Utilization of palliative care and acute care services in older adults with XXXX .

@entity1 @entity204 @entity5 @entity2911
OBJECTIVES: There is a gap in knowledge regarding the rates of utilization of palliative care services (PCS) and acute care services (ACS) among older @entity1 with @entity5 close to end of life. We analyzed the utilization of these services among older adults (65years and older) and compared them to those in younger adults (40-64years) with @entity5 . MATERIALS AND METHODS: A retrospective chart review of 567 veterans who died with @entity5 between 2002 and 2009 and utilized PCS and ACS prior to @entity204 was conducted after IRB approval. To assess PCS utilization, we studied the mean duration between day of hospice referral and time of @entity204 ( @entity2911 ) and the mean length of stay with hospice (LoS). The frequency of emergency room visits (ERVLM), hospital admissions (HALM), and ICU admissions (ICULM) in the last month of life was used as a measure for ACS. The differences among older and younger @entity1 were compared using two sample t-tests. RESULTS: Older adults had earlier referral to PCS [mean @entity2911 : 47.3 versus 34.5days, p=0.015], longer stay with hospice [mean LoS: 32.5 versus 20.2days, p=0.007], fewer hospital [HALM: 0.7 versus 0.9, p=0.043], and ICU admissions [ICULM: 0.1 versus 0.2, p=0.030] per @entity1 . The proportion of @entity1 utilizing ER visits [53.5 % versus 59.5%, p=0.173] and hospital admissions [58.6% versus 65.1%, p=0.13] in the last month of life was similar in both age groups with fewer older adults utilizing ICU care [13.2% versus 19.5%, p=0.047]. CONCLUSION: Older @entity1 with @entity5 are likely to be referred to PCS earlier than younger @entity1 and spend a longer duration with PCS prior to @entity204 . However, there continues to be significant utilization of ACS in all @entity1 with @entity5 . Better understanding of the goals of care in older adults with @entity5 and education of oncology providers regarding the need to utilize and integrate palliative care services earlier in the course of disease is imperative.
