Comparison of healthcare utilization and life‐sustaining interventions between elderly patients with dementia and those with cancer near the end of life: A nationwide, population‐based study in Taiwan

Chen, Yuhan; Ho, Chung‐Han; Huang, Chien‐Cheng; Hsu, Ya-Wen; Chen, Yueh-Chun; Chen, Ping-Jen; Chen, Guan-Ting; Wang, Jhi-Joung

doi:10.1111/ggi.13084

Cited by 32 publications

(34 citation statements)

References 28 publications

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“…In the control group of patients with cancer, 14.6% received tube feeding or intravenous fluids during the last day of life. In contrary to the findings in our study, Chen et al [ 16 ] found that patients with dementia were more likely to receive tube feeding compared to patients with cancer.…”

Section: Discussioncontrasting

confidence: 99%

“…The number of patients with dementia receiving tube feeding or intravenous fluids during the last day of life was very low (3.5%) compared to findings in the literature from several countries. In an Italian study, 20.5% received tube feeding and 66.6% intravenous hydration during the last 48 hours in life [ 11 ], a Taiwanese study found that 67.4% of dementia patients received tube feeding during the last year in life [ 16 ] and Mitchel et al from the US found that 25% of demented residents died with a feeding tube compared with 5.2% of residents with terminal cancer [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Five studies comparing palliative care outcomes between patients with dementia and patients with cancer were found in the literature: McCarthy et al compared 170 patients with dementia to 1513 patients with cancer in a population-based regional study [ 5 ], Ahronheim et al compared 80 patients with dementia to 84 patients with cancer in a hospital setting [ 15 ] and Mitchell et al compared 1609 patients with dementia to 883 with cancer in a nursing home setting [ 10 ]. Chen et al compared outcomes during the last year of life for 908 patients with dementia and 1816 patients with cancer and found that hospitalisation and life-sustaining interventions including cardiopulmonary resuscitation and tube feeding were more common in the dementia group [ 16 ]. Huang et al examined outcomes for 7111 patients with cancer and dementia compared to 28 444 patients with cancer and without dementia.…”

Section: Introductionmentioning

confidence: 99%

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Quality of end-of-life care in patients with dementia compared to patients with cancer: A population-based register study

Martinsson

Lundström

Sundelöf³

2018

PLoS ONE

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IntroductionGlobally, dementia is one of the leading causes of death. Given the growing elderly population in the world, the yearly number of deaths by dementia is expected to increase. Patients dying from dementia are reported to suffer from a burden of symptoms similar to that of patients with cancer, but receive less medication against symptoms, have a lower probability of palliative care planning and seldom have access to specialised palliative care. Studies investigating the quality of palliative care in dementia are scarce. The aim of this Swedish national study was to compare the quality of end-of-life care between patients with dementia and patients with cancer regardless of place of care.MethodsThirteen end-of-life care quality indicators collected by the Swedish Register of Palliative Care (SRPC) were compared between patients dying from dementia and patients dying from cancer. Data were collected from deaths occurring in nursing homes, hospitals, specialised and general palliative home care, and palliative in-patient units during a three-year period (during March 2012 to February 2015). Analyses were performed using a multivariable logistic regression model, adjusted for age and gender. A subgroup of patients with Alzheimer’s disease was identified and compared to patients with other and unspecified types of dementia.ResultsA total of 4624 deaths from Alzheimer’s disease, 11 804deaths from other dementia diagnoses and 51 609 deaths from cancer were included. For six of the 13 quality indicators examined (prescription of PRN drugs against nausea and anxiety, information and bereavement support offered to next of kin, pain assessment and specialised palliative care consultations), poorer outcomes were shown for the dementia group in comparison to the cancer group. Two outcomes (prevalence of pressure ulcers and fluid therapy during the last 24 hours in life) showed better outcomes for the dementia group. The outcomes for the 13 quality indicators were similar for patients with Alzheimer’s disease compared to patients with other and unspecified types of dementia.ConclusionsThe findings in this study indicates that patients dying from Alzheimer’s disease and other types of dementia receive a poorer quality of end-of-life care concerning several important end-of-life care areas when compared to patients dying from cancer. Guidelines for end-of-life care in Sweden cannot explain or justify these differences. Further studies are needed to find possible ways to improve end-of-life care in the large and growing group of patients dying from dementia.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quality of end-of-life care in patients with dementia compared to patients with cancer: A population-based register study

Martinsson

Lundström

Sundelöf³

2018

PLoS ONE

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“…Studies from Taiwan have reported different patterns in the use of lifesaving procedures depending on patient diagnoses (i.e., dementia, cancer, or both) [28]. For instance, patients with dementia had a higher frequency of admission to the hospital and the ICU and a longer duration of hospitalization than those with cancer [6,29], indicating that a reduction in burdensome treatments among advanced dementia patients under palliative care among Taiwanese inpatients is more consistent among those with cancer. Furthermore, the proportion of cancer diagnoses was higher among the study patients than among dementia patients who did not receive palliative care [6].…”

Section: Service Evaluationmentioning

confidence: 99%

Palliative care for nursing home patients with dementia: service evaluation and risk factors of mortality

et al. 2020

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Background: Difficulties in prognostication are common deterrents to palliative care among dementia patients. This study aimed to evaluate the effectiveness of palliative care in reducing the extent of utilization of medical services and the potential risk factors of mortality among dementia patients receiving palliative care. Methods: We surveyed dementia patients involved in a palliative care program at a long-term care facility in Taipei, Taiwan. We enrolled 57 patients with advanced dementia (clinical dementia rating ≥ 5 or functional assessment staging test stage 7b). We then compared the extent of their utilization of medical services before and after the provision of palliative care. Based on multivariable logistic regression, we identified potential risk factors before and after the provision of palliative care associated with 6-month mortality. Results: The utilization of medical services was significantly lower among dementia patients after the provision of palliative care than before, including visits to medical departments (p < 0.001), medications prescribed (p < 0.001), frequency of hospitalization (p < 0.001), and visits to the emergency room (p < 0.001). Moreover, patients dying within 6 months after the palliative care program had a slightly but not significantly higher number of admissions before receiving hospice care (p = 0.058) on univariate analysis. However, no significant differences were observed in multivariate analysis. Conclusions: The provision of palliative care to dementia patients reduces the extent of utilization of medical services. However, further studies with larger patient cohorts are required to stratify the potential risk factors of mortality in this patient group.

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“…Two studies examined hospitalisation risk for people with dementia at the end of life with one Taiwanese register study of people in the last year of life reporting RR for admission 1.14 (0.91-1.41) and the other study of Finnish people with dementia in the final 2 years of life showing lower admission risk (RR = 0.33 (0.31-0.35)). There was low confidence in the evidence as the studies are of moderate and low quality respectively, and they present contradictory estimates [47,48]. Table 2 displays the rates of hospital admissions in people with dementia.…”

Section: Comparison To People Without Dementiamentioning

confidence: 99%

P1‐561: Hospitalisation Rates and Predictors in People With Dementia: A Systematic Review And meta‐analysis

Sommerlad

Shepherd

Chan

et al. 2019

Alzheimer's & Dementia

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Background: Hospitalisation is often harmful for people with dementia and results in high societal costs, so avoidance of unnecessary admissions is a global priority. However, no intervention has yet reduced admissions of community-dwelling people with dementia. We therefore aimed to examine hospitalisation rates of people with dementia and whether these differ from people without dementia and to identify socio-demographic and clinical predictors of hospitalisation. Methods: We searched MEDLINE, Embase, and PsycINFO from inception to 9 May 2019. We included observational studies which (1) examined community-dwelling people with dementia of any age or dementia subtype, (2) diagnosed dementia using validated diagnostic criteria, and (3) examined all-cause general (i.e. non-psychiatric) hospital admissions. Two authors screened abstracts for inclusion and independently extracted data and assessed included studies for risk of bias. Three authors graded evidence strength using Cochrane's GRADE approach, including assessing for evidence of publication bias using Begg's test. We used random effects meta-analysis to pool estimates for hospitalisation risk in people with and without dementia. Results: We included 34 studies of 277,432 people with dementia: 17 from the USA, 15 from Europe, and 2 from Asia. The pooled relative risk of hospitalisation for people with dementia compared to those without was 1.42 (95% confidence interval 1.21, 1.66) in studies adjusted for age, sex, and physical comorbidity. Hospitalisation rates in people with dementia were between 0.37 and 1.26/person-year in high-quality studies. There was strong evidence that admission is associated with older age, and moderately strong evidence that multimorbidity, polypharmacy, and lower functional ability are associated with admission. There was strong evidence that dementia severity alone is not associated. Conclusions: People with dementia are more frequently admitted to hospital than those without dementia, independent of physical comorbidities. Future interventions to reduce unnecessary hospitalisations should target potentially modifiable factors, such as polypharmacy and functional ability, in high-risk populations.

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Comparison of healthcare utilization and life‐sustaining interventions between elderly patients with dementia and those with cancer near the end of life: A nationwide, population‐based study in Taiwan

Cited by 32 publications

References 28 publications

Quality of end-of-life care in patients with dementia compared to patients with cancer: A population-based register study

Quality of end-of-life care in patients with dementia compared to patients with cancer: A population-based register study

Palliative care for nursing home patients with dementia: service evaluation and risk factors of mortality

P1‐561: Hospitalisation Rates and Predictors in People With Dementia: A Systematic Review And meta‐analysis

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