Factors influencing hospice use in Alzheimer's patients identified
MedWire News: Community services and care-recipient factors influence hospice use at the end of life among older adults with Alzheimer's disease (AD), say researchers.
"Although both private and federal sources of data suggest that dementia and AD account for a substantial proportion of hospice use among older adults, hospice services are still underutilized in this population, with less than half of all dying patients using hospice," write Pauline Karikari-Martin (Rush University, Columbia, Minnesota, USA) and colleagues.
In their study, published in the Journal of Hospice & Palliative Nursing, Karikari-Martin and team used the Hospice Use Model to investigate the community, care recipient, and caregiver characteristics associated with hospice use among 145 community-dwelling patients over 65 years of age with Alzheimer's disease and their carers. All recruited patients used either an adult day-care service or were enrolled at the federally funded Rush Alzheimer Disease Center clinic.
They found that older age, male gender, Black race, and better functional health of the care recipients were significantly associated with a decreased likelihood for using a hospice. The patients recruited from the Alzheimer's clinic were more likely to use hospice services than those recruited from day-care centers.
Caregiver characteristics, on the other hand, were not significantly independently associated with hospice use.
However, the hours of care provided by the hospice per week significantly correlated with the site the patients were recruited from. In the patients from the Alzheimer's clinic, hospice use increased with care intensity, whereas this relationship was reversed in the patients from the day-care centers.
The researchers suggest possible explanations for the differences in hospice use between the two types of service. For example, day-care centers may provide more support for carers as care intensity increases and therefore substitute for some forms of formal services. Alternatively, it may be that the Alzheimer's clinic is more likely to refer patients to hospice services than adult day-care centers because the clinic provides a comprehensive evaluation including a medical and neurologic examination by a physician, diagnostic tests, and case management with a nurse.
"Our data may be useful in the design and implementation of interventions and policies aimed at optimal use of hospice in persons with AD...," conclude the researchers.
"Our results suggest that community, caregiver, and care-recipient factors influence hospice use prior to death. As such, we need to be more aware of these factors when designing future interventions focused on increasing hospice use among people with AD."
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By Chloe McIvor