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End of life care of hospitalized patients with Parkinson disease: a retrospective analysis and brief review
BACKGROUND: Towards the end of life (EOL), persons with parkinsonism (PwP) have complex needs and can present with unique palliative care (PC) challenges. There are no widely accepted guidelines to aid neurologists, hospitalists, or PC clinicians in managing the symptoms of PwP at EOL. We examined a...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511646/ https://www.ncbi.nlm.nih.gov/pubmed/37744391 http://dx.doi.org/10.3389/fnagi.2023.1265156 |
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author | Bhansali, Sakhi Assaedi, Ekhlas Yu, Jeryl Ritzi T. Mandava, Nymisha Sonneborn, Claire Hogue, Olivia Walter, Benjamin L. Samala, Renato V. Margolius, Adam |
author_facet | Bhansali, Sakhi Assaedi, Ekhlas Yu, Jeryl Ritzi T. Mandava, Nymisha Sonneborn, Claire Hogue, Olivia Walter, Benjamin L. Samala, Renato V. Margolius, Adam |
author_sort | Bhansali, Sakhi |
collection | PubMed |
description | BACKGROUND: Towards the end of life (EOL), persons with parkinsonism (PwP) have complex needs and can present with unique palliative care (PC) challenges. There are no widely accepted guidelines to aid neurologists, hospitalists, or PC clinicians in managing the symptoms of PwP at EOL. We examined a population of PwP at EOL, aiming to describe trends of in-hospital management and utilization of PC services. METHODS: All PwP admitted to two hospitals during 2018 (N = 727) were examined retrospectively, assessing those who died in hospital or were discharged with hospice (EOL group, N = 35) and comparing them to the main cohort. Their demographics, clinical data, engagement of multidisciplinary and palliative services, code status changes, invasive care, frequency of admissions, and medication administration were assessed. RESULTS: Among the EOL group, 8 expired in hospital, and 27 were discharged to hospice. Forty-six percent of EOL patients received a PC consultation during their admission. The median interval from admission to death was 37 days. Seventy-seven percent had a full code status on admission. Compared to hospice patients, those who expired in hospital had higher rates of invasive procedures and intensive care unit transfers (41% vs. 75%, in both variables), and lower rates of PC involvement (52% vs. 25%). The transition of code status change for the EOL group from Full code to Do Not Resuscitate (DNR) occurred at a median 4–5 days from admission. For patients that passed in the hospital, the median days from transition of code status to death was 0(IQR 0–1). Levodopa dose deviations were frequent in both EOL and non-EOL group, but contraindicated medications were infrequently administered (11% in EOL group vs. 9% in non-EOL group). CONCLUSION: Our data suggest a low utilization of PC services and delayed discussions of goals of care. More work is needed to raise awareness of inpatient teams managing PwP regarding the unique but common challenges facing PwP with advanced disease. A brief narrative review summarizing the suggested management of symptoms common to hospitalized PwP near EOL is provided. |
format | Online Article Text |
id | pubmed-10511646 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-105116462023-09-22 End of life care of hospitalized patients with Parkinson disease: a retrospective analysis and brief review Bhansali, Sakhi Assaedi, Ekhlas Yu, Jeryl Ritzi T. Mandava, Nymisha Sonneborn, Claire Hogue, Olivia Walter, Benjamin L. Samala, Renato V. Margolius, Adam Front Aging Neurosci Aging Neuroscience BACKGROUND: Towards the end of life (EOL), persons with parkinsonism (PwP) have complex needs and can present with unique palliative care (PC) challenges. There are no widely accepted guidelines to aid neurologists, hospitalists, or PC clinicians in managing the symptoms of PwP at EOL. We examined a population of PwP at EOL, aiming to describe trends of in-hospital management and utilization of PC services. METHODS: All PwP admitted to two hospitals during 2018 (N = 727) were examined retrospectively, assessing those who died in hospital or were discharged with hospice (EOL group, N = 35) and comparing them to the main cohort. Their demographics, clinical data, engagement of multidisciplinary and palliative services, code status changes, invasive care, frequency of admissions, and medication administration were assessed. RESULTS: Among the EOL group, 8 expired in hospital, and 27 were discharged to hospice. Forty-six percent of EOL patients received a PC consultation during their admission. The median interval from admission to death was 37 days. Seventy-seven percent had a full code status on admission. Compared to hospice patients, those who expired in hospital had higher rates of invasive procedures and intensive care unit transfers (41% vs. 75%, in both variables), and lower rates of PC involvement (52% vs. 25%). The transition of code status change for the EOL group from Full code to Do Not Resuscitate (DNR) occurred at a median 4–5 days from admission. For patients that passed in the hospital, the median days from transition of code status to death was 0(IQR 0–1). Levodopa dose deviations were frequent in both EOL and non-EOL group, but contraindicated medications were infrequently administered (11% in EOL group vs. 9% in non-EOL group). CONCLUSION: Our data suggest a low utilization of PC services and delayed discussions of goals of care. More work is needed to raise awareness of inpatient teams managing PwP regarding the unique but common challenges facing PwP with advanced disease. A brief narrative review summarizing the suggested management of symptoms common to hospitalized PwP near EOL is provided. Frontiers Media S.A. 2023-09-06 /pmc/articles/PMC10511646/ /pubmed/37744391 http://dx.doi.org/10.3389/fnagi.2023.1265156 Text en Copyright © 2023 Bhansali, Assaedi, Yu, Mandava, Sonneborn, Hogue, Walter, Samala and Margolius. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Aging Neuroscience Bhansali, Sakhi Assaedi, Ekhlas Yu, Jeryl Ritzi T. Mandava, Nymisha Sonneborn, Claire Hogue, Olivia Walter, Benjamin L. Samala, Renato V. Margolius, Adam End of life care of hospitalized patients with Parkinson disease: a retrospective analysis and brief review |
title | End of life care of hospitalized patients with Parkinson disease: a retrospective analysis and brief review |
title_full | End of life care of hospitalized patients with Parkinson disease: a retrospective analysis and brief review |
title_fullStr | End of life care of hospitalized patients with Parkinson disease: a retrospective analysis and brief review |
title_full_unstemmed | End of life care of hospitalized patients with Parkinson disease: a retrospective analysis and brief review |
title_short | End of life care of hospitalized patients with Parkinson disease: a retrospective analysis and brief review |
title_sort | end of life care of hospitalized patients with parkinson disease: a retrospective analysis and brief review |
topic | Aging Neuroscience |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511646/ https://www.ncbi.nlm.nih.gov/pubmed/37744391 http://dx.doi.org/10.3389/fnagi.2023.1265156 |
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