Intensity of Acute Care Services at the End of Life: Nonclinical Determinants of Treatment Variation in an Older Adult Population

Geriatric medicine is a specialty of medicine concerned with physical, mental, functional, and social conditions in acute, chronic, rehabilitative, preventive, and end-of-life care in older patients. Geriatric palliative care integrates the complementary specialties of geriatrics and palliative care to provide comprehensive care for older patients entering the later stage of their lives and their families. This chapter provides physician assistants with an overview of palliative care in older adults, the differences between palliative care and hospice, the understanding and managing of geriatrics syndrome, symptom management in older patients and the complexities of end of life, discussion of goals of care, and communicating with geriatric patients and families.

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Functional status and use of health care services: Longitudinal study on the older adult population in Spain

Maturitas ◽

10.1016/j.maturitas.2007.09.008 ◽

2007 ◽

Vol 58 (4) ◽

pp. 377-386 ◽

Cited By ~ 17

Author(s):

Luz María León-Muñoz ◽

Esther López-García ◽

Auxiliadora Graciani ◽

Pilar Guallar-Castillón ◽

José R. Banegas ◽

...

Keyword(s):

Health Care ◽

Longitudinal Study ◽

Functional Status ◽

Older Adult ◽

Health Care Services ◽

Adult Population ◽

Care Services ◽

Older Adult Population ◽

Use Of Health Care

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Abstract 2379: Use of Hospice and Acute Care in Heart Failure vs. Cancer at End-of-Life

Circulation ◽

10.1161/circ.118.suppl_18.s_713 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Soko Setoguchi ◽

Robert J Glynn ◽

Carol N Flavell ◽

Raisa Levin ◽

Lynne W Stevenson

Keyword(s):

Heart Failure ◽

End Of Life ◽

Acute Care ◽

Solid Organ ◽

Care Services ◽

Life Saving ◽

Acute Care Services ◽

Hospice Use ◽

Care Improvement ◽

Over Time

Advances in heart failure (HF) have prolonged survival but more patients (pts) die from HF than from any type of cancer. Quality of care improvement for HF has focused largely on initiation of life-saving treatments. Pts dying of HF were less likely to be supported by hospice and more likely to die in hospitals than pts with terminal cancer. Two end-of-life cohorts (HF and cancer) were identified using Medicare data. The HF cohort consisted of pts with 2 HF hospitalizations before cardiac death. The cancer cohort had registry-defined solid-organ cancer and death attributed to cancer. We assessed hospice use, ER visit, and acute hospitalization during 30 days prior to death and deaths in hospitals. Time trend and predictors of hospice use were also assessed. Among 7,930 HF pts with median age 82, 78% female and 5% black, 20% were referred to hospice compared to 51% in 7,565 cancer patients. The mean duration of hospice prior to death was longer with heart failure (68 for HF and 15 days for cancer). A modest rise in hospice use over time was parallel in the two groups. Acute care prior to death was higher for HF than cancer pts. (59 vs. 40% for ER visit and 62 vs. 45% for hospitalizations). More HF pts died in acute care hospitals than cancer pts (37 vs. 21%). Younger age, male gender, black race and dialysis therapy were associated with lower use of hospice in multivariate analyses. Although hospice use is increasing slowly over time, the contribution of hospice remains lower in HF, and more HF deaths occur in acute care settings. Further studies are needed to assess indications for hospice and acute care services in HF patients at the end of life.

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