Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia - American Geriatric Society

OBJECTIVES

The end‐of‐life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia.

DESIGN

Retrospective cohort study.

SETTING

A large not‐for‐profit agency in New York City.

PARTICIPANTS

A total of 2629 hospice patients with dementia age 65 years and older.

MEASUREMENTS

Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits).

RESULTS

Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI] = 1.34‐4.38; Hispanic: aOR = 2.99; 95% CI = 1.81‐4.94). Home hospice (aOR = 7.57; 95% CI = 4.04‐14.18), longer length of service (aOR = 1.04; 95% CI = 1.04‐1.05), and more days between nurse visits and discharge (aOR = 1.86; 95% CI = 1.56‐2.21) were also associated with live discharge.

CONCLUSION

To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end‐of‐life trajectory of patients with dementia.

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