Ill, Older Patients Often Live Final Days in Hospital

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 University of California San Francisco. 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 per cent 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. The study 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.

"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 stabilisation 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 centred 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.; Source: University of California - San Francisco

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