End-of-life care for elderly often too aggressive, study says

More seniors are dying in hospice than they did a decade ago, but often it follows a stay in the intensive care unit (ICU) where they are aggressively treated.

That's what a new study found, and according to its author, the research suggests doctors may just be thinking of hospice care as an afterthought.

"For many patients, hospice is an 'add-on' to a very aggressive pattern of care during the last days of life," Dr. Joan Teno, professor of health services policy and practice at Brown University, said in a written statement. "I suspect this is not what patients want."

Palliative care is a form of treatment that aims to alleviate symptoms like pain and nausea while not curing the disease, which should make people more comfortable during their final days.

The new study involved more than 840,000 Medicare beneficiaries who died between 2000 and 2009. Researchers found the proportion of seniors dying in hospice increased from 21.6 percent in 2000 to 42.2 percent in 2009 while the number of patients who were in intensive care in the last month of their life also rose from 24.3 percent in 2000 to 29.2 percent in 2009. More than 25 percent of hospice use in 2009 was for three days or less, and 40 percent of those "late referrals" came after a hospitalization with a stay in the ICU.

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Teno, who is also a palliative care physician at Home & Hospice Care of Rhode Island in Providence, said the analysis of patients' medical histories suggests that the system fell short of providing the comfort and psychological support that hospice is meant to provide dying seniors.

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"With this pattern of going from the ICU to hospice, these dying patients are getting symptom control late and can't benefit as much from the psychosocial supports available were there a longer hospice stay," she said.

Study co-author Dr. David Goodman, director of the Center for Health Policy Research at Dartmouth College, adds that aggressive care is the norm at many medical centers. That was the case for his sister who had advanced colon cancer in 2008 and died during a medical procedure that took place the day before she was supposed to enter hospice, he said.

"The patterns of care observed in this study reflect needlessly painful experiences suffered by many patients, including my sister, and other friends and family members of the research team," Goodman said in the statement.

The study was published Feb. 5 in JAMA, the Journal of the American Medical Association.

Study co-author Dr. Julie Bynum, a gerontologist at the Geisel School of Medicine at Dartmouth, told the Los Angeles Times that family members and doctors should begin the conversation about end-of-life care before a final medical crisis.

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"You need to prevent him from getting into that cycle of acute care" if the patient's wish is to avoid aggressive treatment, she said, "because once they get into the hospital, it's really hard to get them out."

Dr. Mary Tinetti, chief of geriatrics at the Yale University School of Medicine and Yale New Haven Hospital, who wrote an accompanying editorial published in the same journal, said that there should be standards put in place for which elderly patients should get sent to the ICU.

"Why do we have to fill out 25 pages of forms to get hospice [care] or a skilled nursing facility, but not for ICU?" Tinetti told HealthDay. "We need to start proactively thinking about ICU care, and what role it plays in the care of the critically ill."

[zerses]

CBS, you and the mainstream media keep trying to shove "ageism" down the throat of Americans and you will become nothing more than a byword.

I can't believe you'd throw away God given life of any kind.

Pallative care? It's called a death sentence, "here, we can help the process along a bit...take these steroids" WHICH BY THE WAY, we FREAK OUT over if we find that any of our athletes use the SAME substances because we KNOW what kind of REAL damage is done BY the drugs that are "given" to all-too-trusting Americans who don't even know their own bodies.

DOCTORS? I've had a single good one in my life... and I am still not 100% convinced that there are any others!


How DARE you CBS! LIFE is PRECIOUS in any FORM.

[marychgo]

Serious conversations about end-of-life care need to start early; even a 35-year-old could end up in a coma after an accident. But anyone over 60 who hasn't at least STARTED those conversations with family and/or friends and hasn't explored the documents involved is asking for problems. ("Five Wishes" is one good option; see www.agingwithdignity.org for details.)

[ConcernedCaregiver]

Unfortunately and ironically, if you check recent news items and investigative info, the HOSPICE movement, itself is all about money these days. Recently our federal government has successfully sued several chains from all over the country and recovered misused Medicare money. THIS should be reported more, by the major news outlets. Some of those involved with hospices have admitted such offenses as taking cases just to get memorial money later, even though the patients shouldn't have been in hospice. The LAST thing we need to do is give more business and time to hospices. They need to be held more accountable. I applaud our President's administration for apparently being the first to truly hold them accountable. Here is just one of the informative articles out there. Please, before you turn your loved one over to these people, DO RESEARCH. INFORM YOURSELVES.

http://www.nytimes.com/2011/06/28/health/28hospice.html?_r=0

[Readerandthinker]

Unfortunately is all about money. The hospitals are not going to miss the gold mine in intensive care treatments. There is nothing more corrupt that the pharma, hospital and most medical professionals, there are exceptions however. They know very well there is no hope for these elderly and that in fact, the treatments themselves are killing them (to young people too). The medical system is good for trauma and it is quackery regarding chronic illnesses. The families, as the rest of society are brainwashed (I m sorry if I offend, but it is the truth). I took care of my mother and her brother at home until they died at 96 and 97. I know that in America I am not the only one doing that, but we are the exception. It is sad the contempt that in our country people has for the elderly, even for their own flesh and blood. Most people prefer their friends that their family, no gratitude at all. Don't believe me? Look around. Also, notice how on TV elderly people are non-existing, or a joke for vulgar comedy sitcoms, always being ridiculed and emphasis placed only on youth and looks. Well they go away for everybody, the only thing is left is true love and gratitude and there is no much left around in a narcissistic society.

[jaykay3141]

Moving an elderly relative to a care facility is NOT always being heartless and money-grubbing.

You were very fortunate you had the time, money, and stamina to care for your mother and uncle at home. My mother-in-law spent ten years in the grip of Alzheimer's. She couldn't eat, bathe, dress, or use the bathroom without assistance. Caring for her at home would have entailed retrofitting the house (multiple staircases), arranging medical care for every illness and injury, and restraining her when she tried to wander off despite her infirmities. One and probably both of us would have needed to give up our jobs at the same time we still had a mortgage and children in school. Can I say possible bankruptcy and divorce in the same sentence?

We were fortunate to find a care facility that had a special Alzheimer's unit. It was staffed with nurses and doctors whose specialty was caring for victims of the disease. Mom's palliative care was NOT neglect or "helping death along". She had whatever medication was necessary for illness and injury but no heroic measures were taken as she gradually slipped away. In the end she left us quietly and peacefully.

[Texbyers]

I'm 73 years old and the last thing I would want to do is be in ICU or a nursing home to die. I will not have any part of such nonsense. The medical society makes a lot of money and society spends unreal money to use procedures that are appropiate for younger peoplw....I suppose it it the medical oath to save lives, but we all have to face the fact that, at some point in time, it is just plain crazy to jump through hoops to extend the life of someone that really doesn't have a chance for quality life going forward.

[Idahodenizen]

One woman I knew who was age 86 was told her brain tumor, if removed, left her a 50/50 chance of survival. She never got to go home after the surgery. Her family came to visit her in the hospital sometimes during the few weeks she lived. I have an angry suspicion she was kept alive till her Medicare maxed out. Why not tell her instead, you are going to die. Her last few weeks could have been spent with her family, putting her affairs in order, and she could have been spared the surgery and her family could have been spared the suspense. She wasn't completely healthy even without the tumor, and she was 86 - eight years older than the average expectation anyway.

[dharlzen]

For 5 years I had to battle the nursing home every time my father got a fever or fell and bruised something. The calls were unending " we need to hospitalize your father" I refused to consent and they did everything but accuse me of being heartless. Dad survived one two month session of hospice in 2009 and passed away last week quietly in his own room after being ill for two weeks.

[kwoodgr]

When my time comes, please don't use aggressive treatment...make me comfortable, let me see my family (if possible), and ease me into the next life.

[jaykay3141]

I agree completely. I've watched 2 parents and an in-law die by millimeters from cancer and Alzheimer's. My children and their spouses know that when my time ends, I have no desire to be hooked to tubes and wires in a vain effort to gain a few more days. Keep me as pain-free as possible and let God pave the exit ramp for me.