- Email: [email protected]
Trends in Caregiving Near End of Life, 2000-2008 (S742)
490
Poster Abstracts
Research Objectives. Using the 2007 wave of the National Home Health and Hospice Care Survey (NHHCS), this study investigated the effect of care preferences on EC utilization among 3,661 White, Black, and Hispanic hospice patients aged 65 and older. Methods. Patients were drawn from 1,036 home health and hospice agencies and, when weighted for national representation, represent 800,872 older adults in the United States. Using multilevel logistic, tested predictors included patient age, gender, race/ethnicity, marital status, primary diagnosis, number of chronic conditions, and a documented preference for less aggressive care. Results. Results indicated that older patients (OR¼0.983; p¼.032), and those with a documented preference for less aggressive care (OR¼0.855; p¼.035) were less likely to utilize EC. However, Black patients (OR¼2.712; p<.001), those with a primary diagnosis of heart disease (OR¼2.187; p<.001), and patients with more chronic conditions (OR¼1.062; p¼.008) were more likely to utilize EC. Conclusions. Although previous research of non-hospice populations has suggested that racial/ethnic differences in EC utilization may exist within hospice, this study is among the first to report that such differences do exist, and that they persist following adjustments for care preferences. Additional research is needed to better understand factors associated with EC utilization among Black hospice patients, and to test interventions to improve the care of this population.
Implications for research, policy, or practice. Data presented can inform national policy to improve access to and continuity of hospice care for an increasingly diverse group of older adults.
Palliative Care for Patients with Hematologic Malignancies: A Profile of Patients with Blood Cancers Referred to the CHOICE Hospice Network (S741) Thomas LeBlanc, MD, Duke University, Durham, NC. Amy Abernathy, MD FAAHPM, Duke University, Durham, NC. David Casarett, MD, University of Pennsylvania, Philadelphia, PA. Objectives 1. Recognize differences in hematologic malignancies compared to patients with other types of cancer.
Vol. 47 No. 2 February 2014
2. Understand differences in outcomes and care needs among patients with hematologic malignances referred to hospice. Background. Published literature provides an incomplete description of the palliative care needs of the hematologic malignancies (HM) population. Research Objectives. To compare characteristics of hospice patients with HM vs. solid tumors. Methods. Patient data (2008-2012) were extracted from the electronic records of 10 hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness). We identified the subset with HM using ICD-9 codes, comparing them to the subset with all other neoplasias using bivariate analyses. Results. Of the 48,147 cancer patients, 3,518 (7.3%) had HM. Annually, HM patients consistently represented 7.0-7.8% of the hospice cancer population during the 5-year study period. HM patients were somewhat older (mean age 75.1 vs. 70.6; OR 1.03, 95% CI 1.02-1.03; p<0.001), more likely male (53.5% vs. 49.8%; OR 1.09, CI 0.99-1.19; p¼0.06), and Caucasian (87.5% vs. 85%; OR 1.53, CI 1.26-1.86; p<0.001). HM patients had worse Palliative Performance Scale (PPS) scores (32% vs. 24% were < 40; p<0.001) and were more likely to be admitted from a hospital or nursing home vs. home (OR 1.34, CI 1.161.56, and 1.54, CI 1.39-1.72; p<0.001). HM patients were more likely to have a hospice LOS of 1 day (OR 1.66, CI 1.49-1.86; p<0.001), or less than 7 days (OR 1.68, CI 1.56-1.81; p<0.001). By type of HM, patients with leukemia were more likely to have a LOS of 1 day (OR 1.31, 1.1-1.56; p¼0.002) and to die during the study period (HR 1.23, CI 1.13-1.34; p<0.001). Conclusions. Patients with HM referred to hospice appear to be more seriously ill at time of admission, with worse PPS and shorter LOS compared to other cancer patients.
Implications for research, policy, or practice. Targeted efforts to better understand the palliative care needs of the HM population are warranted so that tailored care plans and pathways can be developed.
Trends in Caregiving Near End of Life, 2000-2008 (S742) Jessica Lendon VA Greater Los Angeles, Los Angeles, CA. Daniella Meeker RAND Corporation, Santa Monica, CA. Karl Lorenz, MD MSHS, VA
Vol. 47 No. 2 February 2014
Poster Abstracts
Greater Los Angeles, Los Angeles, CA. Joanne Lynne. Objectives 1. To learn about the overall changes within the past decade in help received by older adults nearing the end of life. 2. To think about the challenges and policy/ practice solutions for better supporting older adults and their caregivers near the end of life. Background. Informal caregiving comprises the bulk of long-term disability care for older adults in the U.S. near the end of life (EOL). Research Objectives. To explore trends in older adult EOL informal caregiving in the recent decade. Methods. We used the Health and Retirement Study to identify 6,076 older decedents between 2000 and 2010 who were queried about needing help with functional impairments (IADL, ADL) within 2 years before death. We estimated outcome mean and proportional differences (2000-2008) using multiple regression models adjusted for age, gender, race, number of health conditions, nursing home residence, and time until death for outcomes of receiving help, number of caregivers, monthly care frequency, daily care hours, number of functional impairments, and care provider. We stratified results by health condition. Results. Of all decedents, 53% reported functional impairments and 84% of those with any functional impairment reported needing help. The prevalence of those needing help near EOL increased 18% for older adults with cancer (from 44% to 52%; 95% CI¼-.15, -.02). Among those who received care for any functional impairment, we found a 20% increase in the mean number of caregivers (1.6 to 1.9; 95% CI¼ .23, .39), a 19% decline in monthly care frequency (26to 20 days monthly; 95% CI¼ -7.4, -2.2), and declines in probability of a relative as caregiver (from .2 to .1; 95% CI: .01, .18.) for those with cancer, and declines in probability of a professional caregiver (from .55 to .51; 95% CI¼ .003, .08). Average daily care hours and functional impairments remained unchanged. Conclusions. Trends indicate care provided to older adults nearing EOL is more diffuse across more caregivers. However, daily care frequency declined, despite stable overall prevalence of caregiving and level of disability.
Implications for research, policy, or practice. Healthcare services may need to emphasize care coordination for older adults nearing
EOL given the increasing complexity of caregiving.
491
diffusion
and
Depression, Spiritual Well-Being and NonHeart Failure-Specific Symptoms are Associated with Quality of Life and Health Status in Symptomatic Heart Failure (S743) Hillary Lum, MD PhD, University of Colorado Denver, Denver, CO. Diane Fairclough, DrPH, Colorado School of Public Health, Denver, CO. Mary Plomondon, PhD, Department of Veterans Affairs, Denver, CO. Evan Carey, MS, VA Denver, Lubbock, TX. David Bekelman, MD MPH, VA Eastern Colorado Health Care System, Denver, CO. John Rumsfeld, MD PhD. Objectives 1. Greater understanding of the patientcentered outcomes quality of life and health status, both overall and in the context of symptomatic heart failure. 2. Greater motivation to use HF-specific measures of quality of life (QOL) and health status compared to overall QOL to identify significant potentially modifiable patient-reported factors such as depression, spiritual well-being and non-traditional HF-related symptoms. Background. Quality of life (QOL) and health status are important patient-reported palliative outcomes which may have different key determinants. Identifying potentially modifiable patient factors that influence overall QOL compared to disease-specific QOL and health status would inform interventions. Research Objectives. Determine which potentially modifiable, patient-reported factors are independently associated with heart failure (HF)-specific QOL, health status or overall QOL. Methods. The Patient-Centered Disease Management Trial collected measures of depression, spiritual well-being and physical symptoms at baseline, 3, 6, and 12 months on veterans with HF and low health status as measured by Kansas City Cardiomyopathy Questionnaire (KCCQ). Outcomes were HF-specific QOL (KCCQ-QOL subscale), HF-specific health status (KCCQ overall score) and overall QOL (single-item from QUAL-E). Analyses with mixed effects modeling of demographics, key baseline clinical covariates (ejection fraction class, biventricular pacemaker, number of comorbidities) and time-varying
Poster Abstracts
Research Objectives. Using the 2007 wave of the National Home Health and Hospice Care Survey (NHHCS), this study investigated the effect of care preferences on EC utilization among 3,661 White, Black, and Hispanic hospice patients aged 65 and older. Methods. Patients were drawn from 1,036 home health and hospice agencies and, when weighted for national representation, represent 800,872 older adults in the United States. Using multilevel logistic, tested predictors included patient age, gender, race/ethnicity, marital status, primary diagnosis, number of chronic conditions, and a documented preference for less aggressive care. Results. Results indicated that older patients (OR¼0.983; p¼.032), and those with a documented preference for less aggressive care (OR¼0.855; p¼.035) were less likely to utilize EC. However, Black patients (OR¼2.712; p<.001), those with a primary diagnosis of heart disease (OR¼2.187; p<.001), and patients with more chronic conditions (OR¼1.062; p¼.008) were more likely to utilize EC. Conclusions. Although previous research of non-hospice populations has suggested that racial/ethnic differences in EC utilization may exist within hospice, this study is among the first to report that such differences do exist, and that they persist following adjustments for care preferences. Additional research is needed to better understand factors associated with EC utilization among Black hospice patients, and to test interventions to improve the care of this population.
Implications for research, policy, or practice. Data presented can inform national policy to improve access to and continuity of hospice care for an increasingly diverse group of older adults.
Palliative Care for Patients with Hematologic Malignancies: A Profile of Patients with Blood Cancers Referred to the CHOICE Hospice Network (S741) Thomas LeBlanc, MD, Duke University, Durham, NC. Amy Abernathy, MD FAAHPM, Duke University, Durham, NC. David Casarett, MD, University of Pennsylvania, Philadelphia, PA. Objectives 1. Recognize differences in hematologic malignancies compared to patients with other types of cancer.
Vol. 47 No. 2 February 2014
2. Understand differences in outcomes and care needs among patients with hematologic malignances referred to hospice. Background. Published literature provides an incomplete description of the palliative care needs of the hematologic malignancies (HM) population. Research Objectives. To compare characteristics of hospice patients with HM vs. solid tumors. Methods. Patient data (2008-2012) were extracted from the electronic records of 10 hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness). We identified the subset with HM using ICD-9 codes, comparing them to the subset with all other neoplasias using bivariate analyses. Results. Of the 48,147 cancer patients, 3,518 (7.3%) had HM. Annually, HM patients consistently represented 7.0-7.8% of the hospice cancer population during the 5-year study period. HM patients were somewhat older (mean age 75.1 vs. 70.6; OR 1.03, 95% CI 1.02-1.03; p<0.001), more likely male (53.5% vs. 49.8%; OR 1.09, CI 0.99-1.19; p¼0.06), and Caucasian (87.5% vs. 85%; OR 1.53, CI 1.26-1.86; p<0.001). HM patients had worse Palliative Performance Scale (PPS) scores (32% vs. 24% were < 40; p<0.001) and were more likely to be admitted from a hospital or nursing home vs. home (OR 1.34, CI 1.161.56, and 1.54, CI 1.39-1.72; p<0.001). HM patients were more likely to have a hospice LOS of 1 day (OR 1.66, CI 1.49-1.86; p<0.001), or less than 7 days (OR 1.68, CI 1.56-1.81; p<0.001). By type of HM, patients with leukemia were more likely to have a LOS of 1 day (OR 1.31, 1.1-1.56; p¼0.002) and to die during the study period (HR 1.23, CI 1.13-1.34; p<0.001). Conclusions. Patients with HM referred to hospice appear to be more seriously ill at time of admission, with worse PPS and shorter LOS compared to other cancer patients.
Implications for research, policy, or practice. Targeted efforts to better understand the palliative care needs of the HM population are warranted so that tailored care plans and pathways can be developed.
Trends in Caregiving Near End of Life, 2000-2008 (S742) Jessica Lendon VA Greater Los Angeles, Los Angeles, CA. Daniella Meeker RAND Corporation, Santa Monica, CA. Karl Lorenz, MD MSHS, VA
Vol. 47 No. 2 February 2014
Poster Abstracts
Greater Los Angeles, Los Angeles, CA. Joanne Lynne. Objectives 1. To learn about the overall changes within the past decade in help received by older adults nearing the end of life. 2. To think about the challenges and policy/ practice solutions for better supporting older adults and their caregivers near the end of life. Background. Informal caregiving comprises the bulk of long-term disability care for older adults in the U.S. near the end of life (EOL). Research Objectives. To explore trends in older adult EOL informal caregiving in the recent decade. Methods. We used the Health and Retirement Study to identify 6,076 older decedents between 2000 and 2010 who were queried about needing help with functional impairments (IADL, ADL) within 2 years before death. We estimated outcome mean and proportional differences (2000-2008) using multiple regression models adjusted for age, gender, race, number of health conditions, nursing home residence, and time until death for outcomes of receiving help, number of caregivers, monthly care frequency, daily care hours, number of functional impairments, and care provider. We stratified results by health condition. Results. Of all decedents, 53% reported functional impairments and 84% of those with any functional impairment reported needing help. The prevalence of those needing help near EOL increased 18% for older adults with cancer (from 44% to 52%; 95% CI¼-.15, -.02). Among those who received care for any functional impairment, we found a 20% increase in the mean number of caregivers (1.6 to 1.9; 95% CI¼ .23, .39), a 19% decline in monthly care frequency (26to 20 days monthly; 95% CI¼ -7.4, -2.2), and declines in probability of a relative as caregiver (from .2 to .1; 95% CI: .01, .18.) for those with cancer, and declines in probability of a professional caregiver (from .55 to .51; 95% CI¼ .003, .08). Average daily care hours and functional impairments remained unchanged. Conclusions. Trends indicate care provided to older adults nearing EOL is more diffuse across more caregivers. However, daily care frequency declined, despite stable overall prevalence of caregiving and level of disability.
Implications for research, policy, or practice. Healthcare services may need to emphasize care coordination for older adults nearing
EOL given the increasing complexity of caregiving.
491
diffusion
and
Depression, Spiritual Well-Being and NonHeart Failure-Specific Symptoms are Associated with Quality of Life and Health Status in Symptomatic Heart Failure (S743) Hillary Lum, MD PhD, University of Colorado Denver, Denver, CO. Diane Fairclough, DrPH, Colorado School of Public Health, Denver, CO. Mary Plomondon, PhD, Department of Veterans Affairs, Denver, CO. Evan Carey, MS, VA Denver, Lubbock, TX. David Bekelman, MD MPH, VA Eastern Colorado Health Care System, Denver, CO. John Rumsfeld, MD PhD. Objectives 1. Greater understanding of the patientcentered outcomes quality of life and health status, both overall and in the context of symptomatic heart failure. 2. Greater motivation to use HF-specific measures of quality of life (QOL) and health status compared to overall QOL to identify significant potentially modifiable patient-reported factors such as depression, spiritual well-being and non-traditional HF-related symptoms. Background. Quality of life (QOL) and health status are important patient-reported palliative outcomes which may have different key determinants. Identifying potentially modifiable patient factors that influence overall QOL compared to disease-specific QOL and health status would inform interventions. Research Objectives. Determine which potentially modifiable, patient-reported factors are independently associated with heart failure (HF)-specific QOL, health status or overall QOL. Methods. The Patient-Centered Disease Management Trial collected measures of depression, spiritual well-being and physical symptoms at baseline, 3, 6, and 12 months on veterans with HF and low health status as measured by Kansas City Cardiomyopathy Questionnaire (KCCQ). Outcomes were HF-specific QOL (KCCQ-QOL subscale), HF-specific health status (KCCQ overall score) and overall QOL (single-item from QUAL-E). Analyses with mixed effects modeling of demographics, key baseline clinical covariates (ejection fraction class, biventricular pacemaker, number of comorbidities) and time-varying