Few Patients With Dementia Receive Palliative Care

By Anne Harding

NEW YORK (Reuters Health) - Patients with dementia who develop acute surgical abdomen have high rates of in-hospital mortality and non-routine discharge, but rarely receive palliative care, according to a new U.S. study using data from the National Inpatient Sample (NIS).

Those who received surgical treatment were less likely to receive palliative care than those who didn’t have surgery, while outcomes were worse in surgical patients, according to the findings, online December 6 in Surgery.

“Patients with dementia usually already have some palliative care needs based on the fact that dementia is a progressive and life-limiting illness, but people often struggle with when to introduce palliative care in a disease like dementia,” Dr. Ana Berlin of Rutgers New Jersey Medical School in Newark, who led the study, told Reuters Health in a telephone interview.

The new findings show, she said, that admission to the hospital for abdominal emergency “really is catastrophic for a lot of patients with dementia, and is an appropriate and legitimate trigger to get palliative care involved.”

Dementia in hospitalized patients increases the likelihood of poor outcomes, and mortality is also higher among these patients, Dr. Berlin and her team note in Surgery, online December 6. Palliative care improves symptom management and reduces costs in surgical patients, they add, but little is known about the use of palliative care in surgical patients with dementia.

To investigate, the researchers reviewed data from NIS on 15,209 patients 50 and older with dementia admitted non-electively for acute abdominal emergency in 2009-2013. In-hospital mortality was 10.2%, while 67.2% had nonroutine discharge, meaning they were transferred to a short-term facility or to their home with assistance.

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Overall, 17.8% of patients had surgery. Those with intestinal ischemia had the highest rates of surgical intervention and postoperative mortality, at 22.8% and 30.7%, respectively.

Palliative care utilization was 7.5% overall, while it was 28.9% for patients who died in the hospital and 6.4% for those discharged non-routinely. Among surgical patients who underwent operation, 5.8% received palliative care, versus 7.9% of those who did not have surgery. For patients discharged non-routinely after an operation, 3.7% received palliative care, versus 7.0% of those discharged non-routinely without surgery.

Median hospital charges were $29,500 for patients who received palliative care, and $31,600 for those who did not. Palliative care patients spent a median five days in the hospital, versus six days for patients who didn’t receive palliative care.

Dr. Berlin and her team also found that white patients were more than twice as likely as Hispanics to receive palliative care. Older age, urban residence and higher household income also increased the likelihood that a patient would receive palliative care.

“Nearly 94% of patients who leave the hospital with some type of disability are not getting palliative care,” Dr. Berlin said. “That’s a huge gap in need for these patients and families.”

Dr. Berlin said she hopes that based on her findings, when surgeons are faced with a patient with dementia and an acute abdominal emergency, they will involve palliative care. Recognizing the shortage of palliative care specialists, efforts are underway to train surgeons and other front-line physicians to provide primary palliative care, Dr. Berlin noted.

“There’s a growing recognition of the need to have surgeons be more cognizant and educated about these issues, and to really take on some of these skills,” she said

SOURCE: https://bit.ly/2kFdHp4

Surgery 2017.

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