Hospice use increases but aggressive care still common: study

Fewer seniors died in hospitals during the past decade and the use of hospice increased, but more elderly were also hospitalized within a month of dying or moved within days of death, research shows.

Results, published in the Journal of the American Medical Association, suggest that hospice care has not replaced aggressive medical intervention at the end of life, said Dr. Joan Teno, lead author of the study and a professor of health services policy and practices at Brown University.

The study looked at where seniors received care during the last three months of life based on data for Medicare enrollees who died in 2000, 2005 and 2009. The study excluded seniors who were covered by Medicare managed care.

Hospice use increased sharply, the analysis found. Those enrolled in hospice when they died increased from 21.6% to 42.2% during the same period. Seniors in hospitals at the time they died declined from 32.6% to 24.6%.

However, the study also found hospital use among dying patients increased, too, as did the number who entered hospice within three days of dying.

The number of seniors who spent time in an intensive-care unit during the final month of life increased from 24.3% in 2000 to 29.2% in 2009, the study found. The number of seniors who entered the hospital at least three times in the last three months of life also increased, though minimally, from 10.3% to 11.5%.

Patients were also transferred more frequently at the end of life in 2009 (three times, on average) than at the start of the decade (twice, on average). During the same period, the number of seniors who were transferred within three days of death also increased, from 10.3% to 14.2%.

More seniors entered hospice and died within three days in 2009 (28.4%) than in 2000 (22.2%), and 40% of those who died within three days of entering hospice care in 2009 had been in a hospital intensive-care unit within the previous month, the study said.

Researchers also looked separately at patients diagnosed in the final six months of life with cancer, chronic obstructive pulmonary disease and dementia and found similar declines in those who died in the hospital and increases for those who died in hospice. Cancer, COPD and dementia patients increasingly entered the intensive-care unit in the last 30 days of life. Cancer and COPD patients also were increasingly likely to have three or more hospitalizations during the last three months of life.