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National trends in palliative care use among older adults with cardiopulmonary and malignant conditions

Published:February 27, 2020DOI:https://doi.org/10.1016/j.hrtlng.2020.02.004

      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)
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