Nursing Home and End-of-Life Care in Parkinson Disease. (S36.003)

OBJECTIVE: To examine the epidemiology of nursing home and end-of-life care in the PD population, and to describe the demographic and clinical characteristics of patients with PD in Long Term Care Facilities (LTCFs). BACKGROUND: Parkinson Disease (PD) is a progressive neurodegenerative condition that causes physical decline. The number of institutionalized patients with PD will rise sharply because of increasing PD prevalence and improved treatments that have prolonged survival in advanced disease stages. DESIGN/METHODS: In this nationwide retrospective cohort study of 36 million Medicare beneficiaries, we examined LTCF and hospice utilization at the end of life among beneficiaries diagnosed with PD. These outcomes were compared by demographic, clinical and outpatient PD physician characteristics. We also examined the impact of outpatient neurologist care for institutionalized PD patients on end-of-life care. RESULTS: We identified 469,055 Medicare beneficiaries diagnosed with PD in 2002. Nearly 25[percnt] (over 100,000 in total) resided in a LTCF. Women with PD had greater odds of nursing facility placement (AOR 1.34, 1.30-1.38). However, Blacks with PD were 34[percnt] more likely than Whites to reside in a LTCF (AOR 1.34, 1.30-1.38), contrary to typical race patterns for LTCF use. Hip fracture (AOR 2.10, 2.04-2.15) and dementia (AOR 4.06, 4.00-4.12) were the strongest clinical predictors of LTCF placement. Only thirty-three percent (n=38,334) of PD nursing home residents had outpatient neurologist care. Eighty-four percent (n=80,877) of LTCF residents died prior to December 31, 2005. Hospice utilization varied little by race and gender. LTCF residents who had outpatient neurologist care were twice as likely to utilize hospice services before death (AOR 2.35, 2.24-2.47). CONCLUSIONS: A large proportion of the general PD population resides in a LTCF. There is substantial need for palliative care in the PD population. Increased efforts to provide specialist care to dependent individuals with PD may improve end of life care. Disclosure: Dr. Safarpour has nothing to disclose. Dr. Thibault has nothing to disclose. Dr. Boyd has nothing to disclose. Dr. DeSanto has nothing to disclose. Dr. Dorsey has received personal compensation for activities with Amgen, Avid Radiopharmaceuticals, Clintrex, Lundbeck Research USA, Inc., Medtronic, and Transparency Life Sciences. Dr. Dorsey has received compensation for editorial services for HD Insigh Dr. Racette has received research support from Phytopharm, PLC, NeuroSearch, Novartis, Schering-Plough Research Institute, Biotie Therapies Inc., Siena Biotech SpA, Abbott Products, Inc., Allergan, Inc, and the National Institutes of Health. Dr. Willis has nothing to disclose.