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Survival in hospice patients with dementia: the effect of home hospice and nurse visits
Luth EA, Russell DJ, Xu JC, Lauder B, Ryvicker MB, Dignam RR, Baughn R, Bowles KH et al.. Journal of the American Geriatrics Society, 2021-02-19
Topic: Risk, prevention and care in population studies
Background Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospice, or experiences a live discharge or long length of stay. Objective Examine how home hospice and nurse visit frequency relate to dying in hospice within the Medicare-intended 6-month period. Design Retrospective cohort study. Setting Non-profit hospice agency. Participants Three thousand eight hundred and thirty seven patients with dementia who received hospice services from 2013 to 2017. Methods Multivariable survival analyses examined the effects of receiving home hospice (vs. nursing home) and timing of nurse visits on death within 6 months of hospice enrollment, compared to live discharge or long length of stay. Models adjust for relevant demographic and clinical factors. Results Thirty-nine percent (39%) of patients experienced live discharge or long length of stay. Home hospice patients were more likely to experience live discharge or long length of stays (HR for death: 0.77, 95%CI: 0.69-0.86, p < 0.001). Frequency of nurse visits was inversely associated with live discharge and long lengths of stay (HR for death: 2.87, 95%CI: 2.47-3.33, p < 0.001). Conclusion Nearly 40% of patients with dementia in our study experienced live discharge or a long length of stay. Additional research is needed to understand why home hospice may result in live discharge or a long length of stay for patients with dementia. Nurse visits were associated with death, suggesting their responsiveness to deteriorating patient health. Hospice guidelines may need to permit longer stays so community-dwelling patients with dementia, a growing segment of hospice patients, can remain continuously enrolled in hospice and avoid burden and costs associated with live discharge.
Key findings
- Background Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden.
- Methods Multivariable survival analyses examined the effects of receiving home hospice (vs. nursing home) and timing of nurse visits on death within 6 months of hospice enrollment, compared to live discharge or long length of stay.
- Results Thirty-nine percent (39%) of patients experienced live discharge or long length of stay.
- Frequency of nurse visits was inversely associated with live discharge and long lengths of stay (HR for death: 2.87, 95%CI: 2.47-3.33, p < 0.001).
- Additional research is needed to understand why home hospice may result in live discharge or a long length of stay for patients with dementia.
Study details
- Study designcohort study
- Evidence strengthModerate
How this study scored 55/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 32 of the 58 points we could judge it on, which is 55 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 33608869) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 32 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 32 of the 58 points we could judge it on is 55 out of 100. |
| Total | 55 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
Luth, E. A., Russell, D. J., Xu, J. C., Lauder, B., Ryvicker, M. B., Dignam, R. R., et al. (2021). Survival in hospice patients with dementia: the effect of home hospice and nurse visits. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.17066
Vancouver
Luth EA, Russell DJ, Xu JC, Lauder B, Ryvicker MB, Dignam RR, et al. Survival in hospice patients with dementia: the effect of home hospice and nurse visits. Journal of the American Geriatrics Society. 2021. doi:10.1111/jgs.17066. PMID: 33608869.
BibTeX
@article{luth2021-33608869,
author = {Luth, E. A. and Russell, D. J. and Xu, J. C. and Lauder, B. and Ryvicker, M. B. and Dignam, R. R. and Baughn, R. and Bowles, K. H. and others},
title = {{Survival in hospice patients with dementia: the effect of home hospice and nurse visits}},
journal = {Journal of the American Geriatrics Society},
year = {2021},
doi = {10.1111/jgs.17066},
pmid = {33608869},
url = {https://doi.org/10.1111/jgs.17066}
}
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