End-of-Life Orders, Resource Utilization, and Costs Among Injured Older Adults Requiring Emergency Services

2020 ◽  
Author(s):  
Amber L Lin ◽  
Craig Newgard ◽  
Aaron B Caughey ◽  
Susan Malveau ◽  
Abby Dotson ◽  
...  
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Resource Utilization ◽  
Emergency Services ◽  
Patient Characteristics ◽  
Vital Statistics ◽  
Fee For Service ◽  
Post Discharge ◽  
Index Event ◽  
Hospice Use

Abstract Background: Portable Orders for Life-Sustaining Treatment (POLST) are increasingly utilized to assist patients approaching the end of life in documenting goals of care. We evaluated the association of POLST, resource utilization, and costs to 1 year among injured older adults requiring emergency services.Methods: This was a retrospective cohort of injured older adults ≥65 years with continuous Medicare fee-for-service coverage transported by emergency medical services (EMS) in 2011 across 4 counties in Oregon. Data sources included EMS, Medicare claims, vital statistics, and state POLST, inpatient and trauma registries. Outcomes included hospital admission, receipt of aggressive medical interventions, costs, and hospice use. We matched patients on patient characteristics and comorbidities to control for bias.Results: We included 2116 patients of which 484 (22.9%) had a POLST form prior to 911 contact. Of POLST patients, 136 (28.1%) had orders for full treatment, 194 (40.1%) for limited interventions, and 154 (31.8%) for comfort measures. There were no significant associations for care during the index event. However, in the year after the index event, patients with care limitations had higher adjusted hospice use (limited interventions OR 1.7 [95% CI: 1.2–2.6]; comfort OR, 2.0 [95% CI: 1.3–3.0]) and lower adjusted post-discharge costs (no POLST, $32,399 [95% CI: 30,041–34,756]; limited interventions, $18,729 [95% CI: 12,913–24,545]; and comfort $15,593 [95% CI: 12,091–19,095]). There were no significant associations for all other outcomes.Conclusions: Care limitations specified in POLST forms among injured older adults transported by EMS are associated with increased use of hospice and decreased costs to 1 year.

scholarly journals Spousal Characteristics and Older Adults' Hospice Use: Understanding Disparities in End-of-Life Care

2016 ◽  
Vol 19 (5) ◽  
pp. 509-515 ◽  
Author(s):  
Katherine A. Ornstein ◽  
Melissa D. Aldridge ◽  
Christine A. Mair ◽  
Rebecca Gorges ◽  
Albert L. Siu ◽  
...  
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Hospice Use

scholarly journals Do Community and Caregiver Factors Influence Hospice Use at the End of Life Among Older Adults With Alzheimer Disease?

2012 ◽  
Vol 14 (3) ◽  
pp. 225-237 ◽  
Author(s):  
Pauline Karikari-Martin ◽  
Judith J. McCann ◽  
Liesi E. Hebert ◽  
Samuel C. Haffer ◽  
Marcia Phillips
Keyword(s):  
Older Adults ◽  
Alzheimer Disease ◽  
End Of Life ◽  
Hospice Use

Higher Incidence of Venous Thromboembolism in the Outpatient Versus the Inpatient Setting Among U.S. Cancer Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 674-674 ◽  
Author(s):  
Alok A Khorana ◽  
Mehul Dalal ◽  
Krishna Tangirala ◽  
Raymond Miao
Keyword(s):  
Venous Thromboembolism ◽  
Research Funding ◽  
Independent Predictor ◽  
Hospital Costs ◽  
Multivariate Logistic Regression Analysis ◽  
Patient Characteristics ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Post Discharge ◽  
Index Event

Abstract Abstract 674 Background: Paradigm changes in cancer therapy have shifted care to primarily outpatient-based regimens. Venous thromboembolism (VTE) is a well-known complication of cancer but contemporary data regarding the burden of VTE in the outpatient versus inpatient cancer settings are lacking. Methods: We conducted a retrospective, observational, cohort study to examine the incidence of VTE in inpatients and outpatients with cancer utilizing a linked database formed from the US Premier Perspective™ and the I3 Pharma Informatics healthcare claims databases, which provide data from the inpatient and outpatient settings, respectively. Patients with ≥1 inpatient or outpatient claims containing a diagnosis of cancer in any position (ICD-9-CM codes: 140.XX-208.99) from January 2005 to June 2009 were identified. VTE including deep vein thrombosis (DVT: ICD-9-CM codes 451 and 453) or pulmonary embolism (PE: ICD-9-CM codes 415.1–415.19) occurring in the inpatient or outpatient setting were identified over the 12 months post-index period. Data regarding demographics, clinical characteristics and cost were assessed. Multivariate analyses were conducted to adjust for differences in patient characteristics before and after the index event. Results: A total of 17,874 patients with cancer were identified. Over the 12 months post-index period, 996 (5.6%) of these patients had VTE (mean age 59.6 years; 46.7% male) and 16878 (94.4%) patients did not (mean age 58.3 years; 46.3% male). Patients with VTE had a higher mean Charlson Comorbidity Index (CCI) score at baseline than the non-VTE patients (0.9 vs. 0.7; P<0.001, respectively). Of patients with VTE, 731 (73.4%) had only DVT and 215 (21.6%) PE, while 50 (5.0%) had both. In multivariate analysis, predictors of VTE included primary site of cancer, particularly (odds ratio [OR], 95% confidence interval [CI]): stomach (2.24, 1.20–4.17; P<0.05); pancreas (2.29, 1.24–4.24; P<0.01); brain (1.82, 1.06–3.10; P<0.05); and testicular (3.06, 1.42–6.59; P<0.01). Increasing age (1.01, 1.00–1.02, P=0.001); increasing CCI score category (0.87, 0.72–1.06; P<0.05); history of pulmonary disease (1.26, 1.05–1.51; P<0.05); and post index use of doxorubicin (1.59, 1.15–2.21; P<0.01) were also significant predictors of VTE. A much higher proportion of VTE was diagnosed in the outpatient than the inpatient setting (78.3% versus 21.7%, P<0.0001). Of patients with outpatient VTE, 167 (21.4%) had a hospitalization within 30 days before their VTE index event. In multivariate logistic regression analysis, VTE was an independent predictor of hospitalization (OR 2.31, CI 1.92–2.78; P<0.0001). VTE was also an independent predictor of higher hospital costs (P<0.0001).Total mean (SD) annual hospital costs were twofold elevated for patients with VTE in comparison with those who did not have VTE $22,917 (SD $14,005) versus $11,250 (SD $6,592) respectively (P<0.0001) after adjusting for patient and treatment characteristics Conclusions: Over three-quarters of all VTE in cancer occurs in the outpatient setting and is associated with hospitalization and increased costs. One-fifth of outpatients with VTE however also had a recent hospitalization. Public health efforts to reduce the burden of VTE in cancer will need to focus on outpatient and post-discharge thromboprophylaxis in select high-risk patients, in addition to ongoing efforts to improve compliance with inpatient prophylaxis. Disclosures: Khorana: Roche/Genentech: Consultancy, Honoraria; Eisai Inc.: Honoraria, Research Funding; Ortho Biotech: Honoraria, Research Funding; Boehringer-Ingelheim: Consultancy, Honoraria; Leo Pharma: Research Funding; sanofi-aventis: Consultancy, Honoraria, Research Funding; Bayer: Consultancy, Honoraria; Daiichi Sankyo: Consultancy, Honoraria. Dalal:sanofi-aventis U.S.: Employment. Tangirala:sanofi-aventis U.S.: Employment. Miao:sanofi-aventis U.S.: Employment.

Associations Between Health Literacy and End-of-Life Care Intensity Among Medicare Beneficiaries

2021 ◽  
pp. 104990912098850
Author(s):  
Qingying Luo ◽  
Kewei Shi ◽  
Peiyin Hung ◽  
Shi-Yi Wang
Keyword(s):  
Health Literacy ◽  
End Of Life ◽  
Linear Models ◽  
Hospital Death ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Low Health Literacy ◽  
Multivariable Analyses ◽  
Hospice Use ◽  
Eol Care

Background: Despite well-documented disparities in end-of-life (EOL) care, little is known about whether patients with low health literacy (LHL) received aggressive EOL care. Objective: This study examined the association between health literacy (HL) and EOL care intensity among Medicare beneficiaries. Method: We conducted a retrospective analysis of Medicare fee-for-service decedents who died in July-December, 2011. ZIP-code-level HL scores were estimated from the 2010-2011 Health Literacy Data Map, where a score of 225 or lower was defined as LHL. Aggressive EOL care measures included repeated hospitalizations within the last 30 days of life, no hospice enrollment within the last 6 months of life, in-hospital death, and any of above. Using hierarchical generalized linear models, we examined the association between HL and aggressive EOL care. Results: Of 649,556 decedents, the proportion of decedents who received any aggressive EOL care among those in LHL areas was 82.7%, compared to 72.7% in HHL areas. In multivariable analyses, decedents residing in LHL areas, compared to those in HHL areas, had 31% higher odds of aggressive EOL care (adjusted odds ratio [AOR] 1.31; 95% confidence interval [CI]:1.21-1.42), including higher odds of no hospice use (AOR 1.35; 95% CI: 1.27-1.44), repeated hospitalization (AOR 1.07; 95% CI: 1.01-1.14) and in-hospital death (AOR 1.21; 95% CI: 1.13-1.29). Conclusion: Medicare beneficiaries who resided in LHL areas were likely to receive aggressive EOL care. Tailored efforts to improve HL and facilitate patient-provider communications in LHL areas could reduce EOL care intensity.

scholarly journals Improvement in ADLs during a Nursing Home Stay for Older Adults with Stroke, Joint Replacement or Hip Fracture

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 912-912
Author(s):  
Warona Mathuba ◽  
Brian Downer ◽  
Rachel Deer
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Acute Care ◽  
Joint Replacement ◽  
Patient Characteristics ◽  
The Elderly ◽  
Fee For Service ◽  
Data Set ◽  
Indwelling Catheters ◽  
Poor Outcomes

Abstract Regularly assessing the health and function of older adults who are in the hospital is important for preventing poor outcomes. Such information may also be useful in post-acute care settings, such as skilled nursing facilities (SNFs) to identify older adults who are high risk for poor outcomes. This study had two objectives: Map items from the Acute Care for the Elderly (ACE) Tracker to items from the Minimum Data Set (MDS). (2) Examine the association between ACE Tracker items and improvement in activities of daily living (ADLs) during a SNF stay. We identified Medicare fee-for-service beneficiaries admitted to a SNF within 3 days of hospital discharge for a hip fracture (n=118,790), joint replacement (n=245,845), or stroke (n=64,153). Items from the ACE Tracker were matched to patients’ first MDS assessment. The first and last MDS assessments were used to calculate a total score for self-performance on seven ADLs. Multivariable logistic regression models were used to identify patient characteristics associated with the odds for improvement in ADL function. Severe ADL limitations at admission and greater hours of physical and occupational therapy were associated with significantly higher odds of ADL improvement. Cognitive impairment, vision limitations, indwelling catheters, and unhealed pressure ulcers were associated with significantly lower odds of ADL improvement. The characteristics associated with improved ADL function were similar between patients with joint replacement, hip fracture, and stroke. Many of the health and functional characteristics routinely measured in hospital settings are also collected in SNFs and are associated with improvement in ADL function.

scholarly journals Engagement in Advance Care Planning: The Association With Cognitive Impairment and Care Preferences

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 417-418
Author(s):  
Hyo Jung Lee ◽  
Giyeon Kim
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Relative Risk ◽  
End Of Life ◽  
Advance Care Planning ◽  
Multinomial Logistic Regression ◽  
Quality Care ◽  
Care Planning ◽  
Advance Care ◽  
Four Levels

Abstract Although there has been growing evidence that Advance care planning (ACP) benefits people with cognitive impairment nearing death, our understanding about this issue is still limited. This study examines whether cognitive impairment is associated with ACP engagement and end-of-life care preferences among older adults in the U.S. Using data from the 2012 National Health and Trends Study (n=1798, aged 65 to 101), we identified four levels of ACP engagement: None (28%), Informal ACP conversation only (12%), Formal ACP only (14%), and Both informal and formal ACP (46%). Older adults with None showed the highest prevalence of having cognitive impairment (17%), followed by those with Formal ACP only (15%) and the other two (6%, 6%). The results of Multinomial Logistic Regression showed that, compared to those without, respondents with cognitive impairment had 143% increased relative risk of having None (RR = 2.43, CI: 1.58-3.73) and 81% increased relative risk of completing Formal ACP only (RR = 1.81, CI: 1.11-2.95) relative to completing Both informal and formal ACP. In addition, respondents with None were more likely to prefer to receive all treatments available nearing death than those with any ACP engagement. Achieving high quality care at the end of life can be more challenging for older adults with cognitive impairment and their family caregivers due to the limited capacity. Although encouraged, informal ACP conversation with loved ones does not necessarily occur before the formal ACP, especially, for those with cognitive impairment. Therefore, they may merit more attention such as early ACP engagement.

scholarly journals Self-compassion as predictor of daily physical symptoms and chronic illness across older adulthood

2021 ◽  
pp. 135910532110023
Author(s):  
Heather Herriot ◽  
Carsten Wrosch
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Chronic Illness ◽  
End Of Life ◽  
Old Age ◽  
Physical Symptoms ◽  
Older Adulthood ◽  
Self Compassion ◽  
Early Old Age

This study examined whether self-compassion could benefit daily physical symptoms and chronic illness in early and advanced old age. The hypotheses were evaluated in a 4-year longitudinal study of 264 older adults. Results showed that self-compassion predicted lower levels of daily physical symptoms across the study period in advanced, but not early, old age ( T-ratio = −1.93, p = 0.05). In addition, self-compassion was associated with fewer increases in chronic illness in advanced, but not early, old age ( T-ratio = − 2.45, p < 0.02). The results of this study suggest that self-compassion may be particularly adaptive towards the end of life.

scholarly journals Changing Educational Gradients in Life Expectancy With and Without Disease Among U.S. Older Adults From 2000 to 2010

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 505-505
Author(s):  
Matthew Farina ◽  
Phillip Cantu ◽  
Mark Hayward
Keyword(s):  
Older Adults ◽  
Life Expectancy ◽  
Chronic Diseases ◽  
Population Aging ◽  
Good Health ◽  
Vital Statistics ◽  
Healthy Life Expectancy ◽  
Healthy Life ◽  
Education Group ◽  
Education Groups

Abstract Recent research has documented increasing education inequality in life expectancy among U.S. adults; however, much is unknown about other health status changes. The objective of study is to assess how healthy and unhealthy life expectancies, as classified by common chronic diseases, has changed for older adults across education groups. Data come from the Health and Retirement Study and National Vital Statistics. We created prevalence-based life tables using the Sullivan method to assess sex-specific life expectancies for stroke, heart disease, cancer, and arthritis by education group. In general, unhealthy life expectancy increased with each condition across education groups. However, the increases in unhealthy life expectancy varied greatly. While stroke increased by half a year across education groups, life expectancy with diabetes increased by 3 to 4 years. In contrast, the evidence for healthy life expectancy provides mixed results. Across chronic diseases, healthy life expectancy decreased by 1 to 3 years for respondents without a 4-year degree. Conversely, healthy life expectancy increased for the college educated by .5 to 3 years. While previous research shows increases in life expectancy for the most educated, trends in life expectancy with chronic conditions is less positive: not all additional years are in lived in good health. In addition to documenting life expectancy changes across education groups, research assessing health of older adults should consider the changing inequality across a variety of health conditions, which will have broad implications for population aging and policy intervention.

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