title: Disability and decline in physical function associated with hospital use at end of life.
abstract: BACKGROUND
  Hospital use near the end of life is often undesirable to patients, represents considerable Medicare cost, and varies widely across regions.
  
  
  OBJECTIVE
  To concurrently examine regional and patient factors, including disability and functional decline, associated with end-of-life hospital use.
  
  
  METHODS
  We sampled decedents aged 65 and older (n = 2,493) from the Health and Retirement Study (2000-2006), and linked data from individual Medicare claims and the Dartmouth Atlas of Health Care. Two-part regression models estimated the relationship between total hospital days in the last 6 months and patient characteristics including physical function, while adjusting for regional resources and hospital care intensity (HCI).
  
  
  RESULTS
  Median hospital days was 7 (range = 0-183). 53% of respondents had functional decline. Compared with decedents without functional decline, those with severe disability or decline had more regression-adjusted hospital days (range 3.47-9.05, depending on category). Dementia was associated with fewer days (-3.02); while chronic kidney disease (2.37), diabetes (2.40), stroke or transient ischemic attack (2.11), and congestive heart failure (1.74) were associated with more days. African Americans and Hispanics had more days (5.91 and 4.61, respectively). Those with family nearby had 1.62 fewer days and hospice enrollees had 1.88 fewer days. Additional hospital days were associated with urban residence (1.74) and residence in a region with more specialists (1.97) and higher HCI (2.27).
  
  
  CONCLUSIONS
  Functional decline is significantly associated with end-of-life hospital use among older adults. To improve care and reduce costs, health care programs and policies should address specific needs of patients with functional decline and disability.
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. amy.kelley@mssm.edu
authors.forename: Amy S
authors.initials: AS
authors.lastname: Kelley
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: R Sean
authors.initials: RS
authors.lastname: Morrison
authors.forename: Qingling
authors.initials: Q
authors.lastname: Du
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Sarkisian
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003704:Dementia / Q000503:physiopathology; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States