Preoperative Frailty Status and Intensity of End-of-Life Care Among Older Adults After Emergency Surgery.
Palliative care
emergency general surgery
end-of-life care
frailty
older adults
Journal
Journal of pain and symptom management
ISSN: 1873-6513
Titre abrégé: J Pain Symptom Manage
Pays: United States
ID NLM: 8605836
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
29
04
2020
revised:
06
11
2020
accepted:
10
11
2020
pubmed:
20
11
2020
medline:
7
8
2021
entrez:
19
11
2020
Statut:
ppublish
Résumé
Emergency general surgery (EGS) is common and highly morbid for older adults, particularly for those who are frail. However, there are little data on the quality of end-of-life care (EOLC) for this population. We sought to examine the association of frailty with intensity of EOLC for older adults with and without frailty who undergo EGS but die within one year. This retrospective cohort study included 100% Medicare fee-for-service beneficiaries, ≥66 years, who underwent one of five EGS procedures with the highest mortality (partial colectomy, small bowel resection, peptic ulcer disease repair, adhesiolysis, or laparotomy) between 2008 and 2014 and died within one year. A validated claims-based frailty index (CFI) identified patients who were not frail (CFI < 0.15), prefrail (0.15 ≤ CFI < 0.25), mildly frail (0.25 ≤ CFI < 0.35), and moderately to severe frail (CFI ≥ 0.35). Multivariable adjusted logistic or Poisson regression compared post-discharge and EOL healthcare utilization. Among 138,916 older EGS adults who died within one year, 32.2% were not frail, 31.7% were prefrail, 29.8% had mild frailty and 6.3% had moderate-to-severe frailty. Decedents with any degree of frailty experienced high-intensity EOLC (P < 0.01), low rates of hospice use (P < 0.01), and fewer days at home. Of those who survived the index hospitalization but died within one year, moderate-to-severely frail decedents had the highest odds of visiting an emergency department (odds ratio [OR] = 1.19, CI = 1.13-1.27), rehospitalization (OR = 1.23, CI = 1.16-1.31), or an intensive care unit admission (OR = 1.22, CI = 1.13-1.30) in the last 30 days of life compared to nonfrail decedents. While all older patients undergoing EGS have poor end-of-life outcomes, frail EGS patients receive the highest intensity EOLC and represent a vulnerable population for whom targeted interventions could limit burdensome treatment.
Identifiants
pubmed: 33212144
pii: S0885-3924(20)30877-0
doi: 10.1016/j.jpainsymman.2020.11.013
pmc: PMC8124083
mid: NIHMS1660223
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
66-74.e3Subventions
Organisme : NIA NIH HHS
ID : K76 AG054859
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG056368
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG062713
Pays : United States
Informations de copyright
Copyright © 2020. Published by Elsevier Inc.
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