Highlights
- •In this observational study of adults 65 years of age and older with cardiopulmonary conditions and cancer, rates of age-adjusted palliative care consultation was highest among discharges with malignant conditions.
- •Compound annual growth rates of palliative care consultation were highest among discharges with cardiopulmonary conditions.
- •Older adults with cardiopulmonary conditions had lower age-adjusted rates of palliative care consultation, but higher growth over time.
Abstract
Background
Palliative care consultation (PCC) is recommended for older adults hospitalized with
cardiopulmonary conditions, but frequently is reserved for patients with malignant
conditions and those with advanced age.
Objectives
To compare age-adjusted PCC trends and the relationship between increasing age and
PCC among older adults with cardiopulmonary and malignant conditions.
Methods
Observational analysis of patients age ≥ 65 years, stratified by age and cardiopulmonary
(heart failure, chronic obstructive pulmonary disease) vs. malignant (lung and gastrointestinal)
conditions. Age-adjusted PCC trends over time and compound annual growth rates (CAGR)
were compared.
Results
Discharges with cardiopulmonary vs. malignant conditions were older, more likely to
be female, and white. Relative to malignant conditions, discharges with cardiopulmonary
conditions had lower age-adjusted PCC rates but higher CAGRS. Increasing age was associated
with PCC in both groups but had a stronger effect among cardiopulmonary conditions.
Conclusions
Older adults with cardiopulmonary conditions experienced lower rates of PCC, but higher
rates of growth over time relative to those with malignant conditions.
Keywords
Abbreviations:
U.S. (United States), PCC (palliative care consultation), COPD (chronic obstructive pulmonary disease), NIS (national inpatient sample), ICD-9-Cm (international classification of diseases 9th revision, clinical modification), CCS (Clinical Classification Software), CCI (Charlson comorbidity index), HCUP (Healthcare Cost Utilization Project), ED (Emergency Department), CAGR (Compound Annual Growth Rate)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute CareAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Multimorbidity and mortality in older adults: a systematic review and meta-analysis.Arch Gerontol Geriatr. 2016; 67: 130-138https://doi.org/10.1016/j.archger.2016.07.008
- Symptom burden among community-dwelling older adults in the United States.J Am Geriatr Soc. 2019; 67: 223-231https://doi.org/10.1111/jgs.15673
Valtorta NK, Moore DC, Barron L, Stow D, Hanratty B. Older adults ’ social relationships and health care utilization: a systematic review. 2018;108(4):1–10. doi:10.2105/AJPH.2017.304256.
- End-of-life discussions with older adults.J Am Geriatr Soc. 2017; 64: 1962-1967https://doi.org/10.1111/jgs.14285.End-of-Life
Center to advance palliative care. America's care of serious illness 2019 state-by-state report card on access to palliative care in our nation's hospitals. https://reportcard.capc.org/. Accessed October 1, 2019.
- The prevalence of inpatients at 33U.S. hospitals appropriate for and receiving referral to palliative care.J Palliat Med. 2016; 19: 360-372https://doi.org/10.1089/jpm.2015.0236
- Epidemiology and management of common pulmonary diseases in older persons.J Gerontol A Biol Sci Med Sci. 2012; 67: 276-291
- Epidemiology, pathophysiology, and prognosis of heart failure in the elderly.Heart Fail Clin. 2007; 3: 381-387
- Palliative care in heart failure: rationale, evidence, and future priorities.J Am College Card. 2017; 70: 1919-1930
- Symptom burden, depression, and spiritual well-being: a comparison of heart failure and advanced cancer patients.J General Intern Med. 2009; 24: 592-598
- Healthcare Cost and Utilization Project (HCUP).Agency for Healthcare Research and Quality, Rockville, MD2011 (Accessed January 11, 2019)
- The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.Lancet. 2007; 370: 1453-1457
- For ICD-9-CM. Healthcare Cost and Utilization Project (HCUP). 2006-2009. 11. Agency for Healthcare Research and Quality, Rockville, MD2019 (Accessed January)
- Cancer statistics 2016.CA Cancer J Clin. 2016; 66: 7-30https://doi.org/10.3322/caac.21332
- Mortality in the United States.NCHS Data Brief. 2017; 293: 1-8
- Effect of chronic diseases and multimorbidity on survival and functioning in elderly adults.J Am Geriatr Soc. 2017; 65: 1056-1060https://doi.org/10.1111/jgs.14868
Centers for Disease Control. ICD - ICD-9-CM - addenda, conversion tables, and guidelines. 2009. http://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm. Accessed January 27, 2019.
- Characteristics of hospitalized cancer patients referred for inpatient palliative care consultation.J Palliat Med. 2017; 20: 1321-1326
- Referral to palliative care in COPD and other chronic diseases: a population-based study.Respir Med. 2013; 107: 1731-1739
- The anatomy of medical research.JAMA. 2015; 22959: 174-189https://doi.org/10.1001/jama.2014.15939
- Health care professionals’ attitudes regarding palliative care for patients with chronic heart failure: an interview study.BMC Palliat Car. 2016; 15: 76
- Professionals’ perceptions and current practices of integrated palliative care in chronic heart failure and chronic obstructive pulmonary disease: a qualitative study in Belgium.BMC Palliat Care. 2018; 17: 103
- Illness trajectories and palliative care.BMJ. 2005; 330: 1007-1011
- An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses.Am J Respir Crit Care Med. 2008; 177: 912-927
- 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation. 2013; 128: e240-e319
- The National Palliative Care Research Center: ten years of promoting and developing research in palliative care.J Palliat Med. 2018; 21: 1548-1557
- State of research on palliative care in heart failure as evidenced by published literature, conference proceedings, and NIH funding.J Card Fail. 2017; 23: 197-200
- Few hospital palliative care programs meet national staffing recommendations.Health Aff. 2016; 35: 1690-1697https://doi.org/10.1377/hlthaff.2016.0113
- Evolving the palliative care workforce to provide responsive, serious illness care evolving the palliative care workforce.Ann Intern Med. 2015; 163: 637-638https://doi.org/10.7326/M15-0071
- Rural readmissions in the palliative care vacuum.J Hosp Palliat Nurs. 2018; 20
- Generalist plus specialist palliative care - creating a more sustainable model.N Engl J Med. 2013; 368: 1169-1171https://doi.org/10.1056/NEJMp1302513
- Validation of the V66.7 code for palliative care consultation in a single academic medical center.J Palliat Med. 2016; XX: 1-6https://doi.org/10.1089/jpm.2016.0363
- Research priorities in subspecialty palliative care: policy initiatives.J Palliat Med. 2017; 20: 813-820
- Life-Sustaining procedures, palliative care consultation, and do-not resuscitate status in dying patients with COPD in US hospitals: 2010-2014.J Pallit Care. 2018; 33: 159-166
- Patterns of palliative care consultation among elderly patients with cancer.J Natl Compr Cancer Netw. 2016; 14: 439-445
- National consensus project clinical practice guidelines for quality palliative care.J Palliat Med. 2018; 21https://doi.org/10.1089/jpm.2018.0431
Article info
Publication history
Published online: February 27, 2020
Accepted:
February 5,
2020
Received in revised form:
January 31,
2020
Received:
November 29,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
