Almost one in every five patients with advanced Alzheimer's or other form of severe dementia will be shuttled from a nursing home to a hospital during their last few months of life, a new U.S. study shows.
The study's authors believe that many of those troublesome "transitions" aren't needed.
Depending on where a patient lives, as many as 37.5 percent may be hospitalized, the study found.
"This study is really a sign of the current inefficiency of how we organize and pay for health care. The current incentive for patients with severe dementia is to hospitalize and get them stuck in a revolving door between acute care hospitals and nursing homes," explained study co-author Dr. Joan Teno, a professor of health services, policy and practice at the Warren Alpert Medical School at Brown University in Providence, R. I.
Results of the study are published in the Sept. 29 issue of the New England Journal of Medicine.
Teno and her colleagues looked at Medicare data from 2000 through 2007, involving almost 475,000 patients. The researchers focused on individuals with advanced mental and funcational impairments who were in a nursing home at least 120 days before their deaths.
The authors defined transitions from nursing homes to hospitals as "burdensome" if the hospitalization occurred in the last three days of life, if they were sent to a different nursing home after hospitalization, or if there were multiple hospitalization during the last 90 days of life.
"These were people who had really advanced cognitive impairment and really impaired functional living. They couldn't perform normal tasks of daily living. About one in five of these patients will have one or more transitiosn that are burdensome," said Teno.