By Lisa Rapaport
(Reuters Health) - Most elderly patients admitted to long-term acute care hospitals die within 5 years, and spend two-thirds of their remaining life as an inpatient, a U.S. study suggests.
The goal of long-term acute care hospitals (LTACHs) is to help patients recover from debilitating illnesses and injuries and regain their ability to live independently. Patients in LTACHs are very ill and may need cardiac monitoring, intravenous lines and mechanical ventilators.
But the study of 14,072 Medicare patients who were transferred from regular acute-care hospitals to LTACHs found that the average patient spent 66% percent of their remaining life in a hospital or inpatient setting. And, 37% of these patients died in a facility without ever returning home, often without receiving any hospice care in their final days.
"The take-home message is that if your loved one is planning on going to an LTACH to recover, then chances are they are very sick and may be nearing the end of life," said Dr. Anil Makam, lead author of the study and a researcher at the University of California, San Francisco.
"Even before going to the LTACH you should have an honest discussion with your doctors and those closest to you about whether staying in a hospital setting and undergoing invasive procedures is most closely aligned with your values and goals," Makam said by email. "For some the answer will be yes, but for others, they might prefer to focus on relieving their symptoms and optimizing their quality of life, even if that means they might not live as long."
LTACHs provide extended, complex, post-acute care to more than 120,000 Medicare beneficiaries annually, researchers note in the Journal of the American Geriatrics Society. They differ from acute-care hospitals and skilled-nursing facilities by focusing on treating patients who require extended inpatient care.
The current study focused on patients 65 and older who were covered by Medicare and transferred to an LTACH to recover after a hospitalization from 2009 to 2013.
Overall, 40% of the patients in the study were admitted to an LTACH for a respiratory diagnosis. These patients survived an average of 8.3 months and only 18% remained alive after 5 years.
By comparison, 75% of breast cancer patients typically survive five years, as do 69% of prostate cancer patients and 51% of colorectal cancer patients, the study team notes.
During their hospital and subsequent LTACH stay, 31% of patients received an artificial life-prolonging procedure, with feeding tubes being the most common at 22%.
A mere 1% percent were seen by a palliative care physician, and only 3.2% saw a geriatrician.
This scant access to palliative care suggests that patients and families need to advocate for themselves to make sure any treatment plans match their wishes, said Dr. Jennifer Goldstein, a hospitalist with Christiana Care Hospitalist Partners who wasn't involved in the study.
"Patients and families should discuss their prognosis and goals of care with their care providers to align their care plans with their wishes," Goldstein said by email. "Discussions with hospice and palliative care providers can be extremely valuable when making these decisions and considerable efforts should be made to include them in these discussions."
Patients and families should also understand that elderly patients admitted to the hospital face a longer, steeper path to recovery than their younger counterparts, said Dr. Alok Kapoor, a researcher at the University of Massachusetts Medical School who wasn't involved in the study.
"Admission to hospital causes a number of different stresses on the body and brain of older adults," Kapoor said by email.
"The constant simulation by alarms and personnel in the hospital setting including long-term acute care can exacerbate underlying dementia and confusion that manifests itself in the form of acute episodes of confusion/delirium that can manifest itself as agitation and self-injury," Kapoor said. "The process of diagnostic testing with required fasting episodes in the hospital can also lead to malnutrition and subsequent muscle breakdown and protein loss which might make the patient more susceptible to falls and infection."
SOURCE: http://bit.ly/2NvKsEu Journal of the American Geriatrics Society, online August 26, 2019.