Survival in hospice patients with dementia: the effect of home hospice and nurse visits
Background Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospi...
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| Veröffentlicht in: | Journal of pain and symptom management 2021-06, Vol.69 (6), p.1529-1538 |
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| creator | Luth, Elizabeth A. Russell, David J. Xu, Jiehui Cici Lauder, Bonnie Ryvicker, Miriam B. Dignam, Ritchell R. Baughn, Rosemary Bowles, Kathryn H. Prigerson, Holly G. |
| description | Background
Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospice, or experiences a live discharge or long length of stay.
Objective
Examine how home hospice and nurse visit frequency relate to dying in hospice within the Medicare‐intended 6‐month period.
Design
Retrospective cohort study.
Setting
Non‐profit hospice agency.
Participants
Three thousand eight hundred and thirty seven patients with dementia who received hospice services from 2013 to 2017.
Methods
Multivariable survival analyses examined the effects of receiving home hospice (vs. nursing home) and timing of nurse visits on death within 6 months of hospice enrollment, compared to live discharge or long length of stay. Models adjust for relevant demographic and clinical factors.
Results
Thirty‐nine percent (39%) of patients experienced live discharge or long length of stay. Home hospice patients were more likely to experience live discharge or long length of stays (HR for death: 0.77, 95%CI: 0.69–0.86, p |
| doi_str_mv | 10.1111/jgs.17066 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8192457</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2586552866</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4716-1c3a6b3653f09c3b0bfcb6a19bd9f187fba915bc305848a02a7f5df46d8888af3</originalsourceid><addsrcrecordid>eNp9kU1LXDEUhoNUdKou_AMl0I1d3Jl836QLQYbWKkIXKi5Dbm7iZLgf0-TeGfz3jR0dasGeTXLIk4dzeAE4xWiKc82Wj2mKSyTEHphgTknBGeYfwAQhRAopMDsEH1NaIoQJkvIAHFIq8kWoCXi4HeM6rE0DQwcXfVoF6-DKDMF1Q4KbMCxg7drcBPMVDgsHnffODrD3mW7d7ovpatiNMTm4DikM6Rjse9Mkd_JyHoH779_u5j-Km5-XV_OLm8KyEosCW2pERQWnHilLK1R5WwmDVVUrj2XpK6MwryxFXDJpEDGl57Vnopa5jKdH4HzrXY1V62qbJ42m0asYWhOfdG-CfvvShYV-7NdaYkUYL7Pg7EUQ-1-jS4NuQ7KuaUzn-jFpwhRWjCOmMvr5H3TZj7HL62nCpeCcSCH-T1FFSi7ks-vLlrKxTyk6vxsZI_0cqs6h6j-hZvbT3zvuyNcUMzDbApvQuKf3Tfr68nar_A23savs</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2539275689</pqid></control><display><type>article</type><title>Survival in hospice patients with dementia: the effect of home hospice and nurse visits</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elsevier ScienceDirect Journals</source><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><creator>Luth, Elizabeth A. ; Russell, David J. ; Xu, Jiehui Cici ; Lauder, Bonnie ; Ryvicker, Miriam B. ; Dignam, Ritchell R. ; Baughn, Rosemary ; Bowles, Kathryn H. ; Prigerson, Holly G.</creator><creatorcontrib>Luth, Elizabeth A. ; Russell, David J. ; Xu, Jiehui Cici ; Lauder, Bonnie ; Ryvicker, Miriam B. ; Dignam, Ritchell R. ; Baughn, Rosemary ; Bowles, Kathryn H. ; Prigerson, Holly G.</creatorcontrib><description>Background
Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospice, or experiences a live discharge or long length of stay.
Objective
Examine how home hospice and nurse visit frequency relate to dying in hospice within the Medicare‐intended 6‐month period.
Design
Retrospective cohort study.
Setting
Non‐profit hospice agency.
Participants
Three thousand eight hundred and thirty seven patients with dementia who received hospice services from 2013 to 2017.
Methods
Multivariable survival analyses examined the effects of receiving home hospice (vs. nursing home) and timing of nurse visits on death within 6 months of hospice enrollment, compared to live discharge or long length of stay. Models adjust for relevant demographic and clinical factors.
Results
Thirty‐nine percent (39%) of patients experienced live discharge or long length of stay. Home hospice patients were more likely to experience live discharge or long length of stays (HR for death: 0.77, 95%CI: 0.69–0.86, p < 0.001). Frequency of nurse visits was inversely associated with live discharge and long lengths of stay (HR for death: 2.87, 95%CI: 2.47–3.33, p < 0.001).
Conclusion
Nearly 40% of patients with dementia in our study experienced live discharge or a long length of stay. Additional research is needed to understand why home hospice may result in live discharge or a long length of stay for patients with dementia. Nurse visits were associated with death, suggesting their responsiveness to deteriorating patient health. Hospice guidelines may need to permit longer stays so community‐dwelling patients with dementia, a growing segment of hospice patients, can remain continuously enrolled in hospice and avoid burden and costs associated with live discharge.
See related editorial by Hunt et al. in this issue.</description><identifier>ISSN: 0002-8614</identifier><identifier>ISSN: 0885-3924</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.17066</identifier><identifier>PMID: 33608869</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Aged, 80 and over ; Caregivers - psychology ; Death ; Dementia ; Dementia - mortality ; Dementia disorders ; Female ; Home Care Services - statistics & numerical data ; Home health care ; hospice ; Hospice care ; Hospice Care - statistics & numerical data ; Humans ; Length of stay ; Length of Stay - statistics & numerical data ; Life expectancy ; live discharge ; long length of stay ; Male ; Medicare - economics ; nurse visits ; Nursing care ; Nursing Homes - statistics & numerical data ; Patient Discharge ; Patients ; Retrospective Studies ; Survival ; Time Factors ; United States</subject><ispartof>Journal of pain and symptom management, 2021-06, Vol.69 (6), p.1529-1538</ispartof><rights>2021 The American Geriatrics Society</rights><rights>2021 The American Geriatrics Society.</rights><rights>2021 American Geriatrics Society and Wiley Periodicals LLC</rights><rights>Copyright Elsevier Limited Oct 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4716-1c3a6b3653f09c3b0bfcb6a19bd9f187fba915bc305848a02a7f5df46d8888af3</citedby><cites>FETCH-LOGICAL-c4716-1c3a6b3653f09c3b0bfcb6a19bd9f187fba915bc305848a02a7f5df46d8888af3</cites><orcidid>0000-0003-1496-1235</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgs.17066$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgs.17066$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27903,27904,30978,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33608869$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luth, Elizabeth A.</creatorcontrib><creatorcontrib>Russell, David J.</creatorcontrib><creatorcontrib>Xu, Jiehui Cici</creatorcontrib><creatorcontrib>Lauder, Bonnie</creatorcontrib><creatorcontrib>Ryvicker, Miriam B.</creatorcontrib><creatorcontrib>Dignam, Ritchell R.</creatorcontrib><creatorcontrib>Baughn, Rosemary</creatorcontrib><creatorcontrib>Bowles, Kathryn H.</creatorcontrib><creatorcontrib>Prigerson, Holly G.</creatorcontrib><title>Survival in hospice patients with dementia: the effect of home hospice and nurse visits</title><title>Journal of pain and symptom management</title><addtitle>J Am Geriatr Soc</addtitle><description>Background
Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospice, or experiences a live discharge or long length of stay.
Objective
Examine how home hospice and nurse visit frequency relate to dying in hospice within the Medicare‐intended 6‐month period.
Design
Retrospective cohort study.
Setting
Non‐profit hospice agency.
Participants
Three thousand eight hundred and thirty seven patients with dementia who received hospice services from 2013 to 2017.
Methods
Multivariable survival analyses examined the effects of receiving home hospice (vs. nursing home) and timing of nurse visits on death within 6 months of hospice enrollment, compared to live discharge or long length of stay. Models adjust for relevant demographic and clinical factors.
Results
Thirty‐nine percent (39%) of patients experienced live discharge or long length of stay. Home hospice patients were more likely to experience live discharge or long length of stays (HR for death: 0.77, 95%CI: 0.69–0.86, p < 0.001). Frequency of nurse visits was inversely associated with live discharge and long lengths of stay (HR for death: 2.87, 95%CI: 2.47–3.33, p < 0.001).
Conclusion
Nearly 40% of patients with dementia in our study experienced live discharge or a long length of stay. Additional research is needed to understand why home hospice may result in live discharge or a long length of stay for patients with dementia. Nurse visits were associated with death, suggesting their responsiveness to deteriorating patient health. Hospice guidelines may need to permit longer stays so community‐dwelling patients with dementia, a growing segment of hospice patients, can remain continuously enrolled in hospice and avoid burden and costs associated with live discharge.
See related editorial by Hunt et al. in this issue.</description><subject>Aged, 80 and over</subject><subject>Caregivers - psychology</subject><subject>Death</subject><subject>Dementia</subject><subject>Dementia - mortality</subject><subject>Dementia disorders</subject><subject>Female</subject><subject>Home Care Services - statistics & numerical data</subject><subject>Home health care</subject><subject>hospice</subject><subject>Hospice care</subject><subject>Hospice Care - statistics & numerical data</subject><subject>Humans</subject><subject>Length of stay</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Life expectancy</subject><subject>live discharge</subject><subject>long length of stay</subject><subject>Male</subject><subject>Medicare - economics</subject><subject>nurse visits</subject><subject>Nursing care</subject><subject>Nursing Homes - statistics & numerical data</subject><subject>Patient Discharge</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Survival</subject><subject>Time Factors</subject><subject>United States</subject><issn>0002-8614</issn><issn>0885-3924</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNp9kU1LXDEUhoNUdKou_AMl0I1d3Jl836QLQYbWKkIXKi5Dbm7iZLgf0-TeGfz3jR0dasGeTXLIk4dzeAE4xWiKc82Wj2mKSyTEHphgTknBGeYfwAQhRAopMDsEH1NaIoQJkvIAHFIq8kWoCXi4HeM6rE0DQwcXfVoF6-DKDMF1Q4KbMCxg7drcBPMVDgsHnffODrD3mW7d7ovpatiNMTm4DikM6Rjse9Mkd_JyHoH779_u5j-Km5-XV_OLm8KyEosCW2pERQWnHilLK1R5WwmDVVUrj2XpK6MwryxFXDJpEDGl57Vnopa5jKdH4HzrXY1V62qbJ42m0asYWhOfdG-CfvvShYV-7NdaYkUYL7Pg7EUQ-1-jS4NuQ7KuaUzn-jFpwhRWjCOmMvr5H3TZj7HL62nCpeCcSCH-T1FFSi7ks-vLlrKxTyk6vxsZI_0cqs6h6j-hZvbT3zvuyNcUMzDbApvQuKf3Tfr68nar_A23savs</recordid><startdate>202106</startdate><enddate>202106</enddate><creator>Luth, Elizabeth A.</creator><creator>Russell, David J.</creator><creator>Xu, Jiehui Cici</creator><creator>Lauder, Bonnie</creator><creator>Ryvicker, Miriam B.</creator><creator>Dignam, Ritchell R.</creator><creator>Baughn, Rosemary</creator><creator>Bowles, Kathryn H.</creator><creator>Prigerson, Holly G.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1496-1235</orcidid></search><sort><creationdate>202106</creationdate><title>Survival in hospice patients with dementia: the effect of home hospice and nurse visits</title><author>Luth, Elizabeth A. ; Russell, David J. ; Xu, Jiehui Cici ; Lauder, Bonnie ; Ryvicker, Miriam B. ; Dignam, Ritchell R. ; Baughn, Rosemary ; Bowles, Kathryn H. ; Prigerson, Holly G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4716-1c3a6b3653f09c3b0bfcb6a19bd9f187fba915bc305848a02a7f5df46d8888af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged, 80 and over</topic><topic>Caregivers - psychology</topic><topic>Death</topic><topic>Dementia</topic><topic>Dementia - mortality</topic><topic>Dementia disorders</topic><topic>Female</topic><topic>Home Care Services - statistics & numerical data</topic><topic>Home health care</topic><topic>hospice</topic><topic>Hospice care</topic><topic>Hospice Care - statistics & numerical data</topic><topic>Humans</topic><topic>Length of stay</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Life expectancy</topic><topic>live discharge</topic><topic>long length of stay</topic><topic>Male</topic><topic>Medicare - economics</topic><topic>nurse visits</topic><topic>Nursing care</topic><topic>Nursing Homes - statistics & numerical data</topic><topic>Patient Discharge</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Survival</topic><topic>Time Factors</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luth, Elizabeth A.</creatorcontrib><creatorcontrib>Russell, David J.</creatorcontrib><creatorcontrib>Xu, Jiehui Cici</creatorcontrib><creatorcontrib>Lauder, Bonnie</creatorcontrib><creatorcontrib>Ryvicker, Miriam B.</creatorcontrib><creatorcontrib>Dignam, Ritchell R.</creatorcontrib><creatorcontrib>Baughn, Rosemary</creatorcontrib><creatorcontrib>Bowles, Kathryn H.</creatorcontrib><creatorcontrib>Prigerson, Holly G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of pain and symptom management</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luth, Elizabeth A.</au><au>Russell, David J.</au><au>Xu, Jiehui Cici</au><au>Lauder, Bonnie</au><au>Ryvicker, Miriam B.</au><au>Dignam, Ritchell R.</au><au>Baughn, Rosemary</au><au>Bowles, Kathryn H.</au><au>Prigerson, Holly G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Survival in hospice patients with dementia: the effect of home hospice and nurse visits</atitle><jtitle>Journal of pain and symptom management</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2021-06</date><risdate>2021</risdate><volume>69</volume><issue>6</issue><spage>1529</spage><epage>1538</epage><pages>1529-1538</pages><issn>0002-8614</issn><issn>0885-3924</issn><eissn>1532-5415</eissn><abstract>Background
Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospice, or experiences a live discharge or long length of stay.
Objective
Examine how home hospice and nurse visit frequency relate to dying in hospice within the Medicare‐intended 6‐month period.
Design
Retrospective cohort study.
Setting
Non‐profit hospice agency.
Participants
Three thousand eight hundred and thirty seven patients with dementia who received hospice services from 2013 to 2017.
Methods
Multivariable survival analyses examined the effects of receiving home hospice (vs. nursing home) and timing of nurse visits on death within 6 months of hospice enrollment, compared to live discharge or long length of stay. Models adjust for relevant demographic and clinical factors.
Results
Thirty‐nine percent (39%) of patients experienced live discharge or long length of stay. Home hospice patients were more likely to experience live discharge or long length of stays (HR for death: 0.77, 95%CI: 0.69–0.86, p < 0.001). Frequency of nurse visits was inversely associated with live discharge and long lengths of stay (HR for death: 2.87, 95%CI: 2.47–3.33, p < 0.001).
Conclusion
Nearly 40% of patients with dementia in our study experienced live discharge or a long length of stay. Additional research is needed to understand why home hospice may result in live discharge or a long length of stay for patients with dementia. Nurse visits were associated with death, suggesting their responsiveness to deteriorating patient health. Hospice guidelines may need to permit longer stays so community‐dwelling patients with dementia, a growing segment of hospice patients, can remain continuously enrolled in hospice and avoid burden and costs associated with live discharge.
See related editorial by Hunt et al. in this issue.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>33608869</pmid><doi>10.1111/jgs.17066</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-1496-1235</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elsevier ScienceDirect Journals; Applied Social Sciences Index & Abstracts (ASSIA) |
| subjects | Aged, 80 and over Caregivers - psychology Death Dementia Dementia - mortality Dementia disorders Female Home Care Services - statistics & numerical data Home health care hospice Hospice care Hospice Care - statistics & numerical data Humans Length of stay Length of Stay - statistics & numerical data Life expectancy live discharge long length of stay Male Medicare - economics nurse visits Nursing care Nursing Homes - statistics & numerical data Patient Discharge Patients Retrospective Studies Survival Time Factors United States |
| title | Survival in hospice patients with dementia: the effect of home hospice and nurse visits |
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