DELHI:An increasing number of elderly Americans suffering from terminal diseases prefer to shift to their homes or hospices for their last days rather than die in hospitals, according to a new study. Patients dying in homes are up from about 31 percent in the year 2000 to 34 percent in 2009, while patients spending their last days in a hospice are up from 22 percent in 2000 to 42 percent in 2009.
However, the study pointed out that this does not mean that people are totally rejecting aggressive medical treatment because hospitalization rates in the last 90 days before death were up from 63 percent to 69 percent and intensive care unit (ICU) admissions in the last three days were up from 24 percent to 29 percent. This shows that people do seek intensive hospital care and intervention, but once they know that death is inevitable, they prefer to stop aggressive interventions and pass on in peace, while getting palliative care.
"Although the Centers for Disease Control (CDC) reports that decedents aged 65 years and older are more likely to die at home, our results are not consistent with the notion that there is a trend toward less aggressive care. Between 2000 and 2009, the ICU utilization rate, overall transition rate, and number of late transitions in the last 3 days of life increased. Thirty-one percent of these late transitions were to hospice services with GIP level of care. Future research is needed to examine whether these trends are improving the quality of life and are consistent with patient preferences," the study report said. Transitions refer to shifting the patient from one facility to another, including shifts to and from the home.
The study led by Joan Teno of the Warren Alpert Medical School of Brown University, Providence, Rhode Island was published in the Journal of American Medical association (JAMA) this week. The researchers analysed medical records of over 800,000 patients who were covered under the Medicare insurance program. Average age of the patients was over 80 years, 57 percent were women and 88 percent white.
The study also noted the practices in last days of terminal patients suffering from cancer, congestive obstructive pulmonary disease (COPD) and dementia - the three biggest causes of death among elderly. Among cancer patients, there was a huge increase in shift to a hospice in the last few days of life, from 45 percent to nearly 65 percent. A similar increase in preference for hospice was seen in dementia patients - deaths at hospices increased from only about 19 percent to 48 percent.
The National Priorities Partnership had identified palliative care as 1 of 6 priorities in improving the quality of US health care.
The study says that during the study period, the number of hospice programs increased from 2300 to more than 3500, with the fastest growth occurring among for-profit hospices.
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