Nurse practitioners (NPs) increasingly are providing more primary care to nursing home residents with Alzheimer’s disease and related dementias (ADRD), and a recent study examined the potential impact of their care on end-of-life outcomes. The study found that residents who received more NP care had lower rates of hospitalizations in the last 30 days of life and higher rates of hospice use compared to those with minimal NP involvement.
The researchers explained that their study and its findings were designed to provide evidence that can inform workforce planning and policy efforts that deliver high-quality end-of-life care to people with ADRD.
While the cohort study, including 334,618 United States nursing home residents with ADRD, indicated that greater NP involvement at the end of life meant fewer hospitalizations and higher hospice use; the strength of this association varied depending on state regulations governing NP scope of practice. In states with full practice authority, where NPs can practice and prescribe without physician supervision, the differences in outcomes between residents receiving minimal NP care and those receiving moderate or extensive NP care were more pronounced. For example, residents with extensive NP care in these states had a 5.2% lower rate of hospitalization and a 5.4% higher rate of hospice use compared to those with minimal NP care.
In contrast, the differences were smaller in states with restricted practice authority regulations. The researchers suggested that these regulations may influence care patterns and patient outcomes in various ways. For instance, full authority to sign do-not-resuscitate orders may allow NPs to initiate timely goals-of-care discussions, preventing unnecessary escalation of care. Additionally, the ability to prescribe controlled substances could improve access to palliative medications for pain and symptom relief.
The findings help define an NP’s role in providing end-of-life care for nursing home residents with ADRD and suggest that state regulations governing NP scope of practice may have implications for hospitalizations, hospice use, and potentially other outcomes for this vulnerable population.
