Restricting Symptoms Before and After Admission to Hospice

Cheraghlou, Shayan; Gahbauer, Evelyne A.; Stabenau, Hans F.; Chaudhry, Sarwat I.; Gill, Thomas M.

doi:10.1016/j.amjmed.2016.02.017

Cited by 19 publications

(22 citation statements)

References 44 publications

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“…End‐of‐life for patients dying from gastrointestinal malignancies has been characterized by a high symptom burden and increased health care utilization . Merchant et al evaluated the symptom profile the year before death of patients dying from esophageal, gastric, colon and anorectal cancers and noted that the last months of life were characterized by moderate‐severe fatigue, as well as lack of well‐being and appetite.…”

Section: Discussionmentioning

confidence: 99%

“…Despite these high costs, quality‐of‐life has been reported to be suboptimal. Specifically, the life of individuals who are seriously ill and dying is plagued with a high symptom burden characterized by pain, fatigue, anxiety, depression, and nausea . Hospice aims to provide compassionate care to individuals facing a life‐limiting illness, such as pancreatic cancer .…”

Section: Introductionmentioning

confidence: 99%

“…Hospice aims to provide compassionate care to individuals facing a life‐limiting illness, such as pancreatic cancer . Hospice has been associated with improved patient functioning, decreased symptom burden, and for some, even longer survival times …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Paredes

Hyer

Tsilimigras

et al. 2019

Journal of Surgical Oncology

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Background: Use of hospice services among patients with pancreatic cancer following pancreatic resection remains unknown. Methods: Patients with pancreatic cancer who underwent resection were identified in the Medicare Standard Analytic Files. Outcomes included overall hospice use, early hospice enrollment (≥4 weeks before death), late hospice enrollment (initiation within 3 days of death), and Medicare expenditures. Results: Among the 4369 deceased individuals, three-fourths of patients (n = 3252, 74.4%) used hospice at the time of death. Patients who did not use hospice were more likely to be male, have a complication on index admission and receive life sustaining treatments on subsequent admissions (P < .05). Only one-third (32.2%) of patients initiated hospice services early. Medicare expenditure during the last month of life was $10 000 lower among patients who initialized hospice services at least 1 month before death versus within 3 days of death (late: $10 581 [$5454-$17 200], early: $221 [$46-$733]; P < .001) Conclusion: While three-fourths of patients utilized hospice services after pancreatic resection, only one-third of patients initiated hospice services at least one-month before death. Late hospice use was associated with higher Medicare expenditures during the last month of life. Further research is needed to understand barriers to early hospice utilization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Paredes

Hyer

Tsilimigras

et al. 2019

Journal of Surgical Oncology

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“…In an earlier article, we reported that the number of restricting symptoms decreased significantly after the start of hospice, a well‐established source of palliative care at the end of life, with large reductions in the occurrence of restricting fatigue, depression, anxiety, and arm and leg weakness. Although hospice care is readily available for older persons at the end of life, its short duration diminishes its benefits .…”

Section: Discussionmentioning

confidence: 99%

Burden of Restricted Activity and Associated Symptoms and Problems in Late Life and at the End of Life

Gill

Allore

Gahbauer

et al. 2018

J American Geriatrics Society

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Objective: To compare the rates of restricted activity and associated symptoms and problems in the last 6 months of life with the period prior to the last 6 months of life. Design: Prospective cohort study. Setting: Greater New Haven, Connecticut. Participants: 754 community-living persons, ≥70 years. Measurements: The occurrence of restricted activity (i.e. staying in bed for at least ½ day or cutting down on one’s usual activities) and 24 prespecified symptoms and problems leading to restricted activity were ascertained monthly for nearly 19 years. Results: The rates of restricted activity per 100 person-months were 36.5 in the last 6 months of life versus 16.1 in the period prior to the last 6 months of life (P<.001). Among the 737 participants with ≥1 month of restricted activity, the rates of restricting symptoms per 100 person-months of restricted activity ranged from 8.0 for frequent or painful urination to 65.6 for been fatigued, while the rates of restricting problems ranged from 0.1 for problem with alcohol to 23.4 for been afraid of falling. Rates were significantly higher in the last 6 months of life than in the prior period for 13 of the 24 restricting symptoms and problems (P<.05), most notably for shortness of breath (38.6 versus 21.8), weakness (37.3 versus 18.9), and confusion (31.2 versus 9.8). The mean [standard error] number of restricting symptoms and problems was significantly higher in the last 6 months of life (6.1 [.1]) than in the prior period (4.7 [.03]), P<.001. Conclusion: The rates of restricted activity and associated symptoms and problems are substantially greater in the last 6 months of life than in the period prior to the last 6 months of life. Enhanced palliative care strategies may be needed to diminish the burden of distressing symptoms and problems at the end of life.

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“…washing, dressing, moving, eating meals and controlling urine and stool excretion causing dependence on other people, reduces the subjective assessment of the quality of life of hospice patients [37]. Most people admitted to the hospice indicate severe and moderate dependence in terms of simple and complex activities of everyday life and limited mobility [38].…”

Section: Variablesmentioning

confidence: 99%

Assessment of the effects of a multi-component individualized physiotherapy program in patients in a home hospice

Ćwirlej-Sozańska¹,

Wójcicka²,

Kluska³

et al. 2020

Preprint

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Background: Hospice care is aimed at chronically and terminally ill patients. It includes symptomatic treatment as standard, but the interest in physiotherapy programs for hospice patients is increasing in order to improve their functioning and quality of life. Aim: The aim of the study is to assess the impact of a multi-component individualized physiotherapy program on the functional and mental condition and quality of life of patients in a home hospice. Material and method:The study included 60 patients (mean 66.3 years) in a home hospice living in southern Poland. Functional status was assessed twice: before and after intervention. The program was performed for 6 weeks (12 trainings) and was managed on the basis of WHO Rehab-Cycle ICF. The program was individually tailored to the patient, but structured according to the same scheme, i.e. breathing, strengthening, transfer, balance and functional exercisesas well as functional ergonomics. Patients participated in setting particular objectives of the program. The study used: Katz (ADL) and Lawton (IADL) scales, Tinetti test, Visual Analogue Scale (VAS) pain scale, WHOQOL – BREF, Yesavage Geriatric Depression Scale (GDS). A set of ICF categories in terms of function, activity and participation was selected for the studied areas. Results: The average functional level of ADL (mean 2.87) and IADL (mean 11.92) as well as quality of life (WHOQL mean 46.43) of researched patients before the intervention were low, whereas the intensity of pain (VAS mean 5.82), the risk of falling (Tinetti mean 8.20) and depression (GDS mean 16.65) were recorded high. After the completion of the intervention program, a significant improvement was found in all assessed areas, in particular in the scope of performing basic everyday activities(ADL mean 3.95), risk of falling (Tinetti mean 12.25) and QOL (mean 52.58). Conclusions: The physiotherapeutic intervention presented here has a significant impact on improving the performance of basic and complex activities of everyday life as well as the emotional state and quality of life of patients in a home hospice. The results of our research confirm the great need for physiotherapy in hospice patients and for comprehensive assessment by means of ICF. Registration number: researchregistry5264

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Restricting Symptoms Before and After Admission to Hospice

Cited by 19 publications

References 44 publications

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Burden of Restricted Activity and Associated Symptoms and Problems in Late Life and at the End of Life

Assessment of the effects of a multi-component individualized physiotherapy program in patients in a home hospice

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