Dementia patients on hospice receive better standard of care

A new study from the US shows hospice patients with dementia are more likely to receive excellent care and have their anxiety and sadness managed than those not on hospice.

However, the researchers at UC San Francisco and Icahn School of Medicine at Mount Sinai found eligibility criteria mean that some patients with dementia face hurdles gaining access to hospice or may risk disenrollment.

In the study researchers tracked Medicare claims and data from the National Health and Aging Trends Study of 2,059 seniors over 70, who had died between 2011 and 2017.

Some 40% of these seniors (951) had dementia, of whom 59% used hospice, which is defined as regular visits by nursing staff, social workers and chaplains provided at the patient’s home, assisted living facility, nursing home, or dedicated area within a hospital or freestanding hospice.  

Researchers compared quality of care in the last month of life between patients with dementia on hospice and patients with dementia not on hospice, by questioning their “proxy,” a spouse or adult child caregiver in most cases, following the death of the patient.

Some 52% of hospice enrollees’ proxies said the standard of care was excellent, versus 41% of proxies of non-hospice enrollees.

Additionally, 67% of hospice enrollees’ proxies said their sadness and anxiety was managed, compared to 46% of proxies of non-hospice enrollees. 

Results also showed the hospice enrollees were less likely to be switched to a different care setting than non-hospice enrollees in the days before their deaths: 10% versus 25%.

First author Krista L Harrison, PhD, Associate Professor in the UCSF Division of Geriatrics, said: ‘Since the hospice model was designed for patients with cancer, we expected end-of-life care to be worse for people with dementia.’

The full research, published in Health Affairs, can be viewed here.

In related news, people living with dementia are being invited to join a new panel to help shape policy and delivery in Scotland.

Photo by Bret Kavanaugh