BACKGROUND This study examined factors associated with potentially burdensome end-of-life (EOL) transitions between care settings among older adults with advanced cancer in nursing homes (NHs). METHODS A retrospective analysis of deceased older NH residents with poor-prognosis solid tumors was conducted with Medicare claims and the Minimum Data Set. A potentially burdensome transition was defined as 2 or more hospitalizations or an intensive care unit admission in the last 90 days of life. RESULTS Among 34,670 subjects, many had moderate to severe cognitive impairment (53.8%), full dependence in activities of daily living (ADLs; 66.5%), and comorbidities such as congestive heart failure (CHF; 29.3%) and chronic obstructive pulmonary disease (34.1%). Only 56.3% of the patients used hospice at any time in the 90 days before death; 36.0% of the patients experienced a potentially burdensome EOL transition, and this was higher among patients who did not receive hospice (45.4% vs 28.7%; P < .01). In multivariable analyses, full dependence in ADLs (odds ratio [OR], 1.70; P < .01), CHF (OR, 1.48; P < .01), and chronic obstructive pulmonary disease (OR, 1.28; P < .01) were associated with a higher risk of burdensome EOL transitions. Those with do-not-resuscitate directives (OR, 0.60; P < .01) and impaired cognition (OR, 0.89; P < .01) had lower odds of burdensome EOL transitions. CONCLUSIONS NH residents with advanced cancer have substantial comorbidities and functional impairment, yet more than a third experience potentially burdensome EOL transitions. These findings help to identify a population at risk for poor EOL outcomes in order to target interventions, and they point to the importance of advanced care planning in this population.

中文翻译：

---

预后不良的疗养院居民的生命周期过渡可能繁重。

背景技术这项研究检查了与养老院中患有晚期癌症的老年人（NHs）之间在医疗机构之间潜在的繁重的寿命终止（EOL）过渡相关的因素。方法使用Medicare索赔和最低数据集对死亡的，预后较差的实体病患者进行回顾性分析。潜在的繁重过渡被定义为在生命的最后90天内住院2次或以上，或接受重症监护病房。结果在34,670名受试者中，许多受试者具有中度至重度认知障碍（53.8％），完全依赖于日常生活活动（ADL； 66.5％），以及合并症，例如充血性心力衰竭（CHF; 29.3％）和慢性阻塞性肺疾病（ 34.1％）。死亡前90天内，只有56.3％的患者在任何时候都使用过临终关怀服务；36。0％的患者经历了潜在的繁重的EOL过渡，而在未接受临终关怀的患者中这一比例更高（45.4％对28.7％； P <.01）。在多变量分析中，对ADL的完全依赖（优势比[OR]，1.70； P <.01），CHF（OR，1.48； P <.01）和慢性阻塞性肺疾病（OR，1.28； P <.01）与繁重的EOL转换风险较高相关。那些具有“不复活”指令（OR，0.60； P <.01）和认知受损（OR，0.89； P <.01）的人，发生繁重的EOL转换的几率较低。结论患有晚期癌症的NH居民有大量合并症和功能障碍，但超过三分之一的人可能会给EOL过渡带来负担。这些发现有助于确定处于不良EOL结果风险中的人群，以便针对干预措施，