Predicting Alzheimer's dementia mortality using Medicare Outcome Assessment and Information Set (OASIS)

Abstract

Background: Dementia describes changes in memory and thinking significant enough to interfere with daily life. Alzheimer's dementia is the most common. End-stage Alzheimer's dementia patients commonly have a long trajectory towards death, and families struggle to provide services in the home. Hospice care could be an alternative, although a physician is required to certify that a patient has less than 6 months to live in order to get Medicare coverage. Alzheimer's dementia patients often rely on home health care at some point during their illness, yet recognizing terminal status and obtaining hospice services remain challenging. Methods: To identify factors that might be associated with mortality from Alzheimer's dementia, an exploratory retrospective study design was employed using data from the Medicare Outcomes Assessment and Information Set (OASIS) database and data from the Fiscal Intermediary Standard System (FISS). Characteristics of patients with Alzheimer's dementia and a randomly selected group of elderly home-care patients without dementia were compared. Time to mortality was also examined using Kaplan-Meier Hazard curves and comparing differences by relevant characteristics, including gender, ethnicity, severity, co-morbid conditions, cognitive functioning, and functional status. Findings: Compared to non-dementia patients, Alzheimer's dementia patients more often were older, were not hospitalized 14 days prior to home health care admission, had severity level of admitting diagnosis categorized as "symptoms controlled with difficulty," were cognitively and functionally impaired, were cared for by paid caregivers, and utilized more home health care and hospice care. Characteristics associated with mortality for Alzheimer's dementia patients were severity level of admitting diagnosis and functional status for non-dementia patients. Implications: Alzheimer's dementia patients receive more home health care, which creates an opportunity for home health care nurses to assess for hospice appropriateness. Few predictive factors were found in the OASIS data that could be used to help nurses target appropriate patients. Future prospective studies should focus on depicting the trajectory of decline and determine factors that may indicate an end-of-life condition with the ultimate goal of providing hospice care.