Elderly Have a Worse Prognosis at Long-Term Acute Care Hospitals Than Advanced Cancer Patients

Fewer than 1-in-5 older adults who are transferred to a long-term acute care hospital are alive five years later, giving these individuals a worse prognosis than advanced cancer, according to researchers at UT Southwestern Medical Center and UC San Francisco.

The study looked at 14,072 patients admitted to the long term care hospitals, and found the average patient spent nearly two thirds of their life in a hospital or inpatient setting and that one third died and never made it home. Only 16 percent of patients ever made it to hospice for an average of 10 days, lower than other medicare patients not in long-term acute care hospitals.

LTACH facilities provide care to 120,000 Medicare beneficiaries each year, and focus on treating patients who need extended inpatient care for around a month after the initial hospitalization.

“Understanding the clinical course after LTACH admission can inform goals of care discussions, planning for care at the end of life and prioritizing health care needs,” said lead author Dr. Anil Makam, assistant professor of medicine at UCSF via release. “It also may lead some patients to shift from intensive life-sustaining and rehabilitative treatment to hospice care, with a focus on managing their symptoms and improving the quality of their remaining life.”

Of the 14,072 patients, 40 percent were admitted for a respiratory diagnosis, but the average survival was 8.3 months, with a one year survival rate of 45 percent and a five-year survival rate of 18 percent. Over half of patients never made it to the 60-day recovery mark.

The five-year survival rate for breast cancer is 75 percent and is 60 percent for prostate cancer. Lung cancer has a 13 percent five-year survival rate, while colorectal and bladder cancers have 51 and 74 percent respective five year survival rates. Researchers recommend that clinicians should waive non-vaccination preventative care treatments for asymptomatic conditions or modifying risk factors to improve the survival rates.

“As we didn’t interview or survey individuals, we don’t know if they desired life-sustaining or intensive care, were informed of their prognosis, received palliative care from their primary physician in the LTACH, or the extent of their symptom burden or quality of life,” Makam said. “But, in many ways, LTACHs are a more ideal setting for palliative care interventions than acute care hospitals given their much longer length of stay, higher concentration of very ill patients and less focus on diagnostic evaluation.”

The research was published in Journal of the American Geriatrics Society in August.