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Only 1 in 5 older adults in LTACH alive after 5 years
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Just 18% of older adults admitted to a long-term acute care hospital were alive after 5 years, making the prognosis for these patients worse than those associated with terminal illnesses, including advanced cancer and end-stage heart failure, according to a study published in the Journal of the American Geriatrics Society.
Anil N. Makam, MD, MAS, an assistant professor in residence at the University of California, San Francisco, told Healio Primary Care that after patients are transferred to a long-term acute care hospital to recover, physicians should “focus on improving their quality of life by addressing symptoms like pain and consider stopping therapies that have a very long time lag to benefit, such as cancer screening and treatments.”
Stopping these therapies will help to “avoid bad outcomes in the distant future, such as intensive diabetes or blood pressure control, since patients may not live long enough to benefit,” he added.
Researchers conducted a retrospective cohort study using Medicare data to evaluate the long-term clinical course for adults aged 65 years who hospitalized and transferred to a long-term acute care hospital after discharge.
A total of 14,072 Medicare fee-for-service beneficiaries were included in the study. Among the cohort, the median survival was 8.3 months after admission to a long-term acute care facility.
After admission, 53% of patients did not reach 60-day recovery. Researchers found that on average, patients spent 65.6% of their remaining life as inpatients and 36.9% died as inpatients and never returned home.
Only 16% of patients were enrolled in hospice for a median of 10 days, and just 1% of patients received palliative care physician consultation.
Makam told Healio Primary Care that patients planning to recover in long-term acute care hospitals should discuss their wishes regarding invasive procedures with their physicians, as some patients would prefer care focused on relieving symptoms and improving their quality of life.
“Even after transfer to a long-term acute care hospital, patients and families should continue to plan and prepare to make tough and challenging medical decisions,” Makam said. “They should inquire about palliative care supportive services to help them with these difficult decisions and focus on what truly matters in their lives.”– by Erin Michael
Disclosure: Makam reports no relevant financial disclosures.