Predicting Hospice Appropriateness for Alzheimers Patients

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Predicting Hospice Appropriateness for
Alzheimers 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

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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 Alzheimers type.

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Research Problem

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

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Research Questions

• To what extent is the Alzheimers - 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?

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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

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Participants (N 112)
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AHOPE Scale Reliability (N 116)

• Scale Mean 17.40
• Item Mean 1.90
• Scale S. D. 4.04
• Inter-item Correlation .21
• Cronbachs Alpha .71

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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 lt.05)
• (NS)

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Logistic Regression ResultsAHOPE Weighted
Categorical Score (N 103)
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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 gt 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 .

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Acknowledgements

• Alzheimers 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 Alzheimers Center Sunset Manor
  Aurora Care Center Brighton Care Center Iliff
  Care Center Bear Creek Nursing Center
• Colorado, USA