Health care transitions during the final months of life are often burdensome and of only limited benefit for patients with advanced cognitive and functional impairment.
Two New England Journal of Medicine (NEJM) articles report on an analysis of nationwide data from the across the USA. Transitions were defined as “burdensome” if they occurred in the last 3 days of life, if they resulted in lack of continuity in nursing homes following hospitalisation during the last 90 days of life, or if they resulted in multiple hospitalisations during the last 90 days of life. Various factors for the variation in the rates of burdensome transition were investigated (including associations between regional rates of burdensome transitions and feeding-tube insertion, hospitalisation to intensive care units (ICUs) in the last month of life, stage IV decubitus ulcers (pressure sores), and enrollment into hospices during the last 3 days of life).
About one fifth of nursing home residents had at least one burdensome transition. Blacks, Hispanics, and people without an advance directive were at increased risk. Rates were associated with receiving a feeding tube, spending time on an ICU in the last month of life, having stage IV decubitus ulcers, and late enrollment to a hospice.
Burdensome transitions were found to be common and – according to the authors of this study – were associated with poor quality in end-of-life care.
Full Text Link (a) (Free access).
Ouslander, JG. Berenson, RA. (2011). Reducing unnecessary hospitalizations of nursing home residents. The New England Journal of Medicine, September 29th 2011, Vol.365(13), pp.1165-7.
Full Text Link (b) (Access online requires a journal subscription).
Gozalo, P. Teno, JM. [and] Mitchell, SL. [et al] (2011). End-of-life transitions among nursing home residents with cognitive issues. The New England Journal of Medicine, September 29th 2011, Vol.365(13), pp.1212-21. (Click here to view the PubMed abstract).