Imagine you’re exploring a maze, but this maze is the hospital journey of individuals with Parkinson’s disease. In this unique study, researchers found that hospitalizations near the end of life for people with Parkinson’s disease are longer, more expensive, and more resource-intensive than earlier hospitalizations. It’s like reaching the final stages of the maze and encountering bigger obstacles! These findings suggest that these end-of-life hospitalizations may be influenced by medical comorbidities, like additional health conditions adding complexity to the journey. To make matters more challenging in the maze, patients who were hospitalized in their last 6 months of life were more likely to experience intensive care unit (ICU) admission and 30-day readmission. These outcomes can serve as markers of transition to the end-of-life period, like flags signaling an even trickier part of the maze ahead. Overall, this study helps us better understand the unique characteristics of end-of-life hospitalizations for people with Parkinson’s disease, providing valuable insight for healthcare providers and families navigating this complex journey. If you want to explore more about this fascinating research, check out the full article linked below!

IntroductionPersons with Parkinson disease (PD) are hospitalized at higher rates, have longer lengths of stay, and are more likely to die in the hospital than age-matched peers. Although prior studies have compared inpatient outcomes between persons with and without PD, little is known about inpatient outcomes across the PD trajectory, or whether hospitalizations occurring in the last 6 months of life differ from earlier hospitalizations.MethodsThis cross-sectional study compared Medicare Part A and B beneficiaries aged 65 and older with a qualifying PD diagnosis who were hospitalized in 2017: decedents who died between 7/1/2017 and 12/31/2017 from all causes and were hospitalized at least once in their last 6 months of life, and non-decedents who were hospitalized between 1/1/2017 and 6/30/2017 and lived 6 or more months after discharge. End-of-life (EoL) hospitalizations were defined as those occurring in the last 6 months of life. Descriptive analyses compared patient-level variables (e.g., demographics, comorbidities, treatment intensity) and encounter-level variables (e.g., length of stay, total charges) between groups. Multivariable logistic regression models also compared rates of intensive care unit (ICU) admission and 30-day readmission between hospitalized decedents and hospitalized non-decedents, adjusting for age, sex, race/ethnicity, rural residence, and Charlson Comorbidity Index Score.ResultsOf 26,492 Medicare decedents with PD, 16,187 (61.1%) were hospitalized in their last 6 months of life. Of 347,512 non-decedents with PD, 62,851 (18.1%) were hospitalized in a 6-month period. Hospitalized decedents were slightly older than hospitalized non-decedents (82.3 [SD 7.40] vs. 79.5 [SD 7.54] years) and had significantly more comorbidities. Compared to non-EoL hospitalizations, EoL hospitalizations were slightly longer (5 [IQR 3–9] vs. 4 [IQR 3–7] days) and more expensive based on total charges per admission ($36,323 [IQR 20,091-69,048] vs. $32,309 [IQR 18,789–57,756]). In covariate-adjusted regression models using hospitalized non-decedents as the reference group, hospitalized decedents were more likely to experience an ICU admission (AOR 2.36; CI 2.28–2.45) and 30-day readmission (AOR 2.43; CI 2.34–2.54).DiscussionHospitalizations occurring in the last 6 months of life among persons with PD in the United States are longer, more costly, and more resource intensive than earlier hospitalizations and may stem from medical comorbidities. Once hospitalized, ICU admission and 30-day readmission may aid in prognostication and serve as markers of transition to the EoL period.

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