Researchers say hospital re-admissions tend to worsen existing disabilities in people during their last year of life. The investigators are advising a more “palliative care approach” as a way to avoid exacerbating such problems.
The 15-year study in West Haven, CT, evaluated the role of intervening hospital admissions on trajectories of disability in the last year of life. Study results were published in a recent issue of the British Medical Journal.
From 1983 to 2013, researchers followed the cases of 552 now-deceased people who were older than 70 who were initially non-disabled in four essential activities of daily living. Over the course of the study, 71% had at least one hospital admission and 25% had multiple hospital admissions.
The study found that among the more than 500 decedents in their last year of life, 28% had persistently severe disability, considered the most disabled. Another 31% had a progressively severe disability. Only 17% of the study cohorts died with no disability.
“Acute hospital admissions play an important role in the disabling process,” study authors noted, adding that knowledge about the course of disability before these intervening events may facilitate clinical decision making at the end of life. “For older patients admitted to [a] hospital with progressive or persistent levels of severe disability … clinicians might consider a palliative care approach to facilitate discussions about advance care planning and to better deal with personal care needs.”