Perplexing Patterns in End-of-Life Care
More hospice use does not seem to bring more serenity.
Although most Americans who are surveyed say that they would prefer to die at home, only a minority do so. To determine if the nature of premortem medical care has changed with the increasing acceptance of hospice care, researchers analyzed patterns of site of death, place of care, and healthcare transitions among a random 20% sample of all fee-for-service Medicare beneficiaries who died in 2000, 2005, or 2009.
Between 2000 and 2009, use of hospice services at time of death almost doubled from 22% to 42%. In 2009, 60% of cancer patients and almost 50% of those with dementia were enrolled in hospice at time of death. Deaths in an acute care hospital decreased from 33% in 2000 to 25% in 2009, but deaths at home increased only minimally from 31% to 34%.
Meanwhile, more terminally ill patients were subject to potentially burdensome moves: Although the percentage of patients with three or more hospitalizations during the last 3 months of life stayed relatively stable (about 10%), more patients had stays in an intensive care unit during the last month of life (from 24% in 2000 to 29% in 2009), were moved from one site of care to another during the last 3 days of life (from 10% to 14%), and received hospice care for 
3 days when they died (from 5% to 10%).
Comment: These results confirm that hospice care is increasingly used at the end of life, but, unfortunately, this trend has not necessarily made death a more peaceful experience for patients or their families. Instead, the data point to frenzied moves during the last months of life, with most medical care and death still transpiring in an institution rather than at home. Presumably, earlier implementation of hospice care would ease some of these burdens for all involved.
Published in Journal Watch General Medicine February 26, 2013
CITATION(S):
http://dx.doi.org/10.1001/jama.2012.207624)- Medline abstract (Free)
ความเห็น (2)
What not mentioned in there is this: "there is a strong trend towards shifting care responsibilities to 'others' (rather than family members)". Perhaps, economic conditions force family to spend more time at work, or modern life styles favour young and entertaining connections.
That's true! Attachment between the family members recently were torn with internal and external greed and self determination. That, thereby, dose not bring a beautiful harmony in most dying situation at this time.