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Disability and Decline in Physical Function Associated with Hospital Use at End of Life

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Journal of General Internal Medicine Aims and scope Submit manuscript



Hospital use near the end of life is often undesirable to patients, represents considerable Medicare cost, and varies widely across regions.


To concurrently examine regional and patient factors, including disability and functional decline, associated with end-of-life hospital use.


We sampled decedents aged 65 and older (n = 2,493) from the Health and Retirement Study (2000–2006), and linked data from individual Medicare claims and the Dartmouth Atlas of Health Care. Two-part regression models estimated the relationship between total hospital days in the last 6 months and patient characteristics including physical function, while adjusting for regional resources and hospital care intensity (HCI).

Key Results

Median hospital days was 7 (range = 0–183). 53% of respondents had functional decline. Compared with decedents without functional decline, those with severe disability or decline had more regression-adjusted hospital days (range 3.47–9.05, depending on category). Dementia was associated with fewer days (−3.02); while chronic kidney disease (2.37), diabetes (2.40), stroke or transient ischemic attack (2.11), and congestive heart failure (1.74) were associated with more days. African Americans and Hispanics had more days (5.91 and 4.61, respectively). Those with family nearby had 1.62 fewer days and hospice enrollees had 1.88 fewer days. Additional hospital days were associated with urban residence (1.74) and residence in a region with more specialists (1.97) and higher HCI (2.27).


Functional decline is significantly associated with end-of-life hospital use among older adults. To improve care and reduce costs, health care programs and policies should address specific needs of patients with functional decline and disability.

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Dr. Kelley had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Financial Disclosures

Dr. Kelley is a Brookdale Leadership in Aging Fellow. Dr. Morrison is the recipient of a Mid-Career Investigator Award in Patient-Oriented Research (K24 AG022345) from the National Institute on Aging and supported by the National Palliative Care Research Center. Dr. Sarkisian is supported by the VA Greater Los Angeles Healthcare System Geriatric Research Education Clinical Center. No sponsors or funders had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

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Correspondence to Amy S. Kelley MD, MSHS.

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Kelley, A.S., Ettner, S.L., Morrison, R.S. et al. Disability and Decline in Physical Function Associated with Hospital Use at End of Life. J GEN INTERN MED 27, 794–800 (2012).

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