# Live Hospice Discharge of Individuals with Cognitive Disabilities: A Systematic Review

## TL;DR

This review finds that people with cognitive disabilities are more likely to be discharged from hospice while still alive, suggesting potential disparities in hospice care quality.

## Contribution

This is the first systematic review focusing on live hospice discharge for individuals with cognitive disabilities.

## Key findings

- Cognitive disability was associated with live hospice discharge in all included studies.
- Individuals with cognitive disabilities had longer hospice lengths of stay.
- Risk factors included female sex, minoritized race, for-profit hospice ownership, and home-based hospice services.

## Abstract

To systematically review the evidence on live hospice discharge for individuals with cognitive disabilities.

Systematic Review

Adults with cognitive disabilities enrolled in hospice in the United States

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched for United States-based (US), English-language, and peer-reviewed literature focused on live discharges from hospice for individuals with cognitive disabilities. We searched PubMed, CINHAL, and Web of Science for articles published between January 1, 2014, through August 1, 2024. We used the Joanna Briggs Institute Analytical Cross-Sectional Studies Appraisal Tool to assess study quality.

After screening 1,543 titles and abstracts, we completed a full text review of 30 articles, of which 8 met inclusion criteria. All included studies were cross-sectional analyses. The indications of cognitive disability varied (i.e., dementia diagnosis, positive result on cognitive function assessment), but there were no studies focused on individuals with acquired brain injuries or intellectual and developmental disabilities, nor was the term cognitive disability used in any of the studies. In all studies, the indicator of cognitive disability was associated with live hospice discharge. Other risk factors included female sex (n =4), minoritized race (n=4), forprofit hospice ownership (n = 4) and delivery of hospice services at home (n=2). In all studies, researchers found that individuals with cognitive disabilities had longer hospice lengths of stay.

This systematic review is the first to focus on live discharge from hospice for individuals with cognitive disabilities. All studies focused exclusively on individuals with dementias. While the term cognitive disability was absent from the literature reviewed, cognitive disability was associated with live discharge. Future research should aim to include the greater cognitive disability community to assess hospice and other end-of-life outcomes to identify potential targets for future intervention.

This review examines live hospice discharge of people cognitive disabilities. In all included studies cognitive disability was associated with live hospice discharge, indicating disparities in hospice quality for this population.