title: Influence of hospice on nursing home residents with advanced dementia who received Medicare-skilled nursing facility care near the end of life.
abstract: OBJECTIVE
  To examine differences in outcomes according to hospice status of skilled nursing facility (SNF) care recipients.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Three thousand three hundred fifty-three U.S. nursing homes (NHs).
  
  
  METHODS
  Four thousand three hundred forty-four persons with advanced dementia who died in NHs in 2006 and received SNF care within 90 days of death were studied, 1,086 of these also received hospice before death: 705 after SNF care, and 381 concurrent with SNF care.
  
  
  METHODS
  Treatments, persistent pain and dyspnea, and hospital death.
  
  
  RESULTS
  Decedents with any hospice received fewer medications, injections, feeding tubes, intravenous fluids, and therapy services and more hypnotics than those without hospice (all P < .001). Decedents with hospice after SNF care received fewer antipsychotics and those with hospice concurrent with SNF care received more antipsychotics than those without (all P < .001). Multivariate logistic regressions showed that decedents with hospice after SNF had lower likelihood of persistent dyspnea (adjusted odds ratio (AOR) = 0.63, 95% confidence interval (CI) = 0.45-0.87) and hospital death (AOR = 0.02, 95% = CI 0.01, 0.07) than those without hospice. Decedents with hospice concurrent with SNF care had a higher likelihood of persistent pain (AOR = 1.65, 95% CI = 1.23, 2.19) and a lower likelihood of hospital death (AOR = 0.13, 95% CI = 0.07, 0.26) than those without hospice.
  
  
  CONCLUSIONS
  Residents dying with advanced dementia who received SNF care in the last 90 days of life had fewer aggressive treatments and lower odds of hospital death if they also received hospice care at any point during that time. Associations between hospice and persistent pain or dyspnea differed according to whether hospice care was received concurrent with or after SNF care.
authors.affiliation: Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA. susan_Miller@brown.edu
authors.forename: Susan C
authors.initials: SC
authors.lastname: Miller
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lima
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
mesh_terms: D000369:Aged, 80 and over; D003704:Dementia / Q000451:nursing*; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D006278:Medicare; D009735:Nursing Homes; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013727:Terminal Care; D014481:United States