Navigation Links
Study Casts Doubt on Hospice Admission Criteria for Patients With Dementia
Date:11/2/2010

By Serena Gordon
HealthDay Reporter

TUESDAY, Nov. 2 (HealthDay News) -- Many people with advanced dementia aren't getting much-needed hospice care because the admission criteria is flawed, researchers say.

"Dementia is a leading cause of death in the U.S., and hospice care can benefit patients with dementia. The main hindrance to getting palliative [comfort] care is guidelines that try to guide practitioners to wait until an estimated life expectancy of six months," said Dr. Susan L. Mitchell, a senior scientist at the Institute for Aging Research at Hebrew SeniorLife in Boston, and lead author of a new study.

Such end-of-life predictions are difficult to make with certainty in dementia cases. Instead of using life expectancy as the requirement for admission, hospice care for dementia patients should be offered based on the patient's and family's desire for comfort care, suggest Mitchell and colleagues in the study published in the Nov. 3 issue of the Journal of the American Medical Association.

Hospice, or palliative, care is most often associated with cancer patients. The goal is to provide comfort and support to patients and their families, instead of life-prolonging treatments.

For people with cancer, the decision to switch to palliative care is more clear-cut. It generally occurs when someone decides to forgo traditional cancer treatments, such as chemotherapy or radiation, that don't seem to be working anymore, and instead receive comfort care, which includes better pain management and discussions about important end-of-life care decisions.

For people with dementia, the decision process is murkier. Most people with advanced dementia are already in nursing homes, receiving around-the-clock care, but palliative care can provide families with additional support and help families make difficult decisions, such as whether or not to treat infections with antibiotics or to use a feeding tube to deliver nutrition. Palliative care may also provide better pain management and symptom relief, said Mitchell.

To improve the likelihood of dementia patients getting palliative care, Mitchell and her co-authors tried to come up with a better tool to assess their potential life expectancy.

This new method, dubbed the Advanced Dementia Prognostic Tool (ADEPT), includes 12 items, such as body mass index, ability to perform tasks of daily living like self-feeding, bowel incontinence, shortness of breath and oral food intake.

The researchers compared their assessment tool with the standard Medicare hospice eligibility guidelines on 606 residents in 21 nursing homes.

Their tool accurately predicted a life expectancy of fewer than six months 67 percent of the time, versus 55 percent for the Medicare guidelines, said Mitchell.

"While ADEPT was better than the Medicare criteria, its predictive ability isn't perfect," said Mitchell. "The delivery of palliative care should be guided by a preference of comfort care rather than by life expectancy," she added.

A 2009 study by Mitchell and her colleagues was the first to label dementia a terminal illness like cancer and other incurable diseases.

Dr. Joseph Shega, an associate professor in the section of geriatrics and palliative medicine at the University of Chicago Medical Center, said he agrees that the issue of comfort care for dementia patients deserves attention.

"It's important to recognize that we're not really good at figuring out how long someone with dementia might live, and I agree with these authors that we should focus more on the goals of care and stop spending resources on trying to figure out how long someone might live," said Shega.

"Hospice provides more support for nursing home staff, better support for the family, and can help better educate the family on the natural process of dementia so they know what's going on," he explained.

Hospice also helps manage symptoms, like discomfort or agitation, Shega added, while making sure that care plans and treatment goals agree with the values and wishes of the patients and their families.

More information

Read more about dementia and end-of-life care from the U.S. National Institute on Aging.

SOURCES: Susan L. Mitchell, M.D., M.P.H., senior scientist, Institute for Aging Research at Hebrew SeniorLife, Boston; Joseph Shega, M.D., associate professor, section of geriatrics and palliative medicine, University of Chicago Medical Center; Nov. 3, 2010, Journal of the American Medical Association


'/>"/>
Copyright©2010 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Black raspberries may prevent colon cancer, study finds
2. Study Unmasks the Biology of Bluffing
3. Shift work linked to higher risk of work injury: UBC study
4. Poor Diet May Make COPD Worse, Study Finds
5. Long Hours Put Surgeons, Patients at Risk, Study Suggests
6. Elderly women at higher risk for unnecessary urinary catheterization, study reports
7. UCI non-small cell lung cancer study highlights advances in targeted drug therapy
8. Study Finds Teens Late Night Media Use Comes at a Price
9. Toothache More Likely to Strike Poor, Minority Kids: U.S. Study
10. Half of Teens Treated for Depression Will Relapse: Study
11. Weekend Admissions Worse for Stroke Victims: Study
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Study Casts Doubt on Hospice Admission Criteria for Patients With Dementia
(Date:2/14/2016)... ... February 14, 2016 , ... ... eating disorders professionals near their residence. The nature of the illnesses requires ongoing ... care or time allotted at work to make traditional appointments. These people struggle ...
(Date:2/13/2016)... ... , ... Hidden Cypress in Sun City is the place to be on March 3rd to ... Weniger will be hosting this educational seminar from 5:30 p.m. – 7:00 p.m. Exciting ... pricing on offers. In addition, prizes will be given away and light refreshments will be ...
(Date:2/13/2016)... ... ... Many individuals looking to lead a healthy lifestyle have decreased carbohydrate consumption and ... Fitness has delved into this niche allowing those giving up their beloved pasta a ... 30 grams of protein and only 7 grams of carbohydrates per 50 gram serving--a ...
(Date:2/13/2016)... ... February 13, 2016 , ... In its newly ... vein visualization technology should be used to ensure patient safety when placing an ... INS Standards mandate the use of vein visualization technology in patients with difficult ...
(Date:2/13/2016)... ... , ... In the early or “honeymoon” stage of a relationship, couples strive ... their way to be romantic, and may exaggerate a strength or two in an ... profile. , A recent study from Queendom.com , however, suggests that new ...
Breaking Medicine News(10 mins):
(Date:2/12/2016)... , Feb. 12, 2016   HeartWare International, Inc ... call and webcast to discuss its financial results for ... on Thursday, February 25, 2016 at 8:00 a.m. ET. ... to the conference call and webcast.  On the conference ... results, highlights from the fourth quarter and business outlook.   ...
(Date:2/12/2016)... AUSTIN, Texas , Feb. 12, 2016 ... Institute for Robotic Surgery at St. David,s North Austin ... the da Vinci ® Xi ® Surgical ... ® 7000dV. Thiru Lakshman , M.D., ... performed a total proctocolectomy utilizing Integrated Table Motion technology, ...
(Date:2/12/2016)... North Carolina , 12 februari 2016 ... Inc. (AAI/CML), een toonaangevende leverancier van productie ... en biotechnologische industrieën, kondigt vandaag een uitbreiding ... mogelijkheden op haar locatie in ... vraag heeft geleid tot meerdere recente investeringen. ...
Breaking Medicine Technology: