Most patients who recover in long-term acute care hospitals die within five years, and some may be missing a chance for end-of-life care that better fits their values and goals, investigators say.
The researchers studied the treatment and outcomes of more than 14,000 hospital patients admitted to an LTACH. Most had a worse prognosis than that of advanced cancer patients, they reported. The average patient spent over 65% of his or her remaining life in a hospital or inpatient setting, and more than a third died in one, never returning home.
Patients aged 85 years and older had the worst prognosis, with an average survival of four months, and almost all spent the remainder of their lives as inpatients. Only 1% were consulted by a palliative care physician, and 3.2% by a geriatrician, leading the researchers to advocate further study to examine unmet palliative care needs.
With these findings in mind, patients and caregivers may want to weigh other options when LTACH care is on the table, said lead study author Anil Makam, M.D., University of California – San Francisco, in a statement. Some may choose to shift from intensive life-sustaining care and rehabilitative treatment to hospice care “with a focus on managing their symptoms and improving the quality of their remaining life,” he said.
“Understanding the clinical course after LTACH admission can inform goals of care discussions, planning for care at the end of life and prioritizing health care needs,” he concluded.
The study was published in the Journal of the American Geriatrics Society.
