Which late-stage Alzheimer's patients should be referred for hospice care?

摘要

Medicare guidelines are used to determine eligibility for hospice care (strength of recommendation [SOR]: C, based on expert opinion), but they correlate with 6-month mortality no better than an experienced clinician's judgment (SOR: B, based on 1 cohort study). Recent studies, however, have identified additional criteria that may better predict survival in select populations. These prognostic criteria include stepwise progression to Functional Assessment Staging Scale (FAST) stage 7c (inability to walk without assistance) (SOR: A, based on 2 small prospective cohort studies) and criteria derived from the Minimum Data Set (MDS) which include: dependency for activities of daily living, bedbound status, bowel incontinence, comorbid conditions (specifically cancer, congestive heart failure, oxygen dependence, or dyspnea), medical instability, eating <25% of meals, sleeping most of the day, male gender, and age >83 years (SOR: B, based on a large retrospective cohort study).