Life-sustaining treatment orders, location of death and co-morbid conditions in decedents with Parkinson's disease.
BACKGROUND
End-of-life care in Parkinson's Disease (PD) is poorly described. Physician Orders for Life Sustaining Treatment (POLST) forms specify how much life-sustaining treatment to provide. This study aims to better understand end-of-life care in PD using data from the Oregon POLST and Death Registries.


METHODS
Oregon death certificates from the years 2010-2011 were analyzed. Death certificates were matched with forms in the Oregon POLST Registry. Descriptive analyses were performed for both the full PD dataset as well as those with POLST forms.


RESULTS
There were 1073 (1.8%) decedents with PD listed as a cause of death and 56,961 without. Three hundred and seventy three (35%) decedents with PD had a POLST form. POLST preferences were not significantly different between those with or without PD, however location of death was; hospital (13% PD vs 24% without p < 0.01), home (32% vs 40% p < 0.01) and care facility (52% vs 29% p < 0.01). Compared to those without a POLST or those without a Comfort Measures Only (CMO) order, decedents with PD and a CMO order were less likely to die in a hospital (5.4% vs 14.7% p < 0.01) and more likely to die at home (39.1% vs 29.1% p < 0.01). In those with PD, dementia was the most common comorbid condition listed on death certificates (16%).


CONCLUSIONS
Decedents with PD die less frequently at home than the general population. POLST forms mitigate some of this discrepancy. While not often thought to be terminal, PD and its complications are commonly recorded causes of death.
Department of Neurology, Oregon Health & Science University, Mail Code OP32, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
Keiran K
KK
Tuck
Department of Emergency Medicine, Oregon Health & Science University 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
Dana M
DM
Zive
Department of Emergency Medicine, Oregon Health & Science University 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA; Palliative Care Service, Mail Code L586, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
Terri A
TA
Schmidt
Department of Neurology, Oregon Health & Science University, Mail Code OP32, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
Julie
J
Carter
Department of Neurology, Oregon Health & Science University, Mail Code OP32, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
John
J
Nutt
Palliative Care Service, Mail Code L586, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. Electronic address: frommee@ohsu.edu.
Erik K
EK
Fromme
D032722:Advance Care Planning / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D009922:Oregon; D010300:Parkinson Disease / Q000401:mortality* / Q000628:therapy*; D012042:Registries; D013727:Terminal Care / Q000706:statistics & numerical data*
Advance care planning; Location of death; Parkinson's disease; Physician orders for life sustaining treatment (POLST)