Aggressive care still the norm for dying seniors


By Alvin Tran

Although federal data show that fewer Medicare beneficiaries are dying in hospitals, new research suggests that doesn’t mean they’re getting less aggressive care in their final days.

Physician and Nurse Pushing Gurney

Researchers at the Warren Alpert School of Medicine at Brown University and others reported in the Journal of the American Medical Association Tuesday that even as deaths in acute hospitals declined between 2000 and 2009, the use of intensive care units in the final 30 days of life increased, as did short-term hospice use.

The rate of changes to care for these patients, such as transitions within the last three days of life, also increased.

To Dr. Joan Teno, the study’s lead author, the increased use of hospice is encouraging, but she worries about when seniors are referred to hospice.

“While there is greater access to hospice services, there’s also more ICU, more repeat hospitalizations, and more late transitions in the last three days of life,” Teno said during an interview. “The good news is that we are referring to hospice. The bad news is we’re referring to hospice in the last hours of life.”

The findings came from an analysis of Medicare claims data from a random sample of more than 800,000 seniors 66 years and older, who died in 2000, 2005, and 2009.

“The good news is that we are referring to hospice. The bad news is we’re referring to hospice in the last hours of life.”

While a 2010 report by the federal Centers for Disease Control and Prevention has looked at the patient’s location at death, researchers in this study examined beneficiaries’ medical claims for the last 180 days of life.

Hospice use at the time of death increased from nearly 22 percent in 2000 to 42 percent in 2009, the authors reported, but short stays of three days or less went from 22 to 28 percent. And four in 10 of those short stays came after time in a hospital ICU.

According to Teno, the study’s findings, particularly the increase in the number of short hospice stays following hospitalizations, suggest that aggressive care at the end of life is growing. “We really need to improve our referral patterns to make sure that people are receiving the appropriate and timely access to palliative care services at the end of the life,” she said.

Jon Radulovic, the vice president of communications of the nonprofit National Hospice and Palliative Care Organization, says the study adds to concerns about end-of-life care. “With the number of patients (in hospice) who die under seven days or less, it’s questionable whether the patient and family caregivers are able to fully benefit from the unique services that hospice offers,” he said.

With some provisions of the federal health law set to take effect in 2014, Teno sees an opportunity to hold institutions more accountable.

“The opportunity under health care reform is to really pay for quality and not pay for another day in the ICU,” she said. “Our fee-for-service system has probably resulted in overutilization of care and really, what we want to do is get the right care at the right time, for the right person, at the right location. And we want to respect the patient’s right to choose.”

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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4 thoughts on “Aggressive care still the norm for dying seniors

  1. cari

    such a waste of health care dollars to spend money on the dying elderly. I see this all the time in the hospital I work in. Guess what? These people NEVER get better. NEVER! Let them die in peace at home or in hospice.

    1. LocalHealthGuide

      RE: Stats

      A quick literature search finds this review in the Journal of General Internal Medicine by Dr. Jacqueline Yuen of Weill Medical College, Cornell University and colleagues: Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them. They argue that doctors do not talk to patients about end-of-life care and DNR soon enough.

      Here’s an excerpt:

      When DNR order discussions do occur, they frequently occur too late. A study of 500 patients who suffered from a cardiac arrest showed that 76% of these patients with DNR orders were incapacitated to make decisions at the time a DNR order was discussed. However, only 11% were impaired at the time of admission. Only 22% of patients participated in the decision about their DNR order. The majority of DNR orders were written within 2 to 3 days before death.

      The full article is online at:

      Citation: J Gen Intern Med. 2011 July; 26(7): 791–797.

  2. WS

    Well, that’s one way to make the numbers work on Obamacare, just let people die. I wonder if you’d feel the same way if it were you, or your parent.

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