Hospice Impacts Spouses' Survival: Live Longer

Using hospice not only benefits patients, there is some evidence that it may help surviving widows and widowers live longer.

Some time ago researchers at Harvard Medical School and the University of Pennsylvania Department of Medicine examined death rates of surviving spouses of 195,553 elderly American couples.  The premise was that the 30,838 people who used hospice had “good deaths” that were less stressful for their spouses and would result in living longer.

The results of the matched retrospective cohort study suggest that the supportive end-of-life care provided by hospice has a beneficial impact on spouses.  “Hospice may attenuate the ordinarily increased mortality associated with becoming widowed,” concluded authors Nicholas Christakis and Theodore Iwashyna.  The results were statistically significant in both men and women.

After adjusting for variables, 5.4% of bereaved women died by 18 months after the death of their husbands when hospice was not used compared with 4.9% when hospice had been used.  Of the surviving husbands, 13.7% died within 18 months when their wives had not had hospice care compared with 13.2% when their wives died with hospice.

The support of hospice care appears to not only improve quality of life for patients, but reduces the stress on survivors to the extent that they live longer.   

For more information see Social Science & Medicine, 2003, vol. 57, issue 3, pages 465-475.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Heart Failure & Hospice

Patients with congestive heart failure who elect hospice live longer than those who don’t.  These were the findings of a defining 2007 study published in the Journal of Pain and Symptom Management.  Other diagnoses also experience longer prognosis with hospice, but none longer than the 81 day extension of life in heart failure.

Many factors probably contribute to the increased longevity.  Hospice care increases monitoring in the home and gives psychological, emotional and spiritual support from friendly visitors.  This holistic attention may increase the desire to live and reduce the sense of being a burden to one’s family.

Skipping the ER

Heart failure is the diagnosis most commonly associated with hospitalization.  By some estimates, patients with heart failure are readmitted at a rate of nearly 50% within six months.  For some patients, knowing that they have 24-hour access to nursing advice and visits for management of symptoms gives them a welcome alternative to the emergency room. 

Who is Appropriate?

Medicare guidelines include:

• Patient is optimally treated with vasodilators or unable to tolerate them.
• Patients with conditions usually treated with surgery are either ineligible or decline it.
• Patient is Class IV on the New York Heart Association scale: unable to do any physical activity without discomfort and symptoms may be present at rest.
• If ejection fraction is available, 20% or less is appropriate for hospice.
• Co-morbidities play a large role in estimating prognosis.  The following co-morbidities support a prognosis of 6 months or less in conjunction with the conditions listed above:
• Symptomatic arrhythmias resistant to treatment
• History of cardiac arrest, resuscitation or unexplained syncope
• Brain embolism of cardiac origin
• Concomitant HIV disease

The extra time that hospice can give patients may be especially important to patients and families trying to find resolution and peace at the end of life.  

Questions to Ask Patients

• Do you have discomfort when physically active? or Does physical activity give you more discomfort?
• Do you get short of breath when you are lying down?
• Do you ever wake up at night feeling short of breath?
• When you are resting in a chair do you ever feel short of breath, perspire or have chest pain?
• Do you have any swelling?
• Do you need help with activities like dressing, bathing, walking or eating?

Supporting Documentation

• Cyanosis
• Rales
• Dusky nail beds
• Tachycardia or bradycardia
• Hyper- or hypotension
• Jugular venous distension
• Liver enlargement
• Cachexia
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Decreased ejection fraction
• Weight gain due to fluid retention

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.