Examining Relationship Between Post-Traumatic Stress Disorder (PTSD) and Inpatient End-of-Life Care in Veterans Affairs (VA) (FR440A)

Abstract

•Describe potential differences between patients with and without PTSD at the end of life.•Consider how these findings may relate to caring for patients with PTSD at end of life. The effects of PTSD on the end of life are not well studied. PTSD is a symptomatic illness, affecting pain sensation, anxiety, and sleep. High symptom burden, reliance on avoidant coping strategies, and high comorbid substance use in PTSD, all suggest that these patients may have a more complicated end-of-life trajectory. To conduct an exploratory descriptive analysis of end-of-life care for veterans with and without PTSD dying in VA hospitals. This was a secondary analysis of a multiple-baseline, stepped-wedge design implementation trial to improve end-of-life care processes for VA inpatients. Variables were collected via direct chart review, using a chart abstraction form. Inter-rater reliability was good to excellent. Analysis included descriptive statistics and chi-square analyses with Bonferroni correction. PTSD was present in 8.76% of the sample (468/5341). The PTSD population was 98.7% male and 36.5% Black (171/468), with a younger mean age at death than those without PTSD (PTSD 65.4, no PTSD 70.5, p<0.0001). Patients with PTSD had higher mean VA hospital admissions and emergency room (ER) visits in the last 12 months of life (admissions: PTSD 2.8, No PTSD 2.4, p<0.0001; ER visits: 3.2, 2.5, p<0.0001). During the final hospitalization, patients with PTSD had higher rates of intensive care unit (ICU) use (49.6%, 42.7%, p=0.0041) and higher rates of advanced directives (48.1%, 37.9%, p<0.0001), trending toward lower rates of do-not-resuscitate status (66.5%, 71.0%, p=0.037). In the last 7 days of life, patients with PTSD had higher rates of receiving benzodiazepines (47.4%, 39.7%, p=0.0012) and antipsychotics (26.3%, 15.7%, p<0.001), trending toward higher receipt of opiates (73.3%, 68.3%, p=0.026). Veterans with PTSD dying in VA hospitals appear to experience differences in end-of-life care, compared to those without PTSD.