end-of-life care. Pertinent sources of distress include the trauma of the physical transfer, increased confusion because of unfamiliar settings and providers, inadequate ability to address the patient's special needs (e.g., assistance with . . .