Live Hospice Discharge of Individuals with Cognitive Disabilities: A Systematic Review.
Victoria M Winogora, Christine E DeForge, Kimberlee Grier and 1 others
PMID 40158532WHAT IT FOUND
In studies of hospice patients with cognitive disabilities, live discharge rates ranged from 21% to 45%, and all studies reported that longer stays were associated with live discharge.
This identifies risk, not a tested way to prevent it.
Key findings
01Live discharge was the second most common outcome after death for hospice patients with cognitive disabilities, and the included studies reported live discharge rates of 21% to 45%.
02All included studies found longer hospice stays for patients with indicators of cognitive disabilities, and prolonged length of stay was associated with 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 review included only cross-sectional reanalyses of existing hospice records, so it can show associations but cannot show why live discharge happened or whether changing care would prevent it. No interventional studies were found, so the review does not provide evidence about what hospice teams should do to reduce live discharge. The evidence was mostly about dementia, not stroke, brain injury, intellectual or developmental disabilities, so it may not apply to all people with cognitive disabilities. Only US adult hospice patients were included, and in-hospital hospice was excluded, so findings may not apply to other countries, children, or hospital-based hospice. The review searched only from 2014 onward and in English, and it may have missed relevant studies. The review used a team-developed definition of cognitive disability, so it may have excluded studies of relevant populations. No study followed patients for a long time after live discharge, so what happened to patients and families after discharge is unclear.
Declared interests
The authors reported no affiliations or financial involvement that conflicted with the material presented.
The easy way to misread this
Do not read the 21% to 45% live discharge rate as proof that cognitive disability causes live discharge or that a specific hospice practice should be changed. The review included only observational reanalyses of existing records and found no interventional studies, so it identifies a risk pattern but does not test how to prevent it.