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Larry Lawhorne


Objective: Palliative and hospice care have been shown to benefit people with dementia and their families. However, for patients with dementia who are nearing the end of life, hospice referral can be challenging because of the difficulty in predicting prognosis. The objective of this retrospective, exploratory study is two-fold: (1) to describe trajectories by analyzing trends in Palliative Performance Scale (PPS) scores for patients admitted to hospice with a neurocognitive disorder from time of enrollment to time of disenrollment and (2) to determine the relationship between PPS and length of stay (LOS) in hospice care.

Methods: The setting for the study is a geriatrics clinic in west central Ohio. Data collection utilized the Athena™ EMR to identify patients with a neurocognitive disorder who were enrolled in a home-based hospice program between January 1, 2015 and December 31, 2018. PPS scores for 55 patients were recorded from periodic hospice documents submitted to the attending physicians in the geriatrics clinic and from progress notes entered by the geriatricians, as they co-managed the patients alongside hospice.

Results: Fifty-five patients received care across five hospices during the study period. Of those included, 22 had a primary diagnosis of Alzheimer's dementia, and 33 had vascular dementia. The median length of stay in hospice care was 93 days, with death being the reason for discharge in all but one patient. Median length of stay decreased incrementally with each decrease in initial PPS score. With regard to PPS changes over time, there was wide variability in individual trajectories, which demonstrates the highly variable and unpredictable nature of dementia. Almost three quarters of the study population died prior to the 6-month mark in hospice care, suggesting that patients with dementia may be receiving hospice care later than they qualify.