At the end of life hospices better option for the elderly than nursing homes

Jul 14 2005

A new study has shown that straight talking elderly people, who are facing death in nursing homes, raises the likelihood of them agreeing to enter hospices in the last days of their life.

Hospices are facilities which specialise in end-of-life care and are able to offer more appropriate care than nursing homes.

Study leader Dr. David Casarett, director of the palliative care clinic at the Philadelphia Veterans Affairs Medical Center, says that over the last 10, 20, 30 years all sorts of high-tech and expensive interventions to improve end-of-life care have been tried, but by just getting people to talk, more are prepared to enter into the hospice sooner.

He says people who have these conversations are more satisfied with the end-of-life care they receive.

At the outset of the study Casarett and his colleagues interviewed nursing home residents or the people who made medical decisions for them, in an attempt to identify those who would benefit from entering hospices.

Out of the 205 nursing home residents who were selected, 107 were given an informational visit describing hospice care, and 98 received the usual care.

The researchers found that one of every five people who got the informational visit entered a hospice within the next 30 days, compared to only one person among those who received usual care.

Eventually, 25 percent of those getting hospice information entered hospices, compared to 6 percent of those who did not.

The researchers noted that the people who entered hospices had fewer acute care hospital admissions and spent fewer days in hospital.

Probably the most important finding was that, family members of those who entered hospices rated the quality of end-of-life care higher, 4.1 on a scale of five, compared to 2.5 for those remaining in nursing homes.

Casarett says that many people nearing the end of life, may not want to have these discussions for a variety of reasons, but on the other hand, many people do, but don't know how.

He says that previous studies have shown that many people are thinking about hospices but are waiting for their physicians to start these discussions.

Although doctors and nurses often have such conversations with patients, it is not done in a systematic way.

He hopes hope that the study will help change that issue.

Background information for the article states that at least one in four Americans dies in a nursing home, and considerable evidence indicates that nursing home residents do not receive optimal end-of-life care.

Approximately 25 percent of residents with daily cancer pain receive no pain medications, and residents are often transferred to an acute care setting to receive aggressive treatment in the last weeks of life.

Families often express dissatisfaction with the end-of-life care their relative receives in nursing homes.

According to the researchers, nursing home residents receiving hospice care are more likely to receive better pain management, have their pain assessed and have lower rates of inappropriate medications and physical restraint use than patients who do not receive hospice care.

But despite its benefits, only one in every four nursing home residents enrolls in hospice care before death.

The study authors say that as Americans spend more time in nursing homes near the end of life, it will become increasingly important to emphasize simple, low-cost interventions such as hospice care, that can help to ensure that residents and their families have access to the best possible quality of care.

Dr. Perry G. Fine who is vice president for medical affairs at the National Hospice and Palliative Care Organization, in Alexandria, Va. says the study confirms that if conversations are initiated with people, they will more often choose hospice care, and they will end up far more satisfied than those who don't.

The report is published in the current issue of the JAMA: The Journal of the American Medical Association.