Characteristics and Outcomes of Hospice Enrollees with Dementia Discharged Alive

Authors

  • Kimberly S. Johnson MD, MHS,

    Corresponding author
    1. Division of Geriatrics, Duke University, Durham, North Carolina
    2. Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
    3. Center for Palliative Care, Duke University, Durham, North Carolina
    4. Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
    • Department of Medicine, Duke University, Durham, North Carolina
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  • Katja Elbert-Avila MD, MHS,

    1. Department of Medicine, Duke University, Durham, North Carolina
    2. Division of Geriatrics, Duke University, Durham, North Carolina
    3. Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
    4. Center for Palliative Care, Duke University, Durham, North Carolina
    5. Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
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  • Maragatha Kuchibhatla PhD,

    1. Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
    2. Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
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  • James A. Tulsky MD

    1. Department of Medicine, Duke University, Durham, North Carolina
    2. Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
    3. Center for Palliative Care, Duke University, Durham, North Carolina
    4. Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina
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  • Related Presentations and Published Abstracts: Elbert-Avila, K, Johnson KS, Kuchibhatla, M, Tanis, D, Tulsky, JA. Predictors of extended prognosis in hospice patients with dementia. Oral Presentation, Annual Meeting of the American Geriatrics Society, 2005. Abstract Only—J Am Geriatr Soc 2005;53(Suppl):S9.

Address correspondence to Kimberly S. Johnson, Duke University Medical Center, DUMC Box 3003, Durham, NC 27710. E-mail: johns196@mc.duke.edu

Abstract

Objectives

To examine the characteristics of hospice enrollees with dementia who were discharged alive because their condition stabilized or improved and predictors of death in the year after discharge.

Design

Cross-sectional analysis of clinical and administrative data.

Setting

For-profit hospice provider.

Participants

Hospice enrollees aged 65 and older with an admission diagnosis of dementia who died or were discharged alive because their condition stabilized or improved between January 1, 1999, and December 31, 2003.

Measurements

Demographic variables and hospice length of stay; data did not include functional status or comorbidities.

Results

Of 24,111 enrollees with dementia, 1,204 (5.0%) were discharged alive because their condition stabilized or improved; the remainder died while receiving hospice. The median length of stay for those who died was 12 versus 236 days for those discharged alive. Those discharged alive were more likely to be female or have a length of stay exceeding 180 days and less likely to be in the oldest age group (≥85), be African American, or reside in a nursing home. In a subgroup of 303 patients discharged alive, 75.5% were still alive at 1 year; none of the demographic variables were associated with death after hospice discharge.

Conclusion

A small proportion of hospice enrollees with dementia was discharged alive. Most died shortly after enrollment. Future research should examine other factors that may predict which hospice enrollees with dementia are likely to be discharged alive and their subsequent trajectory, such as functional status, comorbidities, and preferences for care.

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