LOS ANGELES, CALIFORNIA – A surprising number of frail, elderly Americans in nursing homes are suffering from futile care at the end of their lives, two new federally funded studies reveal.
One found that putting nursing home residents with failing kidneys on dialysis didn’t improve their quality of life and may even push them into further decline. The other showed many with advanced dementia will die within six months and perhaps should have hospice care instead of aggressive treatment.
Medical experts say the new research emphasizes the need for doctors, caregivers and families to consider making the feeble elderly who are near death comfortable rather than treating them as if a cure were possible—more like the palliative care given to terminally ill cancer patients.
Palliative care focuses on managing symptoms of a disease and a main goal is to relieve pain at the end of life. End-of-life care became a divisive issue in the national health care reform debate this summer after one proposal included Medicare reimbursement for doctors who consult with patients on end-of-life counseling. Critics called the counseling “death panels” and a step toward euthanasia.
The new studies were published in last Thursday’s New England Journal of Medicine.
In one study, doctors looked at health records of 3,702 nursing home residents nationwide who started dialysis between 1998 and 2000. The average age was 73 and many had other health problems, including diabetes, heart disease and cancer.
Within the first year, 58 percent died and another 29 percent declined in their ability to do simple tasks such as walking, bathing and getting dressed.
Kidney dialysis helps remove waste from blood, and the vast majority of patients with kidney failure benefit. However, in the case of seniors with failing kidneys, it is less clear whether the benefit outweighs the burden.
The findings call into question the common practice of transporting dialysis patients near the end of life to dialysis centers several times a week and hooking them up to a machine for hours at a time.
The second study followed 323 people with advanced dementia from Boston-area nursing homes. Their average age was 85 and they could not recognize loved ones and were unable to talk or walk.
One out of four died within six months and half died during the 18 months they were followed. Nursing home residents with advanced dementia were more likely to die of pneumonia, fever and eating problems related to their dementia than from strokes or heart attacks.
During their final three months, 41 percent received aggressive care including being hospitalized and tube feeding. However, if the person making their medical decisions was aware of their poor prognosis, they were less likely to receive aggressive care near the end of life, the research found.
If you have any questions or concerns regarding the care that an elderly loved one is receiving in a nursing home or other type of elder care facility, call Berman & Riedel, LLP today at (858) 350-8855. One of our elder abuse attorneys will happily provide you and your family with an initial free consultation to discuss with you what rights you may have under California and federal law. To learn more about Berman & Riedel, LLP, visit the firm’s elder abuse and neglect website at www.preventelderabuse.com.
