Potentially burdensome end-of-life transitions among nursing home residents with poor-prognosis cancer.

Abstract

BACKGROUND:

This study examined factors associated with potentially burdensome end-of-life (EOL) transitions between care settings among older adults with advanced cancer in nursing homes (NHs).

METHODS:

A retrospective analysis of deceased older NH residents with poor-prognosis solid tumors was conducted with Medicare claims and the Minimum Data Set. A potentially burdensome transition was defined as 2 or more hospitalizations or an intensive care unit admission in the last 90 days of life.

RESULTS:

Among 34,670 subjects, many had moderate to severe cognitive impairment (53.8%), full dependence in activities of daily living (ADLs; 66.5%), and comorbidities such as congestive heart failure (CHF; 29.3%) and chronic obstructive pulmonary disease (34.1%). Only 56.3% of the patients used hospice at any time in the 90 days before death; 36.0% of the patients experienced a potentially burdensome EOL transition, and this was higher among patients who did not receive hospice (45.4% vs 28.7%; P < .01). In multivariable analyses, full dependence in ADLs (odds ratio [OR], 1.70; P < .01), CHF (OR, 1.48; P < .01), and chronic obstructive pulmonary disease (OR, 1.28; P < .01) were associated with a higher risk of burdensome EOL transitions. Those with do-not-resuscitate directives (OR, 0.60; P < .01) and impaired cognition (OR, 0.89; P < .01) had lower odds of burdensome EOL transitions.

CONCLUSIONS:

NH residents with advanced cancer have substantial comorbidities and functional impairment, yet more than a third experience potentially burdensome EOL transitions. These findings help to identify a population at risk for poor EOL outcomes in order to target interventions, and they point to the importance of advanced care planning in this population.

• Authors: Daniel E Lage, Clark DuMontier, Yoojin Lee, Ryan D Nipp, Susan L Mitchell, Jennifer S Temel, Areej El-Jawahri, Sarah D Berry
• Journal: Cancer (Cancer) Vol. 126 Issue 6 Pg. 1322-1329 (03 15 2020) ISSN: 1097-0142 [Electronic] United States
• PMID: 31860129 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © 2019 American Cancer Society.

Topics

• Activities of Daily Living
• Aged
• Aged, 80 and over
• Comorbidity
• Dehydration (epidemiology)
• Female
• Hospice Care (statistics & numerical data)
• Hospitalization (statistics & numerical data)
• Humans
• Intensive Care Units (statistics & numerical data)
• Male
• Medicare (statistics & numerical data)
• Neoplasms (mortality)
• Nursing Homes
• Odds Ratio
• Pneumonia (epidemiology)
• Pneumonia, Aspiration (epidemiology)
• Prognosis
• Renal Insufficiency (epidemiology)
• Retrospective Studies
• Sepsis (epidemiology)
• Terminal Care (statistics & numerical data)
• Time Factors
• United States (epidemiology)
• Urinary Tract Infections (epidemiology)