Place of Death, Care Intensity, Symptom Prevalence, and Symptom Management for Patients With Stroke at End-of-Life

Each year in the United States, 795,000 people are diagnosed with a new or recurrent stroke, resulting in 165,393 deaths. However, little is known about the quality of end-of-life (EOL) care in this population, including the place of death, care intensity received, symptom experience, and management. This study sought to explore whether place of death and care intensity received in the last month of life were correlated with EOL symptom prevalence and management in patients with stroke. METHODS: Data for this secondary analysis were drawn from the National Health and Aging Trends Study, a representative sample of Medicare beneficiaries. Logistic regression was used to identify whether place of death and care intensity received in the last month of life were associated with symptom prevalence and symptom management in patients diagnosed with stroke, adjusted for demographic covariates. RESULTS: Of 257 patients diagnosed with stroke, 161 (62.6%) reported pain, 130 (50.6%) reported dyspnea, and 148 (57.6%) reported emotional distress in the last month of life. Patients who died in the acute-care setting were half as likely to report pain (OR: 0.51, 95% CI: 0.27-0.95), but twice as likely to report dyspnea (OR: 2.07, 95% CI: 1.02-4.21) and adequate dyspnea management (OR: 1.97, 95% CI: 1.06-3.67). Place of death was not significantly associated with emotional distress (OR: 1.62, 95% CI: 0.88-2.97), pain management (OR: 0.67, 95% CI: 0.39-1.15), or emotional distress management (OR: 0.97, 95% CI: 0.55-1.68). Age (OR: 0.56, 95% CI: 0.36-0.88) and race/ethnicity (OR: 4.8, 95% CI: 1.15-19.99) were significantly associated with care intensity, but symptom prevalence and management were not associated.

Results suggest that patients with stroke have distressing symptoms at EOL, but future research is needed in the evaluation and management of symptoms at EOL in patients with stroke.