BACKGROUND/RATIONALE:
End-of-life care is a VA priority, and referral to hospice is associated with improved quality of dying. Little is known about dying with Parkinson's disease (PD), and timely referral to hospice remains complicated by difficulty recognizing the threshold of a six month prognosis.

OBJECTIVE(S):
1) Analyze pilot data from caregivers of decedent PD patients; 2) Ascertain which events are more likely to uniquely precede 6-12 months prior to death from PD when compared to the 18-24 month period; 3) Complete an HSR&D evidence synthesis project (ESP); and 4) Develop a proposal for a prospective study examining hypotheses from pilot data about patient needs in end-stage PD.

METHODS:
A manuscript is being submitted based on data from Objective 2, a retrospective study of decedent Veteran PD patients. The measures reflect either frequency (bivariate and categorical variables) or amount (continuous variables) for three 6-month time periods: 6-12 months, 18-24 months, and 30-36 months before death. We identified 534 VISN 20 decedent patients diagnosed with PD and treated with VA dopaminergic prescriptions for at least 3 years, using the VISN 20 Data Warehouse (VDW). Medical record review by a physician excluded those who died from causes other than PD. We compared amount and severity of suspected markers during the 6-12 month and 18-24 month periods using generalized linear models, controlling for repeated measures. We defined variables as relevant to hospice referral when they changed significantly in the 6-12/18-24 month comparison, but not between 18-24/30-36 months.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
End-of-life information about PD was disseminated to health care providers through publications and national meetings. Physicians' confidence in referring PD patients for hospice may improve, and Veterans with PD and their families may benefit from earlier appropriate hospice care. My overall program of research on late stage neurological disorders serves the VA missions of providing the highest quality of medical care, and increasing quality of life at the end of life through appropriate palliative and hospice interventions.

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External Links for this Project

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PUBLICATIONS:

None at this time.

DRA: Aging, Older Veterans' Health and Care, Neurodegenerative Diseases
DRE: Pathology
Keywords: none
MeSH Terms: none