The number of Medicare beneficiaries enrolled in hospice has continued to grow, and older adults account for the largest proportion of patients receiving hospice services. Behavioral and psychological symptoms that do not meet criteria for a psychiatric disorder are common among patients in end of life care (e.g., feeling sad, anxious, or agitated), however the benefit of symptom-driven treatment with psychotropic medications for these patients is less clear. Additionally many medications considered essential in palliative medicine, such as benzodiazepines and conventional antipsychotics, are generally considered inappropriate for use in older adults given a variety of associated adverse effects, which can worsen quality of life at the end of life. Currently, little is known about how psychotropic medications are being used within end of life care and there are few treatment guidelines to guide appropriate and safe use. Despite the number of Medicare beneficiaries enrolled in hospice and the extent of psychotropic use suggested by previous studies, we know little about the factors associated with such widespread psychotropic use and whether particular patients are more likely to receive such treatment. This mixed-methods study will draw on Medicare hospice claims and Part D data to provide comprehensive national estimates of psychotropic medication use among Medicare beneficiaries receiving hospice care. We will build on this large-scale data approach using focus groups with family members and providers of hospice patients that will provide unique insights into the rationale of psychotropic medication use in end of life care, as well as how caregivers and hospice providers weigh the risks and benefits of commonly-used psychotropic medications. As the first national estimate of psychotropic use among older Medicare hospice beneficiaries, this study will provide insights to inform potential treatment guidelines for psychotropic medication use to minimize exposure to adverse effects while promoting quality of life at end of life. The GEMSSTAR program support, project, mentoring team, and educational plan will be invaluable as the candidate progresses towards a career as an independent investigator focused on integration and improving quality of psychiatric care within end of life care.
Although psychotropic medications are routinely used for end of life care, there are few treatment guidelines to direct appropriate and safe use. Within hospice care, there is a need to properly identify patients who would benefit from use of psychotropic medications to improve quality of life while avoiding medications that can contribute to a high side effect burden for patients and potentially reduce their quality of life at end of life. Given that the number of older adults enrolled in hospice has increased significantly, informing guidelines for psychotropic medication use in order to minimize exposure to adverse effects while promoting quality end of life care is of national public health relevance.
