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Cited by 53Palliative Care and End-of-Life IssuesGeriatric Care and Nursing HomesPalliative and Oncologic Care

Specialty Palliative Care Consultations for Nursing Home Residents With Dementia

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Miller, Susan C., Lima, Julie C., Intrator, Orna, Martin, Edward, Bull, Janet, Hanson, Laura C.·2017·Journal of Pain and Symptom Management
DOI 10.1016/j.jpainsymman.2017.03.005PMC PMC5663286
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Abstract

Context U.S. nursing home (NH) residents with dementia have limited access to specialty palliative care beyond Medicare hospice.Objectives The objective of this study was to examine the value of expanded palliative care access for NH residents with moderate-to-very severe dementia.Methods We merged palliative care consultation data in 31 NHs in two states to Medicare data to identify residents with consultations, moderate-to-very severe dementia, and deaths in 2006-2010. Initial palliative consultations were identified as occurring later and earlier (1-30 days and 31-180 days before death, respectively). Three controls for each consultation recipient were selected using propensity score matching. Weighted multivariate analyses evaluated the effect of consultations on hospital or acute care use seven and 30 days before death and on (potentially) burdensome transitions (i.e., hospital or hospice admission three days before death or two plus acute care transitions 30 days before death).Results With earlier consultation (vs. no consultation), hospitalization rates in the seven days before death were on average 13.2 percentage points lower (95% confidence interval [CI] -21.8%, -4.7%) and with later consultation 5.9 percentage points lower (95% CI -13.7%, +4.9%). For earlier consultations (vs. no consultations), rates were 18.4 percentage points lower (95% CI -28.5%, -8.4%) for hospitalizations and 11.9 lower (95% CI -20.7%, -3.1%) for emergency room visits 30 days before death; they were 20.2 percentage points lower (95% CI -28.5%, -12.0%) for burdensome transitions.Conclusion Consultations appear to reduce acute care use and (potentially) burdensome transitions for dying residents with dementia. Reductions were greater when consultations were earlier.

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  • Individuals with an initial palliative care consultation within one month of death also had significantly fewer hospitalizations in the last seven days of life compared with those who did not receive palliative care.

    “Individuals with an initial palliative care consultation within one month of death also had significantly fewer hospitalizations in the last seven days of life compared with those who did not receive palliative care. 939”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [939]

    The Methods define an initial consultation 1–30 days before death as a later consultation. The Results report 5.9 percentage points fewer hospitalizations in the last seven days for that group, but the 95% confidence interval (−13.7% to +4.9%) includes zero; the paper says outcomes did not differ significantly for later consultations compared with no consultation. (LLM, conf=0.90)

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  • For nursing home residents with moderate-to-severe dementia, those who received an initial palliative care consultation between one and six months before death had significantly fewer hospitalizations and emergency department visits in the last seven and 30 days of life compared with those who did not receive palliative care.

    “For nursing home residents with moderate‐to‐severe dementia, those who received an initial palliative care consultation between one and six months before death had significantly fewer hospitalizations and emergency department visits in the last seven and 30 days of life compared with those who did not receive palliative care. 939”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [939]

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Research works printed but not linked: 1

  1. [7]Report to the Congress: Medicare Payment Policy MedPAC Chapter 12 Hospice Services 3 2015

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Authors
Miller, S. C., Lima, J. C., Intrator, O., Martin, E., Bull, J., & Hanson, L. C.
Affiliations
  • Brown University (US)
  • University of Rochester Medicine (US)
  • Four Seasons (US)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Miller, Susan C.
ORCID
Venue
Journal of Pain and Symptom Management
Publisher
Elsevier BV
Published
2017-07
Volume
54
Issue
1
Pages
9-16.e5
ISSN
0885-3924 (ISSN-L)
DOI
10.1016/j.jpainsymman.2017.03.005
PMC
PMC5663286
OpenAlex
W2606316251
Cited by
53
References
45
Citations by year
2026: 4 · 2025: 7 · 2024: 8 · 2023: 8 · 2022: 6 · 2021: 7 · 2020: 8 · 2019: 2 · 2018: 3
FWCI
3.33
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Pain and Symptom Management (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Aging (R21AG042550)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
palliative care consultation, nursing home residents, dementia, end-of-life care, timing of palliative care, emergency department visits, hospice admission, Medicare
MeSH terms
Mental Status and Dementia Tests, Adult, Aged, Aged, 80 and over, Dementia, Emergency Medical Services, Health Expenditures, Female, Medicare, Hospitalization, Humans, Male, Middle Aged, Nursing Homes, Palliative Care, Referral and Consultation, Severity of Illness Index, Time Factors, United States, Multivariate Analysis, Propensity Score

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