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Characteristics and Outcomes of Dementia Patients Who Receive Inpatient Palliative Care Consultation.

Publication ,  Conference
Sharda, N; Zietlow, K; Wong, S; Kuchibhatla, M; Johnson, KS
Published in: J Am Geriatr Soc
September 2020

BACKGROUND/OBJECTIVES: Acute hospitalization may be an ideal opportunity to introduce palliative care to dementia patients, who may benefit from symptom management and goals of care discussions. We know little about patients who receive inpatient palliative care consultations (IPCCs). DESIGN: Retrospective analysis using electronic medical record. SETTING: Tertiary academic medical center and affiliated community hospital. PARTICIPANTS: Patients with dementia by International Classification of Diseases diagnosis, 65 years or older, hospitalized between July 1, 2015, and December 31, 2015. MEASUREMENTS: We used χ2 and t-test/Mann-Whitney U test to compare characteristics (living arrangement, advanced dementia markers, diagnoses of delirium and dementia with behavior disturbance, and admitting diagnosis) and outcomes (change in code status, length of stay [LOS], discharge disposition, and discharge medications for symptom management) of patients who did and did not receive IPCC. Patients were matched on sex, age, and race. RESULTS: Among 927 hospitalized patients with dementia, 17% received IPCC (N = 157). Patients who received IPCC were more likely to be admitted from a nursing facility (35.7% vs 12.7%; P < .0001), experience delirium (71.3% vs 57.3%; P = .01), have behavior disturbance (23.6% vs 13.4%; P = .02), have a pressure ulcer at admission (26.1% vs 11.5%; P = .001), have hypernatremia (12.7% vs 3.2%; P = .002), and be bedbound (20.4% vs 3.2%; P < .000). Patients who received IPCC had a longer LOS (median = 5.9 vs 4.3 days; P = .004) and were more likely to be discharged to hospice (56% vs 3.1%; P < .0001). Patients with IPCC were more likely to have a discharge code status of do not attempt resuscitation (89% vs 46%). There was no significant difference in comfort medications at discharge between groups. CONCLUSIONS: Patients who received IPCC had evidence of more advanced dementia. These patients were more likely to change their code status and enroll in hospice. IPCC may be useful to prioritize patient-centered care and discuss what matters most to patients and families.

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Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

September 2020

Volume

68

Issue

9

Start / End Page

2027 / 2033

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Retrospective Studies
  • Referral and Consultation
  • Patient-Centered Care
  • Patient Discharge
  • Palliative Care
  • Male
  • Inpatients
  • Humans
  • Hospitalization
 

Citation

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ICMJE
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Sharda, N., Zietlow, K., Wong, S., Kuchibhatla, M., & Johnson, K. S. (2020). Characteristics and Outcomes of Dementia Patients Who Receive Inpatient Palliative Care Consultation. In J Am Geriatr Soc (Vol. 68, pp. 2027–2033). United States. https://doi.org/10.1111/jgs.16521
Sharda, Neema, Kahli Zietlow, Serena Wong, Maragatha Kuchibhatla, and Kimberly S. Johnson. “Characteristics and Outcomes of Dementia Patients Who Receive Inpatient Palliative Care Consultation.” In J Am Geriatr Soc, 68:2027–33, 2020. https://doi.org/10.1111/jgs.16521.
Sharda N, Zietlow K, Wong S, Kuchibhatla M, Johnson KS. Characteristics and Outcomes of Dementia Patients Who Receive Inpatient Palliative Care Consultation. In: J Am Geriatr Soc. 2020. p. 2027–33.
Sharda, Neema, et al. “Characteristics and Outcomes of Dementia Patients Who Receive Inpatient Palliative Care Consultation.J Am Geriatr Soc, vol. 68, no. 9, 2020, pp. 2027–33. Pubmed, doi:10.1111/jgs.16521.
Sharda N, Zietlow K, Wong S, Kuchibhatla M, Johnson KS. Characteristics and Outcomes of Dementia Patients Who Receive Inpatient Palliative Care Consultation. J Am Geriatr Soc. 2020. p. 2027–2033.
Journal cover image

Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

September 2020

Volume

68

Issue

9

Start / End Page

2027 / 2033

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Retrospective Studies
  • Referral and Consultation
  • Patient-Centered Care
  • Patient Discharge
  • Palliative Care
  • Male
  • Inpatients
  • Humans
  • Hospitalization