According to a new study published in the journal Surgery, patients with dementia who develop acute surgical abdomen have high rates of in-hospital mortality and non-routine discharge but rarely receive palliative care.Those who received surgical treatment were less likely to receive palliative care than those who didn’t have surgery, while outcomes were worse in surgical patients, the researchers found.
“Patients with dementia usually already have some palliative care needs based on the fact that dementia is a progressive and life-limiting illness, but people often struggle with when to introduce palliative care in a disease like dementia,” said the study leader Dr. Ana Berlin of Rutgers New Jersey Medical School in Newark.
Dementia in hospitalized patients increases the likelihood of poor outcomes, and mortality is also higher among these patients, the researchers noted. Palliative care improves symptom management and reduces costs in surgical patients, but little is known about the use of palliative care in surgical patients with dementia.
The researchers reviewed data from the National Inpatient Sample (NIS) on 15,209 patients (age≥50) with dementia admitted for an acute abdominal emergency in 2009-13. In-hospital mortality was 10.2%, while 67.2% had nonroutine discharge. Overall, 17.8% of patients had surgery. Those with intestinal ischemia had the highest rates of surgical intervention and postoperative mortality, at 22.8% and 30.7%, respectively.
Palliative care utilization was 7.5% overall, while it was 28.9% for patients who died in the hospital and 6.4% for those discharged non-routinely. Among patients who had surgery, 5.8% received palliative care, versus 7.9% of those who did not have surgery. For patients discharged non-routinely after an operation, 3.7% received palliative care, versus 7.0% of those discharged non-routinely without surgery.
Median hospital charges were $29,500 for patients who received palliative care, and $31,600 for those who did not. Palliative care patients spent a median five days in the hospital, versus six days for patients who didn’t receive palliative care.
The researchers also found that white patients were more than twice as likely as Hispanics to receive palliative care. Older age, urban residence, and higher household income also increased the likelihood that a patient would receive palliative care. “Nearly 94% of patients who leave the hospital with some type of disability are not getting palliative care,” Dr. Berlin said.
Dr. Berlin said, she hopes that based on her findings, when surgeons are faced with a patient with dementia and an acute abdominal emergency, they will involve palliative care. Recognizing the shortage of palliative care specialists, efforts are underway to train surgeons and other front-line physicians to provide primary palliative care, she added.