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Are doctors recommending hospice too late?

Despite experiencing symptoms for months before the end of their lives, older adults are spending shorter periods of time in hospice.

The finding suggests there may be a need for more attention to symptoms and disability for these elderly people—and perhaps earlier hospice admission.

Researchers looked at information from a study of 562 people, aged 70 and older, who were not disabled when the study began but died over the following 16 years.

Of these individuals, 244 (43.4 percent) were admitted to hospice during the last year of life. They were slightly older and more likely to have cognitive impairments (problems thinking and making decisions) than older adults who weren’t admitted to hospice.

Cancer and advanced dementia were the conditions that most often resulted in admission. Older adults who were frail were least likely to be admitted to hospice. The most common condition leading to death was frailty, followed by organ failure, advanced dementia, and cancer.

Further, the duration of hospice care was less than 13 days for half of the study participants, suggesting that healthcare providers might need to consider discussing referrals to hospice sooner with people who are approaching the end of their lives.

Alternatively, providers may need to develop and test other ways to reduce the high burden of distressing symptoms and disability at the end of life.

“Failing or delaying to refer older persons to hospice at the end of life can place a high burden on caregivers and result in patient suffering,” says Thomas Gill, professor of medicine at Yale University and first author of the study that appears in the Journal of the American Geriatrics Society.

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Referral to hospice at the end of life should be based on an older adult’s burden of pain and other distressing symptoms, including fatigue, nausea, depression, anxiety, difficulty sleeping, and difficulty with memory, the authors write.

The National Institute on Aging funded the study that was conducted at the Yale Claude D. Pepper Older Americans Independence Center.

Source: Yale University

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