Palliative care consultations appear to reduce acute care use and potentially burdensome transitions for dying nursing home residents, according to a new study led by Dr. Susan Miller, professor of health services, policy and practice.
[Photo: Dr. Susan Miller]
Half of nursing home residents in the U.S. have dementia diagnoses, as do half of persons who die in nursing homes. Access to hospice palliative care in nursing homes is associated with better care processes, outcomes, and fewer end-of-life hospitalizations for persons with dementia, although the effect of specialty palliative care consultations (i.e., consultations by external specialists, primary nurse practitioners with palliative care expertise) in this population has yet to be explored.
To answer this important question, Dr. Miller and her colleagues merged palliative care consultation data in 31 nursing homes in two states to Medicare data to identify residents with consultations, moderate to severe dementia, and deaths in 2006-2010. Initial palliative consultations were identified as occurring later (1-30 days before death) or earlier (31-180 days before death). Compared to no consultation, earlier and later consultations were associated with 13.2 percent and 5.9 percent lower hospitalization rates in the seven days before death, respectively. Earlier consultations were also associated with an 18.4 percent reduction in hospitalizations, an 11.9 percent reduction in emergency room visits in the 30 days before death, and a 20.2 percent reduction in burdensome transitions.
The results of this study, published in Journal of Pain and Symptom Management, suggest that a model of palliative care that includes specialty palliative care consultations is likely to enhance the quality of life among residents with moderate to advanced dementia.