title: Restricting Symptoms Before and After Admission to Hospice.
abstract: Prior work has shown that symptoms leading to restrictions in daily activities are common at the end of life. Hospice is a Medicare benefit designed to alleviate distressing symptoms in the last 6 months of life. The effect of hospice on the burden of such symptoms is uncertain.
  
  
  
  From an ongoing cohort study of 754 community-dwelling older persons, aged ≥70 years, we evaluated 241 participants who were admitted to hospice from March 1998 to December 2013. A set of 15 physical and psychological symptoms leading to restricted activity (ie, cut down on usual activities or spend at least half the day in bed) were ascertained during monthly telephone interviews in the year before and 3 months after hospice admission.
  
  
  
  The prevalence and mean number of restricting symptoms increased progressively until about 2 months before hospice admission, before increasing precipitously to a peak around the time of hospice admission. After the start of hospice, both the prevalence and the mean number of restricting symptoms dropped markedly. For several symptoms deemed most amenable to hospice treatment, including depression and anxiety, the prevalence dropped to levels comparable to or lower than those observed 12 months before the start of hospice. The trends observed in symptom prevalence and mean number of symptoms before and after hospice did not differ appreciably according to hospice admission diagnosis or sex. The median duration of hospice (before death) was only 15 days.
  
  
  
  The burden of restricting symptoms increases progressively several months before the start of hospice, peaks around the time of hospice admission, and decreases substantially after the start of hospice. These results, coupled with the short duration of hospice, suggest that earlier referral to hospice may help to alleviate the burden of distressing symptoms at the end of life.
authors.affiliation: Yale School of Medicine, New Haven, Conn.
authors.forename: Shayan
authors.initials: S
authors.lastname: Cheraghlou
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Conn.
authors.forename: Evelyne A
authors.initials: EA
authors.lastname: Gahbauer
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Conn.
authors.forename: Linda
authors.initials: L
authors.lastname: Leo-Summers
authors.affiliation: Yale School of Medicine, New Haven, Conn.
authors.forename: Hans F
authors.initials: HF
authors.lastname: Stabenau
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Conn.
authors.forename: Sarwat I
authors.initials: SI
authors.lastname: Chaudhry
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Conn. Electronic address: thomas.gill@yale.edu.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000453:epidemiology; D060825:Cognitive Dysfunction / Q000453:epidemiology; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology; D004244:Dizziness / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology; D004487:Edema / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D017051:Hospice Care; D006738:Hospices; D006801:Humans; D057187:Independent Living; D008137:Longitudinal Studies; D008297:Male; D008569:Memory Disorders / Q000453:epidemiology; D018908:Muscle Weakness / Q000453:epidemiology; D059352:Musculoskeletal Pain / Q000453:epidemiology; D009325:Nausea / Q000453:epidemiology; D010343:Patient Admission; D015995:Prevalence; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014570:Urologic Diseases / Q000453:epidemiology; D014786:Vision Disorders / Q000453:epidemiology; D014839:Vomiting / Q000453:epidemiology
keywords: Aging; Disability; Hospice; Longitudinal study