End-of-Life Care of Hospitalized Patients with Parkinson's Disease: A Retrospective Study
Sakhi Bhansali1, Ekhlas Assaedi1, Nymisha Mandava3, Olivia Hogue3, Claire Sonneborn3, Jeryl Ritzi Yu4, Benjamin Walter1, Renato Samala2, Adam Margolius1
1Neurological Institute, 2Department of Palliative and Supportive Care, Cleveland Clinic, 3Cleveland Clinic, 4St. Luke's Medical Center
Objective:
This study describes hospital care and Palliative care (PC) utilization trends for Patients with Parkinsonism (PwP) nearing the End of Life (EOL).
Background:
PwP face unique challenges at EOL, yet no established guidelines exist for managing their symptoms.
Design/Methods:
We retrospectively examined 727 PwP admitted to two hospitals in 2018. The EOL population (N=35), comprising patients who died in the hospital or were discharged with hospice care, was compared with the main cohort of PwP discharged without hospice. We studied the demographics, medical data, PC service involvement, length of stay, treatment approaches, and medication administration.
Results:
In the EOL group, 8 patients died in the hospital, and 27 were discharged with hospice. Approximately 46% of EOL patients received PC consultation during admission. Median time from admission to death was 37 days. Seventy-seven percent of patients were full code on admission, which meant that all medical interventions and life-saving measures would be applied if needed. The EOL group was divided into hospital deaths and hospice care. Patients who died in the hospital had higher rates of invasive procedures and intensive care unit transfers (75% for both), and lower PC engagement (25% vs. 52%). Transitioning from Full code to Do Not Resuscitate (DNR) status took a median of 4.5 days in the hospice group and 5 days in the in-hospital death group. For in-hospital deaths, median time from code status change to death was 0 days. Deviations in levodopa dosing were common in both EOL and non-EOL groups, with infrequent administration of contraindicated medications (11% vs. 9%).
Conclusions:
Our findings reveal limited PC service utilization and delayed discussions about care goals for PwP. This underscores the need to educate inpatient teams on managing advanced PwP with distinct challenges.