Patients with dementia are less likely to receive hospice in their last month of life than those who have other diagnoses, 12.5% compared to 17.3%, a recent study has found.
The six-month terminal prognosis requirement is at the crux of the issue. The Medicare Hospice Benefit initially was designed around the needs of cancer patients, but now the number of patients with other diagnoses is growing — some with less predictable disease patterns. The study appeared in the Journals of Gerontology.
“Because of hospice’s requirement for a prognosis of less than six months, people’s focus on their symptom relief and their access to hospice care is tied to their understanding of their remaining survival time,” the authors indicated in the study. “Accurate prognosis at [end of life] is challenging regardless of illness. Dementia’s long course creates specific challenges to accurately estimate survival time and adequately support patients and their families.”
Dementia patients represented 20.9% of hospice enrollees in 2019, up from 9% in 2002, according to the National Hospice & Palliative Care Organization (NHPCO). The average length of stay for those patients reached 126 days in 2019, compared to 92.6 days for the overall hospice population. For comparison, cancer patients that year were in hospice for an average of 45 days.
Hospices can likely expect an even larger influx of dementia patients going forward. The incidence of dementia-related illnesses is expected to rise by 40%, or 139 million globally by 2050, according to data from the World Health Organization (WHO).
To reach their findings, RTI researchers applied data from the University of Michigan’s Health and Retirement Study (HRS), a multi-year project that surveys a representative sample of more than 20,000 people annually. For their analysis, the RTI team cross-referenced about 6,000 of those survey respondents to Medicare claims.
“Dementia is unique because of the long course of illness, which can complicate end-of-life care for people with dementia,” Ila Hughes Broyles, health services researcher at RTI and lead author of the study, said in a statement. “Our study shows that current health care models for the disease are not always equipped for the sustained burdens of dementia, resulting in inadequate end-of-life care, or even none at all.”