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Potentially burdensome end‐of‐life transitions among nursing home residents with poor‐prognosis cancer
Author(s) -
Lage Daniel E.,
DuMontier Clark,
Lee Yoojin,
Nipp Ryan D.,
Mitchell Susan L.,
Temel Jennifer S.,
ElJawahri Areej,
Berry Sarah D.
Publication year - 2020
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32658
Subject(s) - medicine , minimum data set , odds ratio , heart failure , activities of daily living , intensive care unit , odds , cognitive impairment , retrospective cohort study , cancer , pulmonary disease , disease , intensive care medicine , nursing homes , gerontology , logistic regression , physical therapy , nursing
Background This study examined factors associated with potentially burdensome end‐of‐life (EOL) transitions between care settings among older adults with advanced cancer in nursing homes (NHs). Methods A retrospective analysis of deceased older NH residents with poor‐prognosis solid tumors was conducted with Medicare claims and the Minimum Data Set. A potentially burdensome transition was defined as 2 or more hospitalizations or an intensive care unit admission in the last 90 days of life. Results Among 34,670 subjects, many had moderate to severe cognitive impairment (53.8%), full dependence in activities of daily living (ADLs; 66.5%), and comorbidities such as congestive heart failure (CHF; 29.3%) and chronic obstructive pulmonary disease (34.1%). Only 56.3% of the patients used hospice at any time in the 90 days before death; 36.0% of the patients experienced a potentially burdensome EOL transition, and this was higher among patients who did not receive hospice (45.4% vs 28.7%; P < .01). In multivariable analyses, full dependence in ADLs (odds ratio [OR], 1.70; P < .01), CHF (OR, 1.48; P < .01), and chronic obstructive pulmonary disease (OR, 1.28; P < .01) were associated with a higher risk of burdensome EOL transitions. Those with do‐not‐resuscitate directives (OR, 0.60; P < .01) and impaired cognition (OR, 0.89; P < .01) had lower odds of burdensome EOL transitions. Conclusions NH residents with advanced cancer have substantial comorbidities and functional impairment, yet more than a third experience potentially burdensome EOL transitions. These findings help to identify a population at risk for poor EOL outcomes in order to target interventions, and they point to the importance of advanced care planning in this population.