Live Discharge of Hospice Patients with Alzheimer's Disease and Related Dementias: A Systematic Review.
Stephanie P Wladkowski, Cara L Wallace, Kathryn Coccia and 3 others
PMID 36977504WHAT IT FOUND
Hospice patients with Alzheimer's disease or related dementias are more likely to be discharged alive, often when condition stabilizes.
Families described this transition as distressing and confusing. No evaluated interventions were found.
Key findings
01A diagnosis of Alzheimer's disease or related dementias consistently increases the risk of live discharge from hospice, and receiving hospice care at home rather than in a facility is also a risk factor.
02Patients and families described live discharge as distressing, confusing, and associated with practical and relational losses.
03None of the included studies systematically evaluated interventions to support patients, families, or hospice providers through live discharge.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The included studies covered different date ranges, geographic regions, and populations, including some patients with diagnoses other than Alzheimer's disease or related dementias, so findings could not always be compared directly. Many studies did not separate live discharge caused by patient choice from discharge because the patient no longer met prognosis rules, which are different experiences. Findings about race and ethnicity were inconsistent and may differ by discharge type. The review included no intervention studies, so it cannot say what helps patients and families through live discharge. Search was limited to English studies published from January 1, 2012 to December 7, 2021, and studies had to explicitly include Alzheimer's disease or related dementias patients or caregivers, so relevant work may have been missed. Most experience findings were about discharge due to stabilization or improvement, not patients who chose to revoke hospice.
The easy way to misread this
Do not read live discharge as proof of recovery or as a celebratory graduation. The review found patients with Alzheimer's disease or related dementias are more likely to be discharged alive because prognosis is hard to predict. Families described it as distressing and confusing, and no interventions were tested.