February 26, 2021
Nursing home residents with advanced dementia had fewer hospital transfers when they resided in facilities that followed best practices for the integration of palliative care and infection management, according to a study published online ahead of print in the Journal of Palliative Medicine.
“An estimated 50% of nursing home residents experience hospital transfers in their last year of life, often due to infections. Hospital transfers due to infection are often of little clinical benefit to residents with advanced illness, for whom aggressive treatments are often ineffective and inconsistent with goals of care,” wrote researchers from RAND Corporation and Columbia University School of Nursing.
For the study, investigators looked at whether merging the goals of palliative care and infection management at end of life reduced all-cause hospital transfers and hospital transfers due to infection. The observational study included 143,223 US nursing home residents, 42,761 of whom were in the advanced stages of dementia, congestive heart failure, and chronic obstructive pulmonary disease (COPD).
For residents with advanced dementia, the degree to which nursing homes followed best practices for integration of palliative care and infection management was inversely associated with hospital transfers for all causes as well as hospital transfers due to infection, the study found.
However, for residents with advanced COPD, integration intensity was inversely associated with all-cause hospital transfers—but not infection-caused hospital transfers. For residents with advanced congestive heart failure, integration intensity was associated with neither all-cause hospital transfers nor hospital transfers due to infection, the study found.
“Nursing home policies aimed to promote integration of palliative care and infection management may reduce burdensome hospital transfers for residents with advanced dementia,” researchers concluded. “For residents with advanced congestive heart failure and COPD, alternative strategies may be needed to promote best practices for infection management at end of life.”
Harrison JM, Agarwal M, Stone PW, Gracner T, Sorbero M, Dick AW. Does Integration of Palliative Care and Infection Management Reduce Hospital Transfers among Nursing Home Residents? [published online ahead of print, 2021 Feb 19]. J Palliat Med. 2021;10.1089/jpm.2020.0577. doi:10.1089/jpm.2020.0577