Disability At End Of Life Linked To Number Of Acute Hospitalizations

Thomas M. Gill, M.D Humana Foundation Professor of Medicine (Geriatrics) Professor of Epidemiology (Chronic Diseases) and of Investigative Medicine Director Yale Program on Aging and Yale Center for Disability and Disabling Disorders Director, Yale Training Program in Geriatric Clinical Epidemiology and Aging-Related ResearchMedicalResearch.com Interview with:
Thomas M. Gill, M.D
Humana Foundation Professor of Medicine (Geriatrics)
Professor of Epidemiology  and of Investigative Medicine
Director Yale Program on Aging and Yale Center for Disability and Disabling Disorders
Director, Yale Training Program in Geriatric Clinical Epidemiology and Aging-Related Research

Medical Research: What is the background for this study? What are the main findings?h

Response: Understanding the disabling process at the end of life is essential for informed decision-making among older persons, their families, and their physicians.

We know from prior research that the course of disability at the end of life does not follow a predictable pattern for most older persons.  This raises the question about what is driving the development and progression of disability at the end of life.

We identified six distinct trajectories of disability in the last year of life, ranging from the least disabled to most disabled.  We found that the course of disability in the last year of life closely tracked the monthly prevalence of hospitalization for each of the six trajectories.


Medical Research: What should clinicians and patients take away from your report?

Dr. Gill: These results suggest that the disabling process in the last year of life is strongly influenced by the occurrence of acute hospitalizations.

These results may help to inform decisions about the management of disability and appropriate level of care at the end of life.

  • First, aggressive efforts are clearly warranted to minimize the adverse functional consequences of acute hospitalizations.
  • Second, after a hospitalization, restorative interventions are needed, especially among older persons with previously low levels of disability.
  • Finally, for hospitalized older patients with progressive or persistent levels of severe disability, representing more than half the decedents, clinicians might consider a palliative care approach to facilitate discussions about advance care planning and better address personal care needs.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Gill: Effective and efficient strategies are needed to characterize trajectories of disability so that this information can be used to inform medical decision-making, especially among vulnerable older persons.

Citation:

Heather G Allore et al. The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people. The BMJ, May 2015 DOI: 10.1136/bmj.h2361

 

MedicalResearch.com Interview with: Thomas M. Gill, M.D, Humana Foundation Professor of Medicine (Geriatrics), & Professor of Epidemiology and of Investigative Medicine (2015). Disability At End Of Life Linked To Number Of Acute Hospitalizations 

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