A sick nursing home resident lies in bed

Cancer patients in nursing homes receive more aggressive end-of-life care than their community-dwelling peers, despite an increased emphasis on reducing treatments that compromise quality of life, a new study has found.

Investigators examined metastatic cancer deaths among more than 146,000 cancer patients from 2013 to 2017 using the Minimum Data Set, Medicare and the Surveillance, Epidemiology and End Results Program. Aggressive care was defined as providing cancer treatment; admission to an intensive care unit; more than one emergency department visit or or more than one hospitalization in the last 30 days of life; hospice enrollment in the last three days of life and in-hospital death.

Aggressive care for older patients with metastatic cancer who reside in nursing facilities is associated with hospital admissions in the last 30 days of life and in-hospital death, analyses showed. The finding that nursing home residents are more likely to receive such care than community dwellers came as a surprise to the researchers. Aggressive care is quite common in the latter group as well.

“Multilevel interventions to decrease aggressive end-of-life care should target the main factors associated with its prevalence,” including hospital admissions in the last six months of life and in-hospital death, the researchers concluded.

In the United States, 44% of Medicare fee-for-service beneficiaries are admitted to a nursing home within the last 90 days of life, and 25% die in a nursing facility, according to the authors. 

The study was published in JAMA Network Open.

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