Criteria for enrolling dementia patients in hospice: A replication

Abstract

Because survival time varies greatly in dementia, it is difficult for dementia patients to meet a key criterion for the Medicare Hospice Benefit, a six-month survival time. In a previous study, the authors examined guidelines for admitting dementia patients to hospice; the National Hospice Organization (NHO) guidelines were found to work well in identifying appropriate candidates for hospice among dementia patients. This was especially true for those patients whose deficits had progressed in an ordinal fashion consistent with Functional Assessment Staging (FAST) and who had reached stage 7C. The purpose of this study was to examine the utility of the NHO guidelines in identifying dementia patients who are appropriate for hospice; the limitations of these guidelines regarding non-ordinal patients; and the importance of the actual care plans used--as opposed to our previous study, which only examined initial treatment plans. Forty-five dementia patients enrolled in Hospice of the Great Lakes in Illinois were studied longitudinally over two years; this included a follow-up period of at least six months for all patients. Measures included: survival time; FAST; a medical complications checklist, which consisted of common complications of end-stage dementia; and co-morbid medical conditions and aggressive care, which consisted of feeding tubes, antibiotics, and Foley catheters used during the course of the study. Patients who had reached Stage 7C at intake had a mean survival time of 4.1 months; and the majority (71 percent) died within six months. Non-ordinal patients lived significantly longer at a mean of 10.9 months (p < .01), and and the minority (30 percent) died within six months. Foley catheters decreased survival time; and the use of antibiotics did not make a difference. This study echoed our previous findings regarding the usefulness of NHO guidelines in identifying dementia patients with a survival time of six months or less, specifically those at stage 7C or greater. The findings also suggest that the nature of the palliative care plan influences survival time.

End of life care for community dwelling older people with dementia: an integrated review

“…Contextual factors such as the use of tube feeding and less aggressive care plans (Hanrahan et al, 1999;Lapane et al, 2001) plus the inability of some scoring systems to discriminate between underlying morbidities and different disease trajectories, gender differences, and disabilities mean that existing tools and guidelines need further validation and refinement (Gambassi et al, 1999;Mitchell et al, 2004aMitchell et al, , 2004bMagaziner et al, 2005). A small descriptive study argued that the use of hospice guidelines for people with dementia were useful for identifying survival time of less than six months (Hanrahan et al, 1999), but a study that reviewed the notes of 165 people with dementia admitted to a community-based hospice found that only 64% of people who met criteria for hospice care died within six months of admission. It concluded that advanced age, anorexia and level of function were more useful prognostic indicators than existing guidelines (Schonwetter et al, 2003).…”

Palliative Care for Patients With Dementia in Long-Term Care

“…In a similar study by Hanrahan and colleagues, 10 45 patients were enrolled in hospice using the FAST 7 system. These investigators examined the efficacy of FAST in identifying patients with dementia who were appropriate for hospice.…”

Hospice Referrals of Patients With Alzheimer Disease in Southeastern Georgia

“…The patient with AD is considered appropriate for hospice care at level 7 of the FAST, when the patient has lost the ability to perform any activities of daily living without assistance, has limited speech, and requires assistance with ambulation (Table 1). 47,48 The patient with AD must be below 50% on the KPS to meet hospice criteria, meaning the patient is unable to care for self and requires the equivalent of institutional or hospital care and that the disease may be progressing rapidly (Table 2). 46 Critics of the FAST argue that its use may prevent the admission of some patients with AD to hospice, because the FAST is an ordinal scale, and some patients with AD do not decline in an ordinal fashion.…”