מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Although hospice is gaining popularity for end-of-life care, it is not clear that hospice should routinely have a role in the care of terminally ill nursing home patients, according to a report in the November issue of the Journal of the American Geriatrics Society.
Hospice providers identify additional needs for care in a "substantial proportion" of nursing home patients, study results show, but it remains an open question whether hospices usually have time to intervene, and whether hospice services can improve the care of these patients.
Dr. David J. Casarett from the University of Pennsylvania in Philadelphia and colleagues collected data on 1142 patients, 65 years of age or older, of whom 167 lived in nursing homes and 975 lived in the community. Overall, the researchers say, nursing home residents had "fewer needs for care" compared with community-dwelling patients. Only the need for feeding tube management was more common in nursing homes.
But when the two groups were compared in a linear regression model, "nursing home residence remained a significant predictor of patients' need for care" after adjustment for orientation, Dr. Casarett and associates determined.
Furthermore, they found that hospice teams often identified at least one need for care that had been overlooked by the nursing home. "This finding should pave the way for future research to determine whether hospices are able to intervene effectively to meet the needs for care and, more broadly, whether hospice involvement in the care of nursing home residents offers added benefits," the investigators note.
Nursing home patients had fewer median days of survival from the date of hospice enrollment compared with community-living patients (11 versus 19 days, p < 0.001). "An increased emphasis on hospice care in nursing homes should be accompanied by targeted educational efforts to encourage early referral," the authors suggest.
While the reasons for the need for less care of nursing home patients are not clear, "this finding should be reassuring to hospices that are considering partnerships with nursing homes and should ameliorate hospice concerns about excessive demands on staff time," Dr. Casarett's group comments.
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