A retrospective cross-sectional study was undertaken in Canada using the health system administrative data over the last year of life. This included 1439 individuals – primarily with Parkinson’s disease (1226), progressive supranuclear palsy (78), multiple system atrophy (47) and Huntington’s disease (58).
The results showed
• 45% died in hospital, 36% in long term care, 8% at home and 4% in a hospice
• 64% had one or more emergency department visit, 14% more than 3 visits
• 55% had been hospitalised and 23% spent more than 30 days in hospital
• 2.6% were admitted to intensive care
• 37% were seen in neurology outpatients
• 8.8% had accessed specialist palliative care services (1)
Multivariate logistic regression found that those who received outpatient palliative care consultation or a longer dutration of home care support were more likley to die at home.
Specialist palliative care may enable people to die at home. There would seem to be high usage of hospital services, and patients had limited neurology or specialist palliative care support.
This has been reflected in other studies in people with a non-cancer illness, where palliative care reduced emergency department visits, hospital admissions and Intensive care admisisons and increased the odds of dying at home (2). Studies have also shown improvement in quality of life related to palliative care out-patient consultations (3).
There is a need for further research to look at the effects of palliative care on the care in the last year of life, as the facilitation of home death may improve outcomes for patients and families and may lead to reduced costs.
1. McKenzie ED, Bruno VA, Fong A et al Health utilization in the last year of life in Parkinson Disease and other neurodegenerative movement disorders. Neurology Clinical practice 2022. Doi: 10.1212/CPJ.0000000000200092
2. Quinn KL, Stukel T, Stall NM et al. Association between palliative care and healthcare outcomes among adults with terminal non-cancer illness: population based matched cohort study. BMJ 2020; 370:m2257. doi:10.1136/bmj.m2257
3. Kluger BM, Miyasaki J, Katz M et al. Comparison of integrated outpatient palliative care with standard care in patients with Parkinson disease and related disorders. A randomized clinical trial. JAMA Neurol. 2021; 77: 551-560.
Publish on behalf of the Scientific Panel Palliative Care.