Adding Functional Ability Measures to a Mortality Algorithm to Support Palliative Care Eligibility Decisions.
Elizabeth A Luth, Carlin Brickner, Harivony Rakotoarivelo and 2 others
PMID 40488518WHAT IT FOUND
In older adults, receiving physical or occupational therapy was linked to lower odds of death, while needing help with daily activities or skilled nursing was linked to higher odds.
These functional markers could help identify patients who need palliative care sooner.
Key findings
01Receiving PT/OT services was associated with 26% lower odds of death in multivariate models.
02Needing ADL support was associated with 120% higher odds of death, and skilled nursing with 24% higher odds.
03Among individuals with high mortality risk (>50%), respiratory support and skilled nursing were associated with lower mortality risk.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The study used administrative claims data, which are proxies for functional ability and may miss patients who have functional limitations but do not receive billed services. The data came from a single Medicare Advantage plan in one city, limiting generalizability. The study design is observational, so it cannot prove that PT/OT services cause lower mortality or that skilled nursing causes higher mortality. The 12-month follow-up period may not capture the full timeline of palliative care needs.
Declared interests
The authors disclosed no potential conflicts of interest. The study was supported by the National Institutes of Health.
The easy way to misread this
Do not interpret the association between PT/OT services and lower mortality as evidence that therapy prevents death. It likely reflects that patients receiving therapy are healthier or more resilient than those who are not, or that therapy is withheld from those who are actively dying.