Dementia patients benefit from hospice care

When dementia patients receive hospice care, family members are more likely to report that loved ones' needs were met in their final days and more likely to provide a higher quality of care rating, research shows.

The study, published online July 28 in the Journal of the American Geriatrics Society, surveyed 538 families who were listed as next of kin on death certificates where dementia was given as the cause of death. Compared with families who didn't receive hospice, the 260 families whose patient received hospice care were:

• 51% less likely to report unmet needs and concerns with quality of care.
• 49% less likely to believe there was an unmet need for pain management.
• 50% less likely to say they wished for more emotional support before their loved ones' deaths.

"Our study begins to show the benefits" of hospice care for dementia patients, said Joan M. Teno, MD, a study author and associate director of the Center for Gerontology and Health Care Research at the Warren Alpert Medical School of Brown University in Providence, R.I. The results are in contrast to previous smaller studies that suggested hospice care didn't "improve pain management, unmet needs or family member ratings of the quality of care," the study said (link).

The findings come on the heels of a July report by the Dept. of Health and Human Services' Office of Inspector General. Among other things, the report found that palliative care costs for nursing home patients jumped by 69% between 2005 and 2009. It recommended increased federal oversight of hospices.

Hospice study authors say their findings show the importance of hospice for nursing home patients with dementia. They say policymakers should consider that evidence as they debate Medicare funding for such services.

Dr. Teno said years ago people talked about dementia patients not feeling pain at the end of life. But that has changed, she said, and there is good evidence that dementia patients feel pain at the end of life, and that it can be managed.

"They are sometimes more challenging patients, because they can't communicate the pain. We have to be more vigilant. ... We need to treat people with dementia just like any other patient with a terminal illness. They can benefit from hospice care," Dr. Teno said.

The study, funded by the National Institute of Aging, also found that getting dementia patients hospice services at the "right time" made a difference in family members' perception of end-of-life care. Families who reported getting hospice too late in the process reported feeling worse than families who had no hospice care at all.