A National Study of End-of-Life Care among Older Veterans with Hearing and Vision Loss

Objectives: Hearing and visual sensory loss is prevalent among older adults and may impact the quality of healthcare they receive. Few studies have examined sensory loss and end-of-life (EOL) care quality. Our aim was to describe hearing and vision loss and their associations with the quality of EOL care and family perception of care in the last 30 days of life among a national sample of veteran decedents.

Design: Retrospective medical record review and Bereaved Family Survey (BFS).

Setting: Veterans Affairs (VA) Medical Centers (N = 145).

Participants: Medical record review of all veterans who died in an inpatient VA Medical Center between October 2012 and September 2017 (N = 96 424). Survey results included 42 428 individuals.

Measurements: Three indicators of high-quality EOL care were measured: palliative consultation in the last 90 days of life, death in a non-acute setting, and contact with a chaplain. The BFS reflects a global evaluation of quality of EOL care; pain and posttraumatic stress disorder management; and three subscales characterizing perceptions regarding communication, emotional and spiritual support, and information about death benefits in the last month of life.

Results: In adjusted models, EOL care quality indicators and BFS outcomes for veterans with hearing loss were similar to those for veterans without hearing loss; however, we noted slightly lower scores for pain management and less satisfaction with communication. Veterans with vision loss were less likely to have received a palliative care consult or contact with a chaplain than those without vision loss. Although BFS respondents for veterans with vision loss were less likely than respondents for veterans without vision loss to report excellent overall care and satisfaction with emotional support, other outcomes did not differ.

Conclusion: In general, the VA is meeting the EOL care needs of veterans with hearing and vision loss through palliative care practices. J Am Geriatr Soc 68:817-825, 2020.