Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Ill, Older Patients Who Rely on Emergency Room Often Live Final Days in Hospital, Study Finds

05.06.2012
Hospice Care Would Improve Quality of Life and Lower Costs, Say Authors
Half of adults over age 65 made at least one emergency department (ED) visit in the last month of life, in a study led by a physician at the San Francisco VA Medical Center (SFVAMC) and UCSF.

Three quarters of ED visits led to hospital admissions, and more than two-thirds of those admitted to the hospital died there.

In contrast, the 10 percent of study subjects who had enrolled in hospice care at least one month before death were much less likely to have made an ED visit or died in the hospital.

“For too many older Americans, the emergency department is a conduit to hospital admission and death in the hospital,” said lead author Alexander K. Smith, MD, MS, MPH, a palliative medicine doctor at SFVAMC and an assistant professor of medicine in the Division of Geriatrics at UCSF.

The study, published in the June issue of Health Affairs, was based on an analysis of health records of 4,518 people age 65 and older who died while enrolled in the Health and Retirement Study, an ongoing nationally representative longitudinal study of health, retirement and aging sponsored by the National Institute on Aging.

“Unfortunately, the emergency department is not an ideal setting for patients nearing the end of life,” observed Smith. “Aside from the fact that most patients prefer to die at home, ED visits can be incredibly expensive for patients and families, and contribute significantly to the high costs of care at the end of life.”

In addition, he noted, “the traditional focus of the ED is stabilization and triage, not end-of-life care, while hospice provides care specifically for patients with a prognosis of six months of life or less.”

Smith explained that hospice care, which is free to everyone enrolled in Medicare, is centered on the treatment and relief of symptoms that are common near the end of life, such as pain, nausea, shortness of breath and confusion. “These are quite often the symptoms that lead patients who are not in hospice care to visit the ED,” he said.

The majority of hospice care is provided in the patient’s home.

“The interdisciplinary hospice care team is very skilled at providing relief from other forms of suffering as well, such as spiritual and psychological pain,” said Smith. “They also provide bereavement support for families before and after death.”

To encourage timely enrollment in hospice care, the study authors recommended that governments, health care systems and insurers institute policies that encourage physicians to discuss end-of-life care with patients and their families, including reimbursement for advance care planning.

Smith also noted that even if more patients and families make earlier preparations for end-of-life care, “some patients will still end up in the emergency department near the end of life.” To cope with that eventuality, he said, “we need to encourage policies that will make the ED a place where patients can receive the kind of care they need, such as better care of pain, nausea and other symptoms.” He suggested that a “palliative care pathway” could be created to meet the needs of patients who go to the ED seeking relief from suffering.

Co-authors of the study are Ellen P. McCarthy, PhD, MPH, of Harvard Medical School and Beth Israel Deaconess Medical Center (BIDMC), Boston, MA; Ellen Weber, MD, of UCSF; Irena Stijacic Cenzer, MA, and W. John Boscardin, PhD, of SFVAMC and UCSF; Jonathan Fisher, MD, MPH, of Harvard Medical School and BIDMC; and Kenneth E. Covinsky, MD, MPH, of SFVAMC and UCSF.

The study was supported by funds from the National Palliative Care Research Center, the National Center for Research Resources UCSF-Clinical and Translational Science Institute (CTSI) and the National Institute on Aging, some of which were administered by the Northern California Institute for Research and Education.

NCIRE — The Veterans Health Research Institute — is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

Steve Tokar | EurekAlert!
Further information:
http://www.ncire.org

More articles from Studies and Analyses:

nachricht Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

Im Focus: Shrinking the proton again!

Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.

It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

Climate Engineering Conference 2017 Opens in Berlin

10.10.2017 | Event News

 
Latest News

Ocean atmosphere rife with microbes

17.10.2017 | Life Sciences

Neutrons observe vitamin B6-dependent enzyme activity useful for drug development

17.10.2017 | Life Sciences

NASA finds newly formed tropical storm lan over open waters

17.10.2017 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>