There have been multiple studies that attempt to quantify the positive effects hospice care has on patients in the last weeks and months of their lives. While some have focused on the amount of time a patient may enjoy in hospice care, a study conducted by Yale researchers has been used to show how quality of life is impacted by hopsice through decreased symptoms. The Precipitating Events Project, PEP, enrolled 754 adults over the age of 70, who lived in the community, rather than an in-patient facility or nursing home, and were not disabled. These participants were interviewed monthly until their death about their health. The results of this study have allowed for a number of subsequent studies into what impacts a person's life and health in the months before death. Here, we focus on a study recently published in the American Journal of Medicine, which tracked the monthly occurrence of symptoms in these individuals and how those symptoms changed after enrollment in hospice care.
The results of this study show two things. First, for most individuals, hospice care was reserved for a time when the number and prevelence of symptoms that restrict daily activity increased sharply. For example, the mean number of activity limiting symptoms rose from one to three over a three month period immediately prior to hospice enrollment. The prevelence of any activity limiting symptom rose from about 25-percent to over 50-percent in the same time period.
Second, the data shows that following hospice enrollment, these same metrics decreased sharply and nearly returned to the levels of four months prior to enrollment. Over the first 90 days in hospice care, the number of symptoms fell to less than two. In the same period, the prevelence of symptoms dropped more than 20-percent. It should be noted that patients typically required up to a month to begin seeing significant reductions in their acitivity limiting symptoms.
The first takeaway is not surprising. Families and patients typically wait to enroll in hospice until the quality of life of the patient has been significant affected. The Hospice Medicare benefit also doesn't allow for enrollment until a patient receives a diagnosis with a life expectancy of 6 months or less.
Even so, the mean time from admission in hospice care to death was only about 15 days. This means that many patients both don't receive the full benefit of hospice care, and spend an unnecessary amount of time battling limiting symptoms before enrolling in hospice.
The second takeaway is made even more meaningful when you examine the specific symptoms that hospice helps to reduce. The most common symptoms affected by hospice for participants in this study were fatigue, depression, anxiety, and arm or leg weakness. Each of these directly contributes to a patient's quality of life, and, as they improve, introduce opportunities to enjoy activities they otherwise would have missed out on.
In addition to these findings, the PEP data has been instrumental in other research, including disability trajectories in the last year of life, and the prevelence of dyspnea in older adults in the last year of life.
If you or a loved one are in need of hospice or palliative care, or if you'd like to research these care options, please contact us at Cura-HPC by calling 1-800-797-3839.