Research Activities, March 2014
Whether patients have dementia does not greatly influence the quality of their hospice care
Patient Safety and Quality of Care
Hospice patients with Alzheimer's disease and other types of dementia find it more difficult to communicate with providers and caregivers than the terminal cancer patients for which hospice care was originally conceived. However, this difference does not appear to affect the overall quality of their care, according to a new study. This is important because the proportion of hospice patients with Alzheimer's disease or other forms of dementia has been increasing. Jennifer S. Albrecht, Ph.D., of the University of Maryland School of Pharmacy, Baltimore, and Jon P. Furuno, Ph.D., of the Oregon Health & Science University College of Pharmacy, Portland, and colleagues found that the majority of quality-of-care measures for individuals receiving hospice care differed little between patients with and without dementia.
Nonetheless, hospice patients with dementia were 2.6 times more likely to receive tube feeding than other hospice patients, despite findings that tube feeding is not associated with longer survival, better nutrition, fewer pressure ulcers, or reduced risk of aspiration pneumonia in individuals with advanced dementia.
In addition, hospice patients with dementia were 40 percent less likely to have a report of pain at last assessment than other hospice patients. Among individuals with dementia, observation of the patient was used in only 54 percent of cases to assess pain. Based on their findings, the researchers suggest that the use of feeding tubes and assessment of pain by validated methods could serve as dementia-specific quality measures for hospices. Their findings were based on analysis of quality measures for 4,711 individuals (prevalence of dementia 9.5 percent) included in the 2007 National Home and Hospice Care Survey who were discharged to home care or died. The study was funded in part by AHRQ (HS21068, HS20970).
More details are in "Quality of hospice care for individuals with dementia," by Dr. Albrecht, Ann L. Gruber-Baldini, Ph.D., Erik K. Fromme, M.D., and others in Journal of the American Geriatrics Society 61(7), pp. 1060-1064, 2013.