More Stroke Patients Seeking Hospice Care

Hospice utilization among stroke patients is on the rise as an increasing number choose to end their lives in their homes, according to a recent study in the Journal of the American Medical Association-Neurology.

More than 2 million people in the United States died as a result of cerebrovascular disease during the study period, which ran from Jan. 1, 2003 to Dec. 31, 2017. Deaths among stroke patients in hospitals dropped nearly 10% from 72,691 to 53,467. The number of stroke patients who died in a nursing facility saw a similar decline, from 35% of all stroke decedents to 25.4%.

“While the majority of patients who had a stroke die in the hospital, our data suggest that the proportion of patients who had a stroke die at home, a location preferred by patients, has increased substantially,” the study’s authors noted. “However, the experience of patients who had a stroke dying at home, and that of their caregivers, remains under-investigated. Furthermore, we demonstrate that hospice facility use has also increased.”

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The number of stroke patients who died in their homes rose to 27,684 in 2017, up from slightly more than 17,000 in 2003, the study found. Deaths in hospice facilities saw a significant rise, representing 11.9% of all stroke decedents in 2017, up from 0.2% in 2003.

Demographics also played a role in where stroke patients died during the study period.

“We noted important disparities. Patients who had a stroke who were nonwhite or Hispanic, while more likely to die at home or in a hospital, were less likely to die in a hospice facility than white and non-Hispanic patients,” the authors found. “Lower use of palliative care and hospice services has been reported among minorities for other conditions and our analysis demonstrates consistency of this trend in stroke patients. Further research is needed to elucidate if racial and ethnic disparities in location of death represent a lack of access to home supports or hospice services or if they reflect differences in culture and care preferences.”

Hospice utilization among stroke patients is relatively low compared to those suffering from other conditions such as cancer, heart failure or dementia, representing only 9.4% of Medicare decedents in 2017, according to the National Hospice & Palliative Care Organization. However, the numbers are rising. Between 2016 and 2017, the number of stroke patients using hospice rose to 103,684 from 97.074.

The researchers used data from the U.S. Centers for Disease Control & Prevention’s Online Data for Epidemiologic Research database to examine stroke decedents who passed away in hospitals, homes, nursing facilities, inpatient hospice facilities, outpatient facilities, and hospital emergency departments as well as those who arrived deceased at a hospital.