Critically ill people admitted to long-term hospitals have poor health outcomes after discharge, according to an NIA-funded study. Eighty percent of adults over 50 who were admitted to a long-term acute care hospital (LTCH) either died or had severe functional or cognitive impairment within 2.5 years. The results were published in JAMA Network Open.

LTCHs specialize in treating critically ill patients who are often transferred from an intensive care unit (ICU) or intensive care unit. Most LTCH patients stay three to four weeks while receiving multidisciplinary care, such as ventilator care, head trauma care, and pain management. While statistics show that fewer than 50% of adults over 65 years of age survive the year following an LTCH stay, less is known about the functional and cognitive outcomes of critically ill patients who survive their time in an LTCH and how these outcomes can inform palliative and long-term acute care decision-making for patients, families, clinicians, and caregivers.

To look deeper into the problem, the team led by researchers at the University of California, San Francisco analyzed data from 396 people enrolled in the long-term, nationally representative Health and pension survey (HRS) of Americans over age 50. The researchers looked at participant data from 2002 through 2020, which included cognitive tests and self-assessments every two years of the level of assistance with activities of daily living (ADL), such as walking, dressing, bathing, eating, toileting, etc. The median age of the participants was 75. mechanical ventilation during an acute care or LTCH stay. The researchers found that 80% of participants died or survived with severe impairment (functional, cognitive, or both) within 2.5 years of LTCH admission. The team noted that participants who died or survived with severe disability—defined as needing help in two or more of the ADLs—were older than those who survived with no or mild disability. The chance of dying or surviving with severe disability was closely related to a patient’s baseline physical and cognitive health status before LTCH admission. Patients most likely to survive an LTCH stay with fairly intact function and cognition were those who had a good survival prognosis and either no or mild cognitive or ADL problems before their first admission.

The researchers believe these findings underscore an urgent need for increased discussions about palliative care and goals of care among older adults facing hospitalization in an LTCH. They note that previous studies have shown that only 1% of patients had received palliative care during hospitalization prior to transfer to or in LTCH. They hope to expand on this research in future studies and provide more detail to reflect recent Medicare policy changes designed to focus LTCHs on more seriously ill patients.

This research was supported in part by NIA grants P30AG044281, R03AG078942, T32AG01934, P30AG021342, K24AG054415, and K23AG052603.

These activities relate to NIH’s AD+ADRD Research Implementation Milestone 13.Z“Care & Caregiving: Healthcare Decision Making.”

Reference: Jain S, et al. Survival, function and cognition after admission to long-term acute care hospitals. JAMA Network Open. 2024. Epub May 1 doi: 10.1001/jamanetworkopen.2024.13309.