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Scope of treatment and clinical-decision making in the older patient with COVID-19 infection, a European perspective. Eur Geriatr Med 2023; 14:43-50. [PMID: 36477605 PMCID: PMC9735039 DOI: 10.1007/s41999-022-00721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Older patients were particularly vulnerable to severe COVID-19 disease resulting in high in-hospital mortality rates during the two first waves. The aims of this study were to better characterize the management of older people presenting with COVID-19 in European hospitals and to identify national guidelines on hospital admission and ICU admission for this population. METHODS Online survey based on a vignette of a frail older patient with Covid-19 distributed by e-mail to all members of the European Geriatric Medicine Society. The survey contained questions regarding the treatment of the vignette patient as well as general questions regarding available services. Additionally, questions on national policies and differences between the first and second wave of the pandemic were asked. RESULTS Survey of 282 respondents from 28 different countries was analyzed. Responses on treatment of the patient in the vignette were similar from respondents across the 28 countries. 247 respondents (87%) would admit the patient to the hospital, in most cases to a geriatric COVID-19 ward (78%). Cardiopulmonary resuscitation was found medically inappropriate by 85% of respondents, intubation and mechanical ventilation by 91% of respondents, admission to the ICU by 82%, and ExtraCorpular Membrane Oxygenation (ECMO) by 93%. Sixty percent of respondents indicated they would consult with a palliative care specialist, 56% would seek the help of a spiritual counsellor. National guidelines on admission criteria of geriatric patients to the hospital existed in 22 different European countries. CONCLUSION This pandemic has fostered the collaboration between geriatricians and palliative care specialists to improve the care for older patients with a severe disease and often an uncertain prognosis.
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Pérez-Ros P, Cauli O, Julián-Rochina I, Long CO, Chover-Sierra E. Level of knowledge and attitudes towards palliative care for people with advanced dementia in Spain: role of professional and academic factors. Curr Alzheimer Res 2022; 19:CAR-EPUB-128370. [PMID: 36545733 DOI: 10.2174/1567205020666221221145259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Providing quality end-of-life care to individuals with advanced dementia is crucial. To date, little attention has been paid to palliative care knowledge and attitudes toward palliative care for people with advanced dementia in Spain Objectives: To investigate the knowledge of and attitudes toward palliative care for advanced dementia among registered nurses and physicians in Spain. DESIGN AND METHODS A descriptive, cross-sectional survey design was used. This study included a convenience sample of 402 nurses (n = 290) and physicians (n = 112). Two instruments were administered: demographic characteristics and Spanish version of the Questionnaire of Palliative Care for Advanced Dementia (qPAD-SV). Descriptive statistics and multiple regression were used for data analysis. RESULTS Overall, the nurses and physicians had moderate mean scores for both knowledge of and attitudes regarding palliative care for advanced dementia. Physicians had a higher level of knowledge (p<0.05) compared to nurses. Additionally, physicians and nursing staff who had professional experience/education in geriatrics and those who had received palliative care and hospice training had greater (p<0.01) knowledge of palliative care. In addition, healthcare professionals who had received dementia care training and who had worked in nursing homes had higher levels (p<0.05) of knowledge and attitudes toward palliative care. CONCLUSION This study indicates the need to provide nurses and physicians with more education for select groups of professionals who have had limited education and experience in caring for older adults with advanced dementia.
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Affiliation(s)
- Pilar Pérez-Ros
- Nursing Department, Facultat d'Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Omar Cauli
- Nursing Department, Facultat d'Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Iván Julián-Rochina
- Nursing Department, Facultat d'Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Carol O Long
- Nursing Care and Education Research Group (GRIECE), University of Valencia, 46010 Valencia, Spain
| | - Elena Chover-Sierra
- Nursing Department, Facultat d'Infermeria i Podologia, University of Valencia, 46010 Valencia, Spain
- Palliative Care Essentials, Fredericksburg, Virginia, USA
- Nursing Care and Education Research Group (GRIECE), University of Valencia, 46010 Valencia, Spain
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Van Den Noortgate NJ, Van den Block L. End-of-life care for older people: the way forward. Age Ageing 2022; 51:6637441. [PMID: 35811087 DOI: 10.1093/ageing/afac078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Indexed: 11/14/2022] Open
Abstract
Even though many older people will live longer in good health, many will also be confronted with frailty, multi-morbidity, cognitive decline, disability and serious illnesses in the last years of their life. The end-of-life trajectories of frail older people have a major impact on the care that needs to be provided. Older people develop different physical, psychological, and/or social needs in varying intensity during the last years of life. Moreover, determining a clear terminal phase of life is difficult in this population. In this commentary, we aim to highlight the importance of an integrated palliative, geriatric and rehabilitative care approach for older people, emphasizing the importance of setting-specific and cross-setting interventions. We stress the importance of person-centred care planning with the older patient and the role of their families, communities and society as a whole. We identify and formulate some of the research gaps that can be addressed in the near future.
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Affiliation(s)
- Nele Julienne Van Den Noortgate
- Ghent University Hospital - Geriatric Medicine, Ghent, Belgium.,Vrije Universiteit Brussel (VUB) & Ghent University - End-of-Life Care Research Group, Ghent, Belgium
| | - Lieve Van den Block
- Vrije Universiteit Brussel (VUB) & Ghent University - End-of-Life Care Research Group, Ghent, Belgium
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Pereira J, Meadows L, Kljujic D, Strudsholm T, Parsons H, Riordan B, Faulkner J, Fisher K. Learner Experiences Matter in Interprofessional Palliative Care Education: A Mixed Methods Study. J Pain Symptom Manage 2022; 63:698-710. [PMID: 34998952 DOI: 10.1016/j.jpainsymman.2021.12.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/09/2021] [Accepted: 12/31/2021] [Indexed: 12/17/2022]
Abstract
CONTEXT Interprofessional collaboration is needed in palliative care and many other areas in health care. Pallium Canada's two-day interprofessional Learning Essential Approaches to Palliative care Core courses aim to equip primary care providers from different professions with core palliative care skills. OBJECTIVES Explore the learning experience of learners from different professions who participated in Learning Essential Approaches to Palliative care Core courses from April 2015 to March 2017. METHODS This mixed methods study was designed as a secondary analysis of existing data. Learners had completed a standardized course evaluation survey online immediately post-course. The survey explored the learning experience across several domains and consisted of seven closed ended (Likert Scales; 1 = "Total Disagree", 5 = "Totally Agree") and three open-ended questions. Quantitative data were analyzed using descriptive statistics and Kruskal-Wallis non-parametric test tests, and qualitative data underwent thematic analysis. RESULTS During the study period, 244 courses were delivered; 3045 of 4636 participants responded (response rate 66%); physicians (662), nurses (1973), pharmacists (74), social workers (80), and other professions (256). Overall, a large majority of learners (96%) selected "Totally Agree" or "Agree" for the statement "the course was relevant to my practice". A significant difference was noted across profession groups; X2 (4) = 138; p < 0.001. Post-hoc analysis found the differences to exist between physicians and pharmacists (X2 = -4.75; p < 0.001), and physicians and social workers (X2 = -6.63; p < 0.001). No significant differences were found between physicians and nurses (X2 = 1.31; p = 1.00), and pharmacists and social workers (X2 = -1.25; p = 1.00). Similar results were noted for five of the other statements. CONCLUSION Learners from across profession groups reported this interprofessional course highly across several learning experience parameters, including relevancy for their respective professions. Ongoing curriculum design is needed to fully accommodate the specific learning needs of some of the professions.
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Affiliation(s)
- José Pereira
- Pallium (J.P., B.R., J.F.), Ontario, Canada; Division of Palliative Care, Department of Family Medicine (J.P.), McMaster University, Hamilton, Canada; Institute for Culture and Society (ICS) (J.P.), University of Navara, Pamplona, Spain.
| | - Lynn Meadows
- Department of Community Health Sciences (L.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dragan Kljujic
- Database Manager and Analyst (D.K.), Independent Consultant, Brampton, Canada
| | - Tina Strudsholm
- School of Health Sciences (T.S.), University of Northern British Columbia, Prince George, Canada
| | - Henrique Parsons
- Division of Palliative Care (H.P.), Department of Medicine, University of Ottawa; The Ottawa Hospital Research Institute Clinical Epidemiology Program; Bruyere Research Institute, Ontario, Canada
| | | | | | - Kathryn Fisher
- School of Nursing, Faculty of Health Sciences (K.F.), McMaster University, Hamilton, Canada
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Brennan F, Gardiner MD, Narasimhan M. The neuropalliative multidisciplinary team-Members and their roles. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:33-59. [PMID: 36055719 DOI: 10.1016/b978-0-323-85029-2.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurodegenerative conditions are prominent contributors to both morbidity and mortality worldwide. They pose a significant challenge to health professionals, health systems, and the often unpaid, untrained family members and carers. The many and varied challenges encountered are best managed by a multidisciplinary neuropalliative team, as it is impossible for a single clinician to possess and deliver the wide range of skills and services required to optimally care for these patients. This chapter discusses the assembly, maintenance, and care of such a team, as well as potential difficulties and solutions in domains such as funding, training, geographical remoteness, as well as the potential lack of awareness and acceptance by colleagues. A comprehensive description of the role of all possible team members is discussed. The chapter outlines the concept, content, and potential benefits of a multidisciplinary team in neuropalliative care. Its thesis is twofold: that multidisciplinary care is vital and, second, that the sum of the whole of a team can be greater than the individual parts with respect to organization, planning, experience, and creativity of approach. With all these factors considered, and implemented wherever possible, we may all move closer to optimizing the comfort and care of our shared neuropalliative patients.
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Affiliation(s)
- Frank Brennan
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia.
| | - Matthew D Gardiner
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - Manisha Narasimhan
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia; Department of Neurology, Sutherland Hospital, Sydney, NSW, Australia
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Breslin L, Connolly E, Purcell R, Lavan A, Kenny RA, Briggs R. What factors are associated with advance care planning in community-dwelling older people? Data from TILDA. Eur Geriatr Med 2021; 13:285-289. [PMID: 34826110 DOI: 10.1007/s41999-021-00593-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess advance care planning (ACP) in a large population-representative sample of older people. METHODS At Wave 4 of the Irish Longitudinal Study on Ageing, participants were asked: Have you made your wishes/preferences known about the kind of care that you would like to receive in the event of serious illness? RESULTS One quarter (1153/4831) had discussed ACP. Of those, 90% had discussed with family/friends, 10% documented ACP in writing, while 2% had discussed with a healthcare professional. Age ≥ 80 years [OR 1.63 (1.31-2.02)], female sex [OR 1.58 (1.37-1.83)], higher educational attainment [OR 1.42 (1.18-1.71)], poorer self-rated health [OR 1.67 (1.06-2.62)] and lower levels of religiosity [OR 1.50 (1.02-2.19)] were independently associated with ACP. CONCLUSION Only one in four older people had discussed ACP informally, while less than 3% have ACP documented in writing. Further work is required to educate the public and healthcare professionals regarding treatment choices at end-of-life.
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Affiliation(s)
- Laura Breslin
- Mercer's Institute for Successful Ageing, St James's Hospital, James's St, Dublin 8, Ireland
| | - Eimear Connolly
- Mercer's Institute for Successful Ageing, St James's Hospital, James's St, Dublin 8, Ireland
| | - Roisin Purcell
- Mercer's Institute for Successful Ageing, St James's Hospital, James's St, Dublin 8, Ireland.,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 1, Ireland
| | - Amanda Lavan
- Mercer's Institute for Successful Ageing, St James's Hospital, James's St, Dublin 8, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 1, Ireland.,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 1, Ireland
| | - Rose Anne Kenny
- Mercer's Institute for Successful Ageing, St James's Hospital, James's St, Dublin 8, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 1, Ireland.,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 1, Ireland
| | - Robert Briggs
- Mercer's Institute for Successful Ageing, St James's Hospital, James's St, Dublin 8, Ireland. .,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 1, Ireland. .,Discipline of Medical Gerontology, Trinity College Dublin, Dublin 1, Ireland.
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