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predicting hospice appropriateness for alzheimer

daniel_millan
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predicting hospice appropriateness for alzheimer

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    1. Predicting Hospice Appropriateness for Alzheimer’s Patients Gene W. Marsh, RN, PhD Professor, Acute & Critical Care Nursing University of Sheffield School of Nursing and Midwifery Associate Professor University of Colorado Health Sciences Center Denver, Colorado USA

    2. Purpose The purpose of this study was to test an instrument for predicting the appropriateness of Hospice care for individuals with late stage dementia of the Alzheimer’s type.

    3. Research Problem Hospice organizations within the United States increasingly provide services to individuals with dementia of the Alzheimer’s type. The appropriateness of admitting individuals to Hospice services is determined partially by assessing the individual’s six-month survival prognosis. Prognostic assessment parameters are less well defined in Alzheimer’s like dementia than in other illnesses. As a result, Hospice care and resources for individuals with late stage dementia of the Alzheimer’s type and their caregivers have been underutilized.

    4. Research Questions To what extent is the Alzheimer’s - Hospice Placement Evaluation Scale (AHOPE) a reliable and valid predictor of the appropriateness of Hospice care for individuals with late stage dementia? What additional variables and clinical indicators contribute to the precision of assessment for hospice eligibility of an individual with late stage dementia?

    5. Research Design A descriptive, correlational design was utilized to test the predictive validity of the AHOPE scale and other variables. Data Analysis Descriptive Reliability Logistic Regression

    6. Participants (N = 112)

    7. AHOPE Scale Reliability (N = 116) Scale Mean 17.40 Item Mean 1.90 Scale S. D. 4.04 Inter-item Correlation .21 Cronbach’s Alpha .71

    8. Logistic Regression Model Predictor Variables Total AHOPE with weighted categorical score Age Gender Hospitalizations in past year Falls with injury in past 6 months Fevers in past 2 months Infections in past 6 months Weight change since admission Number of comorbid conditions Future treatment plans (p <.05) (NS)

    9. Logistic Regression ResultsAHOPE Weighted Categorical Score (N = 103)

    10. Summary of Findings The best predictor of death within six months was the weighted categorical AHOPE Scale. Weighted items: swallowing, fluid intake, weight change Individuals with moderately high and high scores (scores > 22) were 13.22 and10.5 times more likely to die than survive within six months. Demographic variables were not predictive of death. Initial results showed promise. Future research is warranted to establish the predictive validity of the AHOPE at a clinically significant level .

    11. Acknowledgements Alzheimer’s Association, Rocky Mountain Chapter Denver Area Hospices University of Colorado Health Sciences Center Center for Nursing Research and Department of Neurology Denver, Colorado, USA Helen Tarnecki, Hospice of Metro Denver Garden Terrace Alzheimer’s Center; Sunset Manor; Aurora Care Center; Brighton Care Center; Iliff Care Center; Bear Creek Nursing Center Colorado, USA

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