Bock Meredith, Gan Siqi, Aldridge Melissa, Harrison Krista L, Yaffe Kristine, Smith Alexander K, Boscardin John, Hunt Lauren J
Division of Geriatrics, Department of Medicine, University of California, San Francisco.
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA Netw Open. 2025 Mar 3;8(3):e250014. doi: 10.1001/jamanetworkopen.2025.0014.
Neurodegenerative disorders are now the most common reason that Medicare beneficiaries enroll in hospice for end-of-life care. People with all-cause dementia have high rates of suboptimal hospice use, but little is known about hospice use patterns in Lewy body disease, which includes both Parkinson disease (PD) and dementia with Lewy bodies (DLB).
To compare patient characteristics, hospice agency characteristics, and patterns of use for beneficiaries with PD and DLB vs Alzheimer disease (AD).
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study including a 100% sample of national 2010-2020 calendar year Medicare data on hospice enrollees was performed. Data analysis was conducted from November 2023 to May 2024.
A diagnosis of PD or DLB, compared with AD as the reference group.
Proportion of enrollees with short stays (<7 days), proportion with long stays (>180 days), proportion disenrolled for any reason before death, and disenrollment by type.
Of 11 327 324 Medicare beneficiaries enrolled in hospice between 2010 and 2020 who met eligibility criteria (mean [SD] age, 85.2 [7.5] years; 781 763 [63.0%] female), there were 958 182 (8.4%) with a primary diagnosis of AD, 232 864 (2.1%) with PD, and 49 340 (0.4%) with DLB. People with PD were more likely to experience a long stay (odds ratio [OR], 1.15; 95% CI, 1.13-1.16) compared with AD, whereas the odds for those with DLB were not increased. However, people with either PD or DLB were less likely to be disenrolled for extended prognosis compared with AD (OR for DLB, 0.82; 95% CI, 0.79-0.85; OR for PD, 0.86; 95% CI, 0.85-0.88). People with PD were more likely to revoke hospice (OR, 1.29; 95% CI, 1.27-1.32) compared with AD.
In this cohort study of Medicare beneficiaries, hospice use patterns differed by dementia subtype. Higher likelihood of hospice revocation in PD raises important questions about unmet needs and highlights the need for more research around the experience of the end of life in this growing population.
神经退行性疾病现已成为医疗保险受益人登记接受临终关怀的最常见原因。患有各种原因导致的痴呆症的人群临终关怀使用情况欠佳的比例很高，但对于路易体病（包括帕金森病（PD）和路易体痴呆（DLB））的临终关怀使用模式却知之甚少。
比较帕金森病和路易体痴呆患者与阿尔茨海默病（AD）患者的特征、临终关怀机构特征及使用模式。
设计、设置和参与者：进行了一项回顾性队列研究，纳入了2010 - 2020历年全国医疗保险临终关怀参保者100%的样本数据。数据分析于2023年11月至2024年5月进行。
以AD作为参照组，比较帕金森病或路易体痴呆的诊断情况。
短期住院（<7天）的参保者比例、长期住院（>180天）的比例、在死亡前因任何原因退出临终关怀的比例以及按类型划分的退出比例。
在2010年至2020年间登记接受临终关怀且符合资格标准的11327324名医疗保险受益人中（平均[标准差]年龄为85.2[7.5]岁；781763名[63.0%]为女性），原发性诊断为AD的有958182名（8.4%），PD的有232864名（2.1%），DLB的有49340名（0.4%）。与AD相比，PD患者更有可能长期住院（优势比[OR]为1.15；95%置信区间为1.13 - 1.16），而DLB患者的这种可能性并未增加。然而，与AD相比，PD或DLB患者因预后延长而退出临终关怀的可能性较小（DLB的OR为0.82；95%置信区间为0.79 - 0.85；PD的OR为0.86；95%置信区间为0.85 - 0.88）。与AD相比，PD患者更有可能撤销临终关怀（OR为1.29；95%置信区间为1.27 - 1.32）。
在这项针对医疗保险受益人的队列研究中，临终关怀的使用模式因痴呆亚型而异。PD患者撤销临终关怀的可能性较高，这引发了关于未满足需求的重要问题，并凸显了针对这一不断增长的人群临终体验进行更多研究的必要性。
