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Impact of mental illness on end‐of‐life emergency department use in elderly patients with gastrointestinal malignancies

BACKGROUND: Elderly patients with gastrointestinal cancer and mental illness have significant comorbidities that can impact the quality of their care. We investigated the relationship between mental illness and frequent emergency department (ED) use in the last month of life, an indicator for poor e...

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Autores principales: Kashyap, Mehr, Harris, Jeremy P., Chang, Daniel T., Pollom, Erqi L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957203/
https://www.ncbi.nlm.nih.gov/pubmed/33621438
http://dx.doi.org/10.1002/cam4.3792
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author Kashyap, Mehr
Harris, Jeremy P.
Chang, Daniel T.
Pollom, Erqi L.
author_facet Kashyap, Mehr
Harris, Jeremy P.
Chang, Daniel T.
Pollom, Erqi L.
author_sort Kashyap, Mehr
collection PubMed
description BACKGROUND: Elderly patients with gastrointestinal cancer and mental illness have significant comorbidities that can impact the quality of their care. We investigated the relationship between mental illness and frequent emergency department (ED) use in the last month of life, an indicator for poor end‐of‐life care quality, among elderly patients with gastrointestinal cancers. METHODS: We used SEER‐Medicare data to identify decedents with gastrointestinal cancers who were diagnosed between 2004 and 2013 and were at least 66 years old at time of diagnosis (median age: 80 years, range: 66–117 years). We evaluated the association between having a diagnosis of depression, bipolar disorders, psychotic disorders, anxiety, dementia, and/or substance use disorders and ED use in the last 30 days of life using logistic regression models. RESULTS: Of 160,367 patients included, 54,661 (34.1%) had a mental illness diagnosis between one year prior to cancer diagnosis and death. Patients with mental illness were more likely to have > 1 ED visit in the last 30 days of life (15.6% vs. 13.3%, p < 0.01). ED use was highest among patients with substance use (17.7%), bipolar (16.5%), and anxiety disorders (16.4%). Patients with mental illness who were male, younger, non‐white, residing in lower income areas, and with higher comorbidity were more likely to have multiple end‐of‐life ED visits. Patients who received outpatient treatment from a mental health professional were less likely to have multiple end‐of‐life ED visits (adjusted odds ratio 0.82, 95% confidence interval 0.78–0.87). CONCLUSIONS: In elderly patients with gastrointestinal cancers, mental illness is associated with having multiple end‐of‐life ED visits. Increasing access to mental health services may improve quality of end‐of‐life care in this vulnerable population.
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spelling pubmed-79572032021-03-19 Impact of mental illness on end‐of‐life emergency department use in elderly patients with gastrointestinal malignancies Kashyap, Mehr Harris, Jeremy P. Chang, Daniel T. Pollom, Erqi L. Cancer Med Clinical Cancer Research BACKGROUND: Elderly patients with gastrointestinal cancer and mental illness have significant comorbidities that can impact the quality of their care. We investigated the relationship between mental illness and frequent emergency department (ED) use in the last month of life, an indicator for poor end‐of‐life care quality, among elderly patients with gastrointestinal cancers. METHODS: We used SEER‐Medicare data to identify decedents with gastrointestinal cancers who were diagnosed between 2004 and 2013 and were at least 66 years old at time of diagnosis (median age: 80 years, range: 66–117 years). We evaluated the association between having a diagnosis of depression, bipolar disorders, psychotic disorders, anxiety, dementia, and/or substance use disorders and ED use in the last 30 days of life using logistic regression models. RESULTS: Of 160,367 patients included, 54,661 (34.1%) had a mental illness diagnosis between one year prior to cancer diagnosis and death. Patients with mental illness were more likely to have > 1 ED visit in the last 30 days of life (15.6% vs. 13.3%, p < 0.01). ED use was highest among patients with substance use (17.7%), bipolar (16.5%), and anxiety disorders (16.4%). Patients with mental illness who were male, younger, non‐white, residing in lower income areas, and with higher comorbidity were more likely to have multiple end‐of‐life ED visits. Patients who received outpatient treatment from a mental health professional were less likely to have multiple end‐of‐life ED visits (adjusted odds ratio 0.82, 95% confidence interval 0.78–0.87). CONCLUSIONS: In elderly patients with gastrointestinal cancers, mental illness is associated with having multiple end‐of‐life ED visits. Increasing access to mental health services may improve quality of end‐of‐life care in this vulnerable population. John Wiley and Sons Inc. 2021-02-23 /pmc/articles/PMC7957203/ /pubmed/33621438 http://dx.doi.org/10.1002/cam4.3792 Text en © 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Cancer Research
Kashyap, Mehr
Harris, Jeremy P.
Chang, Daniel T.
Pollom, Erqi L.
Impact of mental illness on end‐of‐life emergency department use in elderly patients with gastrointestinal malignancies
title Impact of mental illness on end‐of‐life emergency department use in elderly patients with gastrointestinal malignancies
title_full Impact of mental illness on end‐of‐life emergency department use in elderly patients with gastrointestinal malignancies
title_fullStr Impact of mental illness on end‐of‐life emergency department use in elderly patients with gastrointestinal malignancies
title_full_unstemmed Impact of mental illness on end‐of‐life emergency department use in elderly patients with gastrointestinal malignancies
title_short Impact of mental illness on end‐of‐life emergency department use in elderly patients with gastrointestinal malignancies
title_sort impact of mental illness on end‐of‐life emergency department use in elderly patients with gastrointestinal malignancies
topic Clinical Cancer Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957203/
https://www.ncbi.nlm.nih.gov/pubmed/33621438
http://dx.doi.org/10.1002/cam4.3792
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