Featured Research

from universities, journals, and other organizations

Modify hospice eligibility for dementia patients: Preference for comfort, not life expectancy, should guide care, experts say

Date:
November 2, 2010
Source:
Hebrew SeniorLife Institute for Aging Research
Summary:
The system for hospice admissions for patients with advanced dementia, a terminal illness, should be guided by patient and family preference for comfort, not estimated life expectancy, according to experts in a new article.

The system for hospice admissions for patients with advanced dementia, which is a terminal illness, should be guided by patient and family preference for comfort, not estimated life expectancy, says a new study published in the Nov. 3 Journal of the American Medical Association by the Institute for Aging Research at Hebrew SeniorLife, an affiliate of Harvard Medical School.

Currently, patients requesting hospice services must be certified by their physician to have six months or less to live, and must sign a statement choosing comfort care services in lieu of curative treatments.

"Whether a patient with advanced dementia lives one month, six months or longer," says lead author Susan L. Mitchell, M.D., M.P.H., a senior scientist at the Institute for Aging Research, "they should get high-quality palliative [comfort] care if that is their wish. Because we can't predict with a high level of accuracy who will die within six months, hospice eligibility should be guided by a desire for comfort care, not by how long a patient is expected to live."

Hospice has been shown to benefit patients dying with dementia, but hospice has traditionally under-served dementia patients. Only about 10 percent of hospice patients have a diagnosis of dementia and only an estimated one out of 10 people dying with dementia gets hospice care. Hospice professionals cite estimating life expectancy as the main hindrance to enrolling patients.

Earlier this year, Dr. Mitchell and her colleagues created a new tool to assess mortality risk in advanced dementia patients. The 12-item Advanced Dementia Prognostic Tool (ADEPT) scores such measures as age, shortness of breath, bowel incontinence, and weight loss to estimate a dementia patient's estimated risk of death within six months. The higher the score, the higher the risk of death. The tool was designed using rigorous statistical models and a nationwide database of nursing home residents with advanced dementia.

vThe Institute for Aging Research study then compared the ability of the ADEPT score to current Medicare hospice guidelines to predict six-month survival in a cohort of 606 Greater Boston-area nursing home residents with end-stage dementia.

Medicare hospice eligibility guidelines use two criteria to estimate life expectancy for dementia patients: a score of at least 7c on the Functional Assessment Staging scale (inability to dress, bathe or toilet; bowel incontinence; speech limited to less than 5 words; and non-ambulatory) and the presence of at least one of six serious medical conditions in the past year. How well these criteria actually predict six-month survival had not been previously known.

Dr. Mitchell found that 67 percent of the time the ADEPT score correctly classified residents who died and those who did not die over six months. In comparison, current hospice criteria correctly classified those who died and those who survived only 55 percent of the time, or slightly better than chance.

The findings show that while the ADEPT score was better than the current Medicare criteria at predicting the death of advanced dementia patients within six months, its predictive ability was not perfect. This underscores the challenge of estimating how long one will live with advanced dementia and suggests, says Dr. Mitchell, that determining eligibility for hospice based on life expectancy for these patients limits their access to hospice services.

"Our study strongly suggests that delivery of palliative care to these patients should be guided by a preference for comfort as the primary goal and not by life-expectancy estimates," says Dr. Mitchell, an associate professor of medicine at Harvard Medical School. "The challenge for health-care professionals is to ensure that high-quality palliative care is accessible to the growing number of individuals dying with dementia in nursing homes, an effort that may necessitate both revisiting the six-month prognosis requirement for hospice and expanding comprehensive palliative care services in the nursing home."

Currently, more than 5 million Americans suffer from dementia, a number that is expected to increase by almost three-fold in the next 40 years. Dementia is a group of symptoms severe enough to interfere with daily functioning, including memory loss, difficulty communicating, personality changes, and an inability to reason. Alzheimer's disease is the most common form of dementia.

A 2009 study by Dr. Mitchell and her colleagues (Oct. 15, 2009 New England Journal of Medicine) was the first to rigorously describe the clinical course of dementia and to label the disease a terminal illness similar to other incurable illnesses, such as cancer.

Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making.

The Institute has introduced many well regarded assessment tools, including the Minimum Data Set, which helps nursing homes gather information on residents' health, needs and strengths in order to develop the best caregiving plans.


Story Source:

The above story is based on materials provided by Hebrew SeniorLife Institute for Aging Research. Note: Materials may be edited for content and length.


Journal Reference:

  1. S. L. Mitchell, S. C. Miller, J. M. Teno, D. K. Kiely, R. B. Davis, M. L. Shaffer. Prediction of 6-Month Survival of Nursing Home Residents With Advanced Dementia Using ADEPT vs Hospice Eligibility Guidelines. JAMA: The Journal of the American Medical Association, 2010; 304 (17): 1929 DOI: 10.1001/jama.2010.1572

Cite This Page:

Hebrew SeniorLife Institute for Aging Research. "Modify hospice eligibility for dementia patients: Preference for comfort, not life expectancy, should guide care, experts say." ScienceDaily. ScienceDaily, 2 November 2010. <www.sciencedaily.com/releases/2010/11/101102101614.htm>.
Hebrew SeniorLife Institute for Aging Research. (2010, November 2). Modify hospice eligibility for dementia patients: Preference for comfort, not life expectancy, should guide care, experts say. ScienceDaily. Retrieved July 30, 2014 from www.sciencedaily.com/releases/2010/11/101102101614.htm
Hebrew SeniorLife Institute for Aging Research. "Modify hospice eligibility for dementia patients: Preference for comfort, not life expectancy, should guide care, experts say." ScienceDaily. www.sciencedaily.com/releases/2010/11/101102101614.htm (accessed July 30, 2014).

Share This




More Health & Medicine News

Wednesday, July 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Concern Grows Over Worsening Ebola Crisis

Concern Grows Over Worsening Ebola Crisis

AFP (July 30, 2014) Pan-African airline ASKY has suspended all flights to and from the capitals of Liberia and Sierra Leone amid the worsening Ebola health crisis, which has so far caused 672 deaths in Guinea, Liberia and Sierra Leone. Duration: 00:43 Video provided by AFP
Powered by NewsLook.com
At Least 20 Chikungunya Cases in New Jersey

At Least 20 Chikungunya Cases in New Jersey

AP (July 30, 2014) At least 20 New Jersey residents have tested positive for chikungunya, a mosquito-borne virus that has spread through the Caribbean. (July 30) Video provided by AP
Powered by NewsLook.com
Generics Eat Into Pfizer's Sales

Generics Eat Into Pfizer's Sales

Reuters - Business Video Online (July 29, 2014) Pfizer, the world's largest drug maker, cut full-year revenue forecasts because generics could cut into sales of its anti-arthritis drug, Celebrex. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins