At End of Life, Seniors Still Accepting Aggressive Care

Hospice and palliative care services enable a growing majority of seniors the comfort of living out their last days at home, but many have not yet turned away from receiving more aggressive forms of care before death.

There’s no doubt that hospice care has been gaining popularity over the years.

The percentage of patients ages 65 or older requiring hospice services at the time of death rose from 21.6% in 2000, to 42.2% in 2009, according to a report from the Warren Alpert Medical School of Brown University. 

The same years also saw a decrease in the number of patients dying in acute care settings from 32.6% in 2000, to 24.5% in 2009, the study notes. 

But while the rise in hospice services correlates with the decrease in the number of patients dying in acute care settings during the same period, patients did not shy away from intensive care unit (ICU) treatment during the last month of life.

Rising gradually, the percentage of beneficiaries receiving ICU treatment rose from 24.3% in 2000, to 29.2% in 2009.

Even with hospice becoming more accepted among the terminally ill, nearly one third of patients in 2009 used it for 3 days or less. Of these late hospice referrals, the study mentions 40.3% were preceded by hospitalization with an ICU stay.

This refutes data from the Center for Disease Control and Prevention (CDC), which reported the vast majority of seniors are more likely to die at home.

“Although the CDC reports that decedents aged 65 years and older are more likely to die at home, our results are not consistent with the notion that there is a tried toward less aggressive care,” writes lead author Joan Teno, MD, MS, Warren Alpert Medical School of Brown University. 

Because of the 31% of late transitions to hospice services, Teno urges that future research is needed to examine whether these trends are improving the quality of life and are consistent with patient preferences. 

Written by Jason Oliva