Research: Hospice referral at end of life should be based on older adult's pain, distressing symptoms

A team of researchers from Yale University has studied how soon older adults who were experiencing distressing symptoms and disability were admitted to hospice near the end of their lives . Their study was published in the Journal of the American Geriatrics Society.

The researchers examined information from a study of 562 people, aged 70 and older, who were not disabled when the study began. Of these people, 244 (43.4 percent) were admitted to hospice during the last year of life. These people were slightly older and more likely to have cognitive impairments (problems thinking and making decisions) than those individuals who weren't admitted to hospice.

The most common condition leading to death was frailty (the medical term for physical weakness or an increasing likelihood for poor health), followed by organ failure (the term for certain parts of our body no longer working as they should), advanced dementia, and cancer.

The researchers found that cancer and advanced dementia were the conditions that most often resulted in being admitted for hospice care. Older adults who were frail were least likely to be admitted to hospice.

The duration of hospice care was less than 13 days for half of the study participants. The short duration of hospice suggests that healthcare providers might need to consider discussing referrals to hospice sooner with people who are approaching the end of their lives. Alternatively, we may need to develop and test other ways to reduce the high burden of distressing symptoms and disability at the end of life, said the researchers.

The researchers suggest that referral to hospice at the end of life should be based on an older adult's burden of pain and other distressing symptoms.