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01.07.2012 | Original Research

Disability and Decline in Physical Function Associated with Hospital Use at End of Life

verfasst von: Amy S. Kelley, MD, MSHS, Susan L. Ettner, PhD, R. Sean Morrison, MD, Qingling Du, MS, Catherine A. Sarkisian, MD, MSHS

Erschienen in: Journal of General Internal Medicine | Ausgabe 7/2012

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Abstract

Background

Hospital use near the end of life is often undesirable to patients, represents considerable Medicare cost, and varies widely across regions.

Objective

To concurrently examine regional and patient factors, including disability and functional decline, associated with end-of-life hospital use.

Design/Participants

We sampled decedents aged 65 and older (n = 2,493) from the Health and Retirement Study (2000–2006), and linked data from individual Medicare claims and the Dartmouth Atlas of Health Care. Two-part regression models estimated the relationship between total hospital days in the last 6 months and patient characteristics including physical function, while adjusting for regional resources and hospital care intensity (HCI).

Key Results

Median hospital days was 7 (range = 0–183). 53% of respondents had functional decline. Compared with decedents without functional decline, those with severe disability or decline had more regression-adjusted hospital days (range 3.47–9.05, depending on category). Dementia was associated with fewer days (−3.02); while chronic kidney disease (2.37), diabetes (2.40), stroke or transient ischemic attack (2.11), and congestive heart failure (1.74) were associated with more days. African Americans and Hispanics had more days (5.91 and 4.61, respectively). Those with family nearby had 1.62 fewer days and hospice enrollees had 1.88 fewer days. Additional hospital days were associated with urban residence (1.74) and residence in a region with more specialists (1.97) and higher HCI (2.27).

Conclusions

Functional decline is significantly associated with end-of-life hospital use among older adults. To improve care and reduce costs, health care programs and policies should address specific needs of patients with functional decline and disability.

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Titel: Disability and Decline in Physical Function Associated with Hospital Use at End of Life
verfasst von: Amy S. Kelley, MD, MSHS
Susan L. Ettner, PhD
R. Sean Morrison, MD
Qingling Du, MS
Catherine A. Sarkisian, MD, MSHS
Publikationsdatum: 01.07.2012
Verlag: Springer-Verlag
Erschienen in: Journal of General Internal Medicine / Ausgabe 7/2012
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-012-2013-9

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Abstract

Background

Objective

Design/Participants

Key Results

Conclusions

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