Changing End-of-Life Care

While hospice enrollment has been on the rise for older Americans, that doesn't mean care as been less aggressive - the rate of ICU use within the last month of life has also increased.

While hospice enrollment has been on the rise for older Americans, the rate of intensive care unit (ICU) use within the last month of life has also increased, according to research.

From 1989 to 2007 the percentage of Americans aged 65 and older dying at home increased from 15% to 24%. However, the researchers noticed another change in where seniors are receiving care during the last three months of their lives.

The study, published in JAMA, noted that the number of seniors who spent time in an ICU during the final month of life increased from 24% in 2000 to 29% in 2009.

According to the researchers, the data shows that despite the increased enrollment at hospices over that time period, hospice care has not replaced more aggressive care at the end of a patient’s life.

Although hospice use did increase, more than a quarter (28%) used the hospice for just three days or less in 2009. And a third of those short hospice stays were preceded by an ICU stay.

“Although a hospice stay of one day may be viewed as beneficial by a dying patient and family, an important yet unanswered research question is whether this pattern of care is consistent with patient preferences and improved quality of life,” the researchers wrote.

Patients were also transferred more frequently. On average, in 2009 a patient would be transferred three times, while in 2000, it was just an average of two times. Plus, regardless of where they died, the number of seniors who entered the hospital at least three times in the last three months of life also increased slightly.

“…information on patient preference is missing,” the researchers admitted. “It is quite possible that observed patterns of care are consistent with patient preferences. However, research suggests this is a unlikely explanation given the important opportunities to improve the process of communication and decision making in geographic regions with higher intensity of care.”

Read more:

Change in End-of-Life Care for Medicare Beneficiaries - JAMA