Last Updated: 2003-04-11 17:00:22 -0400 (Reuters Health)

NEW YORK (Reuters Health) -The current model of hospice care, which assumes that patients will live for no more than six months, is not adequate to cover frail elderly patients who often survive for years, a new study shows.

It's almost impossible to predict when a frail, dependent, elderly person is within six months of dying, researchers reported in the Journal of the American Geriatrics Society.

"These patients don't die of catastrophic conditions," the study's lead author, Dr. Kenneth E. Covinsky, said in an interview with Reuters Health. "What happens is that a series of conditions just keep piling up, often including dementia. It's a progressive decline."

Currently, hospice care is set up to help patients with catastrophic illnesses, such as cancer, said Covinsky, a staff physician at the San Francisco V.A. Medical Center and an associate professor at the University of California at San Francisco.

Hospice benefits through Medicare, for example, cover only six months of end-of-life care, according to Covinsky.

"It's important to understand what people's needs are at the end of life," Covinsky said. "Hospice care focuses on maximizing comfort at the end of life. Pain control is a very big feature of hospice care. And so is care giver support."

There is evidence showing that outside of hospices elderly people often don't get adequate pain relief, Covinsky said.

For the new study, Covinsky and his colleagues reviewed the medical records of 917 frail elderly patients who were enrolled in one of twelve nationwide demonstration sites of the Program of All-inclusive Care for the Elderly (PACE).

The program cares for frail older people who meet the criteria for nursing home placement, with the goal of keeping the patient at home. All patients in the study lived for at least two years after enrolling in PACE, Covinsky said.

Of the 917 patients, 583 had experienced mental declines two years before death, while 334 did not. The average age of the patients at death was 84.

The researchers looked at changes in each patient's level of dependence on others to bathe, eat and walk as possible markers of the patient's imminent decline towards death. They also checked to see if and when the patients became incontinent.

Ultimately, there were no clear signals as to when patients were within six months of dying, Covinsky said.