A National Study of End‐of‐Life Care among Older Veterans with Hearing and Vision Loss

Abstract

OBJECTIVES Hearing and visual sensory loss is prevalent among older adults and may impact the quality of healthcare they receive. Few studies have examined sensory loss and end‐of‐life (EOL) care quality. Our aim was to describe hearing and vision loss and their associations with the quality of EOL care and family perception of care in the last 30 days of life among a national sample of veteran decedents. DESIGN Retrospective medical record review and Bereaved Family Survey (BFS). SETTING Veterans Affairs (VA) Medical Centers (N = 145). PARTICIPANTS Medical record review of all veterans who died in an inpatient VA Medical Center between October 2012 and September 2017 (N = 96 424). Survey results included 42 428 individuals. MEASUREMENTS Three indicators of high‐quality EOL care were measured: palliative consultation in the last 90 days of life, death in a non‐acute setting, and contact with a chaplain. The BFS reflects a global evaluation of quality of EOL care; pain and posttraumatic stress disorder management; and three subscales characterizing perceptions regarding communication, emotional and spiritual support, and information about death benefits in the last month of life. RESULTS In adjusted models, EOL care quality indicators and BFS outcomes for veterans with hearing loss were similar to those for veterans without hearing loss; however, we noted slightly lower scores for pain management and less satisfaction with communication. Veterans with vision loss were less likely to have received a palliative care consult or contact with a chaplain than those without vision loss. Although BFS respondents for veterans with vision loss were less likely than respondents for veterans without vision loss to report excellent overall care and satisfaction with emotional support, other outcomes did not differ. CONCLUSION In general, the VA is meeting the EOL care needs of veterans with hearing and vision loss through palliative care practices. J Am Geriatr Soc 68:817–825, 2020

Assessment of Sensory Impairment and Health Care Satisfaction Among Medicare Beneficiaries

“…In is associated with reduced satisfaction with quality of care, 28,32 and that vision or hearing impairment are associated with overall dissatisfaction with care. 30 However, to our knowledge, no previous study focusing on patient-reported satisfaction with care has examined dual sensory impairment as an exposure and instead opted to explore hearing or vision alone.…”

“…Notably, older adults with dual sensory impairment had the highest odds of dissatisfaction, followed by hearing impairment only. Previous studies 7,8,[28][29][30][31] Medicare beneficiaries with vision impairment only and dual sensory impairment reported dissatisfaction with ease of getting to doctors from their homes. In sensitivity analyses limited to older adults, the association remained significant for the dual sensory impairment group only.…”

“…Covariates that may confound the association between sensory impairment and satisfaction with care were identified in the satisfaction with care and disability literature. 28,30,33…”

“…Previous work has focused on the association of individual sensory impairments and satisfaction with care, particularly with hearing impairment among older adults. 28,32 Few articles have focused on vision impairment specifically 30,33 and none have addressed dual sensory impairment in terms of general health care satisfaction. Dual sensory impairment may exacerbate the impact of either individual sensory impairment, as it strains an individual's ability to use sensory compensation strategies.…”

“…[21][22][23] Moreover, sensory impairment has been associated with higher health care utilization and costs [24][25][26][27] and with difficulty communicating with health care professionals and accessing health information. 7,8,[28][29][30][31] People with vision impairment have also reported physical access barriers, including getting to and around physicians' offices. 31 The combined effects of access to care barriers, poor communication with health care professionals, and higher health resource needs and costs may contribute to reduced patient satisfaction with care among adults with sensory impairment.…”