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The Article in Brief
Functional Trajectories in the Year Before Hospice
Thomas M. Gill , and colleagues
Background Because of restrictions on hospice (end of life) care and confusion between hospice and palliative care (treatment of stress and pain during serious illness), many older persons do not receive hospice or palliative care near the end of life. This can burden caregivers and increase patients' suffering. This study examines the course, or trajectory, of disability in older patients in the year before hospice.
What This Study Found The study found five trajectories, representing worsening disability, among patients 70 years or older who were later enrolled in hospice. Participants with neurodegenerative disease had the worst functional trajectory, whereas those with a cancer diagnosis had the most favorable. Nearly 60 percent of the study sample had progressively or persistently severe disability during the year before hospice. The median survival in hospice was only 14 days and did not differ significantly by functional trajectory.
Implications
- Late admission to hospice, as shown by patients' short survival, coupled with high levels of severe disability before hospice indicate there are potential unmet palliative care needs for many at the end of life.