Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T09:20:31.108Z Has data issue: false hasContentIssue false
  • English
  • Français

Palliative care and aggressive interventions after falling: A Nationwide Inpatient Sample analysis

Published online by Cambridge University Press:  05 March 2021

Vanessa P. Ho Open the ORCID record for Vanessa P. Ho [Opens in a new window] ,
Wyatt P. Bensken Open the ORCID record for Wyatt P. Bensken [Opens in a new window]  and
Siran M. Koroukian Open the ORCID record for Siran M. Koroukian [Opens in a new window]
Vanessa P. Ho*
Affiliation:
Department of Surgery, MetroHealth Medical Center, Cleveland, OH Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
Wyatt P. Bensken
Affiliation:
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
Siran M. Koroukian
Affiliation:
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
*
Author for correspondence: Vanessa P. Ho, Department of Surgery, Division of Trauma, Critical Care, Burn, and Acute Care Surgery, 2500 MetroHealth Drive, Cleveland, OH 44109, USA. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The purpose of this study is to identify whether there is an opportunity for improvement to provide palliative care services after a serious fall. We hypothesized that (1) palliative care services would be utilized in less than 10% of patients over the age of 65 who fall and (2) more than 20% of patients would receive aggressive life-sustaining treatments (LSTs) prior to death.

Methods

Using the 2017 Nationwide Inpatient Sample, we identified patients who were admitted to the hospital with a fall (ICD-10 W00-W19) and were hospitalized at least two days with valid discharge data. Palliative care services (Z51.5) or LSTs (cardiopulmonary resuscitation, ventilation, reintubation, tracheostomy, feeding tube placement, vasopressors, transfusion, total parenteral nutrition, and hemodialysis) were identified with ICD-10 codes. We examined the use of palliative care or LSTs by discharge destination (home, facility, and death). Logistic regression was used to identify factors associated with palliative care.

Results

In total, 155,241 patients were identified (median 82 years old, interquartile range 74–88); 2.5% died in hospital, and 69.4% were transferred to a facility. Palliative care occurred in 4.5% of patients, and LST occurred in 15.1%. Patients who died were significantly more likely to have had palliative care (50.1% vs. 3.4% of home or facility discharges) and were more likely to have an LST [53.0% vs. 9.8% (home) vs. 15.9% (facility)]. Palliative care was associated with both death [adjusted odds ratio (AOR) 19.84, 95% confidence interval (CI) 18.39–21.41, p < 0.001] and LST (AOR 1.36, 95% CI 1.27–1.46, p < 0.001).

Significance of results

Palliative care is associated with both death and LST, suggesting that physicians use palliative care as a last resort after aggressive measures have been exhausted. Patients who fall would likely benefit from the early use of palliative care to align future goals of care.

Keywords

Geriatric traumaPalliative careTrauma
Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 1 , February 2022 , pp. 101 - 106
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Aharonoff, GB, Koval, KJ, Skovron, ML, et al. (1997) Hip fractures in the elderly: Predictors of one year mortality. Journal of Orthopaedic Trauma 11(3), 162–165.CrossRefGoogle ScholarPubMed
Ayoung-Chee, P, McIntyre, L, Ebel, BE, et al. (2014) Long-term outcomes of ground-level falls in the elderly. The Journal of Trauma and Acute Care Surgery 76(2), 498–503; discussion 503.CrossRefGoogle ScholarPubMed
Bergen, G, Stevens, MR and Burns, ER (2016) Falls and fall injuries among adults aged ≥65 years – United States, 2014. MMWR: Morbidity and Mortality Weekly Report 65(37), 993–998.Google Scholar
Bhangu, JK, Young, BT, Posillico, S, et al. (2020) Goals of care discussions for the imminently dying trauma patient. Journal of Surgical Research 246, 269–273.CrossRefGoogle ScholarPubMed
Burns, E and Kakara, R (2018) Deaths from falls among persons aged ≥65 years – United States, 2007-2016. MMWR: Morbidity and Mortality Weekly Report 67(18), 509–514.Google Scholar
Burns, ER, Stevens, JA and Lee, R (2016) The direct costs of fatal and non-fatal falls among older adults – United States. Journal of Safety Research 58, 99–103.CrossRefGoogle ScholarPubMed
Cooper, Z, Koritsanszky, LA, Cauley, CE, et al. (2016) Recommendations for best communication practices to facilitate goal-concordant care for seriously Ill older patients with emergency surgical conditions. Annals of Surgery 263(1), 1–6.CrossRefGoogle ScholarPubMed
Dunn, RH, Ahn, J and Bernstein, J (2016) End-of-life care planning and fragility fractures of the hip: Are we missing a valuable opportunity? Clinical Orthopaedics and Related Research 474(7), 1736–1739.CrossRefGoogle ScholarPubMed
Elixhauser, A, Steiner, C, Harris, DR, et al. (1998) Comorbidity measures for use with administrative data. Medical Care 36(1), 8–27.CrossRefGoogle ScholarPubMed
Farahmand, BY, Michaelsson, K, Ahlbom, A, et al. (2005) Survival after hip fracture. Osteoporosis International 16(12), 1583–1590.CrossRefGoogle ScholarPubMed
Feder, SL, Redeker, NS, Jeon, S, et al. (2018) Validation of the ICD-9 diagnostic code for palliative care in patients hospitalized with heart failure within the veterans health administration. American Journal of Hospice and Palliative Care 35(7), 959–965.CrossRefGoogle ScholarPubMed
Florence, CS, Bergen, G, Atherly, A, et al. (2018) Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society 66(4), 693–698.CrossRefGoogle ScholarPubMed
Haas, B, Gomez, D, Xiong, W, et al. (2011) External benchmarking of trauma center performance: Have we forgotten our elders? Annals of Surgery 253(1), 144–150.CrossRefGoogle ScholarPubMed
Hernandez, RA, Hevelone, ND, Lopez, L, et al. (2015) Racial variation in the use of life-sustaining treatments among patients who die after major elective surgery. American Journal of Surgery 210(1), 52–58.CrossRefGoogle ScholarPubMed
Hua, M, Li, G, Clancy, C, et al. (2017) Validation of the V66.7 code for palliative care consultation in a single academic medical center. Journal of Palliative Medicine 20(4), 372–377.CrossRefGoogle Scholar
Johnston, CB, Holleran, A, Ong, T, et al. (2018) Hip fracture in the setting of limited life expectancy: The importance of considering goals of care and prognosis. Journal of Palliative Medicine 21(8), 1069–1073.CrossRefGoogle ScholarPubMed
Kelley, AS and Morrison, RS (2015) Palliative care for the seriously Ill. New England Journal of Medicine 373(8), 747–755.CrossRefGoogle ScholarPubMed
Kelley, AS, Covinsky, KE, Gorges, RJ, et al. (2017) Identifying older adults with serious illness: A critical step toward improving the value of health care. Health Services Research 52(1), 113–131.CrossRefGoogle ScholarPubMed
Koso, RE, Sheets, C, Richardson, WJ, et al. (2018) Hip fracture in the elderly patients: A sentinel event. American Journal of Hospice and Palliative Care 35(4), 612–619.CrossRefGoogle ScholarPubMed
Leibson, CL, Tosteson, AN, Gabriel, SE, et al. (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: A population-based study. Journal of the American Geriatrics Society 50(10), 1644–1650.CrossRefGoogle ScholarPubMed
Lilley, EJ, Lee, KC, Scott, JW, et al. (2018) The impact of inpatient palliative care on end-of-life care among older trauma patients who die after hospital discharge. The Journal of Trauma and Acute Care Surgery 85(5), 992–998.CrossRefGoogle ScholarPubMed
Mosenthal, AC, Murphy, PA, Barker, LK, et al. (2008) Changing the culture around end-of-life care in the trauma intensive care unit. Journal of Trauma 64(6), 1587–1593.Google ScholarPubMed
NHDS (2019) National Hospital Discharge Survey. Available at: https://www.cdc.gov/nchs/nhds/index.htm.Google Scholar
O'Connell, K and Maier, R (2016) Palliative care in the trauma ICU. Current Opinion in Critical Care 22(6), 584–590.CrossRefGoogle ScholarPubMed
Rapp, K, Becker, C, Lamb, SE, et al. (2008) Hip fractures in institutionalized elderly people: Incidence rates and excess mortality. Journal of Bone and Mineral Research 23(11), 1825–1831.CrossRefGoogle ScholarPubMed
Ritchie, CS, Kelley, AS, Stijacic Cenzer, I, et al. (2016) High levels of geriatric palliative care needs in hip fracture patients before the hip fracture. Journal of Pain and Symptom Management 52(4), 533–538.CrossRefGoogle ScholarPubMed
Rivet, EB, Ferradsa, P, Albrecht, T, et al. (2017) Characteristics of palliative care consultation at an academic level one trauma center. American Journal of Surgery 214(4), 657–660.CrossRefGoogle ScholarPubMed
Roche, JJ, Wenn, RT, Sahota, O, et al. (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: Prospective observational cohort study. BMJ 331(7529), 1374.CrossRefGoogle ScholarPubMed
Schnell, S, Friedman, SM, Mendelson, DA, et al. (2010) The 1-year mortality of patients treated in a hip fracture program for elders. Geriatric Orthopaedic Surgery & Rehabilitation 1(1), 6–14.CrossRefGoogle Scholar