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Vossius C, Bergh S, Selbæk G, Lichtwarck B, Myhre J. Cause and place of death in Norwegian nursing home residents. Scand J Public Health 2024; 52:159-165. [PMID: 36474362 DOI: 10.1177/14034948221140195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Nursing home (NH) residents are in their last phase of life, and two aims of the NH's medical care in Norway is to prevent unnecessary hospital admissions that would not benefit the resident and to facilitate a peaceful death in familiar surroundings when the time comes. However, little is known about the share of residents dying in NHs and the causes of death. We therefore evaluated the cause and place of death in a cohort of NH residents followed from the time of NH admission until death. METHODS NH residents were followed from admission to the NH and over the entire course of their NH stay. Demographic and clinical data were collected. Cause and place of death were retrieved from the Norwegian Cause of Death Registry. RESULTS Of 1283 residents, 6.2% died in hospital and 91.2% in a NH. Those who died in hospitals were more often male, died sooner after NH admission, had a less severe degree of dementia and had poorer general health. Dementia was the most common underlying cause of death, followed by cardiovascular disease. CONCLUSIONS Dementia is one of the main causes of death in NH residents. In addition, our findings indicate a low number of inappropriate referrals to hospital during the last stage of life. However, further research should explore whether the terminal phase of NH residents is formed in accordance with their preferences and whether appropriate palliative care is offered.
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Affiliation(s)
- Corinna Vossius
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Norway
- Centre for Age-related Medicine, Stavanger University Hospital, Norway
| | - Sverre Bergh
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Norway
| | - Geir Selbæk
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Norway
- Department of Geriatric Medicine, University of Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Bjørn Lichtwarck
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Norway
| | - Janne Myhre
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Norway
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Günther A, Schmid S, Weidlich-Wichmann U, Czaputa E, Hasseler M, Weber J. Frequency of resuscitation attempts with dying nursing home residents. A full survey in an urban district in Germany based on registry data from 2018-2021. Resusc Plus 2023; 16:100508. [PMID: 38026139 PMCID: PMC10679822 DOI: 10.1016/j.resplu.2023.100508] [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: 07/14/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Aim The realities of emergency care and resuscitation research involving nursing home (NH) residents suggest an overuse of resuscitation attempts in NHs. A complete analysis of all NH resident deaths is needed to provide a complementary perspective of potential underuse. The present research investigated whether residents of different NH homes died at the NH during attempted resuscitation or after transfer to hospital. Methods A full survey of resuscitation attempts and deaths among NH residents, via retrospective analysis of data from the death registry and the German Resuscitation Registry for the years 2018 to 2021. Results Over the 4-year study period, 14,598 individuals died, of whom 3,288 (22.5%) were residents of 31 different NHs. The mean age of the deceased NH residents was 87 years (±8.6); 2,196 (66.8%) were female, 118 (3.6%) underwent a resuscitation attempt, and 58.5% died at the NH. NH averages were as follows: deaths per NH: 106 (±51; min-max: 36-292); number of beds: 102 (±39; 34-210); deaths per bed per year 0.27 (±0.07; 0.15-0.51); resuscitation attempts per 1,000 beds per year: 9.5 (±5.5; 0-21.1); and ratio of futile resuscitation attempts to deaths: 6.0% (0-12.5%). Considering the entire study region before and during the COVID-19 pandemic, a slight underuse of resuscitation attempts with female NH residents emerged. On a facility level, substantial disparities and opposing trends were found. The incidence of deaths and resuscitation attempts, as well as the place of death and the ratio of futile resuscitation attempts to deaths, varied considerably. Conclusion Resuscitation attempts are rarely administered to dying NH residents. However, their frequency varies considerably between NHs.
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Affiliation(s)
- Andreas Günther
- Institute for General Practice and Palliative Care, Hannover Medical School, Hanover, Germany
- Fire Department, City of Braunschweig, Eisenbütteler Straße 2, 38122 Braunschweig, Germany
| | - Sybille Schmid
- Fire Department, City of Braunschweig, Eisenbütteler Straße 2, 38122 Braunschweig, Germany
| | - Uta Weidlich-Wichmann
- Faculty of Health and Health Care Sciences, Ostfalia University of Applied Sciences, Wolfsburg, Germany
| | - Eileen Czaputa
- Faculty of Health and Health Care Sciences, Ostfalia University of Applied Sciences, Wolfsburg, Germany
| | - Martina Hasseler
- Faculty of Health and Health Care Sciences, Ostfalia University of Applied Sciences, Wolfsburg, Germany
| | - Jan Weber
- Social Services Department, City of Braunschweig, Braunschweig, Germany
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Pechová K, Loučka M. Factors Influencing Decision Making in Terminal Hospitalization of Nursing Home Residents: A Qualitative Study of the Perspective of Nurses, Social Workers, and General Practitioners. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:942-959. [PMID: 37051657 DOI: 10.1080/01634372.2023.2199796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 06/19/2023]
Abstract
A significant percentage of nursing home residents die in hospitals. The objective of this study is to explore the factors that influence decision-making about hospitalizations of nursing home residents in the Czech Republic that become terminal. A total of 27 semi-structured interviews with nurses and social workers registered with nursing homes, as well as general practitioners cooperating with nursing homes, were conducted. Data were analyzed using thematic analysis. Six themes of the factors influencing decision-making about hospitalizations were made: the options of the nursing home, the accessibility of medical decision-making, inadequate care planning, the age of the resident, fear of legal action, and making the decision to hospitalize. Terminality of life seems to have no impact on the decision of nurses about hospitalization. Terminal hospitalization seems to be the result of the limited options that nurses have in different nursing homes in terms of how to organize end-of-life care.
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Affiliation(s)
- Karolína Pechová
- Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Martin Loučka
- Centre for Palliative Care, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
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[What are the effects of different places of death of old people?]. Rechtsmedizin (Berl) 2023; 33:40-51. [PMID: 35910857 PMCID: PMC9310373 DOI: 10.1007/s00194-022-00584-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 01/28/2023]
Abstract
Background Inadequate quality of medical postmortem examinations has been discussed in the forensic medical literature for many years. It is known that older deceased persons are less likely to have a non-natural cause of death certified and autopsies are performed less frequently compared to younger deceased persons. Methods Death certificates of all deaths that occurred in Munich with an age of ≥ 75 years during the death period 01/01/2013-31/12/2014 were analyzed. Standardized, anonymized data entry was performed. The collected data were analyzed descriptively. Results A total of 26,303 persons died during the study period. Of these deaths, 16,146 (60.7%) were ≥ 75 years. Most common places of death for the aged were hospital (56.1%), private address (21.8%), and nursing home (20.0%). A natural mode of death was reported in 88.5%, unexplained in 8.8%, and non-natural in 2.7%. Most common immediate causes of death were diseases of the circulatory system (23.5%), inaccurately designated or unknown causes of death (20.0%), and diseases of the respiratory system (16.3%). Autopsies were performed on 4.9%, largely judicial. The parameters studied showed large differences in the analyses depending on the place of death. Discussion This study again shows considerable quality deficiencies in the issuance of death certificates. Despite the dual approach of the Munich health authority (control, training), the quality of death certificates could not be sustainably improved in recent years. Types and causes of death showed partly considerable differences depending on the place of death and the doctor who issued the certificate. The deficits identified in the information provided under the heading "Causes of death" are also likely to have a negative impact on the cause of death statistics.
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Sterbefälle Münchner Altenheimbewohner und betagter Allgemeinbevölkerung – ein Vergleich ausgestellter Todesbescheinigungen. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00441-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hoffmann F, Allers K. Ten-year trends in end-of-life hospitalizations of nursing home residents in Germany, 2006-2015. Maturitas 2020; 134:47-53. [PMID: 32143776 DOI: 10.1016/j.maturitas.2020.02.006] [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: 09/21/2019] [Revised: 02/03/2020] [Accepted: 02/18/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We investigated trends in end-of-life hospitalizations among nursing home residents (NHR) over 10 years and looked at differences between age groups and sexes as well as the length of terminal hospital stays. STUDY DESIGN Retrospective cohort study based on health insurance claims data of the AOK Bremen/Bremerhaven. All NHR aged 65 years or more who died between 2006 and 2015 were included. MAIN OUTCOME MEASURES We assessed the proportions of decedents who were in hospital on the day of death and during the last 3, 7, 14 and 30 days of life, stratified by two-year periods. Multiple logistic regressions were conducted to study changes over time, adjusting for covariates. RESULTS A total of 10,781 decedents were included (mean age 86.1 years, 72.1 % females). Overall, 29.2 % died in hospital, with a slight decrease from 30.3 % in 2006-2007 to 28.3 % in 2014-2015 (OR 0.86; 95 % CI 0.75-0.98). Of the 3150 terminal hospitalizations, 35.5 % lasted up to 3 days and the mean length of stay decreased from 9.0 (2006-2007) to 7.5 days (2014-2015). When looking at the last 7, 14 and 30 days of life, no changes over time were found. Male sex and younger age were associated with a higher chance of end-of-life hospitalization in almost all analyses. CONCLUSIONS End-of-life hospitalizations of NHR are common in Germany. There has been a small decrease during recent years in the proportion of in-hospital deaths, but not of hospitalizations during the last 7, 14 and 30 days of life. This might be explained by shorter durations of hospital stays.
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Affiliation(s)
- Falk Hoffmann
- Carl von Ossietzky University Oldenburg, Department of Health Services Research, Oldenburg, Germany.
| | - Katharina Allers
- Carl von Ossietzky University Oldenburg, Department of Health Services Research, Oldenburg, Germany
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Viel E, Vanoli A, Truong D, Harami D, Filbet M, Chaumier F, Tricou C. Quality of palliative care in identified palliative care beds. Int J Palliat Nurs 2020; 26:64-69. [PMID: 32125915 DOI: 10.12968/ijpn.2020.26.2.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dedicated identified palliative care beds (IPCB) are unique to France. AIMS This study aimed to assess their use and advantages in a medical oncology department of a private provincial hospital. FINDINGS Of the last 100 patients who died in the medical oncology department, 57 had an IPCB. Those with an IPCB had a longer final hospital stay and significant advantages for them were access to pain evaluation by nurses and professional psychological support. Opioid use was higher, but not significantly so. There were no significant differences for the presence of close relatives, physiotherapy interventions, social workers or specific anti-cancer treatment in the last 15 days of life. CONCLUSION This study shows some advantages for IPCB (treatment of pain, psychologist), which should be further explored. The length of the final hospital stay is controversial.
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Affiliation(s)
- Erika Viel
- Medical oncologist and palliative care consultant, Oncology, Ramsay Générale de Santé, HÔpital Privé Sainte Marie and Institut de Cancérologie de Bourgogne, Chalon-sur-Saône, France
| | - André Vanoli
- Medical oncologist, Oncology, Ramsay Générale de Santé, HÔpital Privé Sainte Marie and Institut de Cancérologie de Bourgogne, Chalon-sur-Saône, France
| | | | - Djamel Harami
- Clinical research organiser, Ramsay Générale de Santé, HÔpital Privé Sainte Marie, Chalon-sur-Saône, France
| | - Marilène Filbet
- Palliative care practitioner, Centre de soins palliatifs, Centre hospitalier Lyon sud, Hospices Civils de Lyon, France
| | - François Chaumier
- Palliative care practitioner, Palliative Care Team, CHRU de Tours and INSERM U1246, Tours, France
| | - Colombe Tricou
- Palliative care practitioner, Centre de soins palliatifs, Centre hospitalier Lyon sud, Hospices Civils de Lyon, France
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Elyn A, Sourdet S, Morin L, Nourhashemi F, Saffon N, de Souto Barreto P, Rolland Y. End of life care practice and symptom management outcomes of nursing home residents with dementia: secondary analyses of IQUARE trial. Eur Geriatr Med 2019; 10:947-955. [PMID: 34652768 DOI: 10.1007/s41999-019-00234-9] [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: 06/11/2019] [Accepted: 08/29/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE End-of-life care is a central issue in nursing homes. Poor care outcomes have been reported, especially among residents with dementia. Our aim was two-fold: to assess whether the diagnosis of dementia was associated with specific patterns of care and symptom management for residents with dementia during the last 6 months of life, and to compare these patterns of care between residents with dementia who died within 6 months and those who survived longer. METHODS Secondary prospective analyses of the IQUARE trial (trial registration number NCT01703689). 175 nursing homes in South West France. Residents with and without dementia at baseline (May-June 2011), stratified according to their vital status at 6-month follow-up. RESULTS Of 6275 residents enrolled in IQUARE study (including 2688 with dementia), 494 (7.9%) died within 6 months. Compared to residents without dementia (n = 254), those with dementia (n = 240) were less likely to be self-sufficient (OR = 0.08, 95% CI 0.01-0.64). They were more likely to have physical restraints (OR = 1.65, 95% CI 1.08-2.51) and less likely to be prescribed benzodiazepines (OR = 0.58, 95% CI 0.38-0.88). Among residents with dementia, those who died during the first 6 months of follow-up were more likely to be identified with a formal "end-of-life" status (OR = 5.71, 95% CI 3.48-9.37) although such identification remains low with only 15% of them. They were more likely to experience pain (OR = 1.43, 95% CI 1.04-1.97) and to be physically restrained (OR = 1.46, 95% CI 1.08-1.98). However, pain relief and psychological distress management were not improved. CONCLUSIONS Poor quality indicators such as physical restraints are associated with end-of-life care for residents with dementia. Among symptom management outcomes, pain medication remains low even if pain complaint increased at life end.
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Affiliation(s)
- Antoine Elyn
- Palliative Care Unit "Résonance", University Hospital of Toulouse, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France.
| | - Sandrine Sourdet
- Frailty Hospital, Gerontology and Internal Medicine, University Hospital of Toulouse, Cité de la santé, 20, Rue du Pont Saint-Pierre, TSA 60033, 31059, Toulouse Cedex 9, France.,INSERM, URM1027 "Aging and Alzheimer Disease: From Observation to Intervention", Faculté de Médecine, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Lucas Morin
- Aging Research Centre, Karolinska Institutet and Stockholm University, Gävlegatan 16-113, 30, Stockholm, Sweden
| | - Fati Nourhashemi
- INSERM, URM1027 "Aging and Alzheimer Disease: From Observation to Intervention", Faculté de Médecine, 37 Allées Jules Guesde, 31000, Toulouse, France.,Gerontology and Internal Medicine, University Hospital of Toulouse, Cité de la santé, 20, Rue du Pont Saint-Pierre, TSA 60033, 31059, Toulouse Cedex 9, France
| | - Nicolas Saffon
- Palliative Care Unit "Résonance", University Hospital of Toulouse, Place du Docteur Baylac, TSA 40031, 31059, Toulouse Cedex 9, France
| | - Philipe de Souto Barreto
- INSERM, URM1027 "Aging and Alzheimer Disease: From Observation to Intervention", Faculté de Médecine, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Yves Rolland
- INSERM, URM1027 "Aging and Alzheimer Disease: From Observation to Intervention", Faculté de Médecine, 37 Allées Jules Guesde, 31000, Toulouse, France.,Gerontology and Internal Medicine, University Hospital of Toulouse, Cité de la santé, 20, Rue du Pont Saint-Pierre, TSA 60033, 31059, Toulouse Cedex 9, France
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Abstract
BACKGROUND End-of-life hospitalizations in nursing home residents are common, although they are often burdensome and potentially avoidable. AIM We aimed to summarize the existing evidence on end-of-life hospitalizations in nursing home residents. DESIGN Systematic review (PROSPERO registration number CRD42017072276). DATA SOURCES A systematic literature search was carried out in PubMed, CINAHL, and Scopus (date of search 9 April 2019). Studies were included if they reported proportions of in-hospital deaths or hospitalizations of nursing home residents in the last month of life. Two authors independently selected studies, extracted data, and assessed the quality of studies. Median with interquartile range was used to summarize proportions. RESULTS A total of 35 studies were identified, more than half of which were from the United States (n = 18). While 29 studies reported in-hospital deaths, 12 studies examined hospitalizations during the last month of life. The proportion of in-hospital deaths varied markedly between 5.9% and 77.1%, with an overall median of 22.6% (interquartile range: 16.3%-29.5%). The proportion of residents being hospitalized during the last month of life ranged from 25.5% to 69.7%, and the median was 33.2% (interquartile range: 30.8%-38.4%). Most studies investigating the influence of age found that younger age was associated with a higher likelihood of end-of-life hospitalization. Four studies assessed trends over time, showing heterogeneous findings. CONCLUSION There is a wide variation in end-of-life hospitalizations, even between studies from the same country. Overall, such hospitalizations are common among nursing home residents, which indicates that interventions tailored to each specific health care system are needed to improve end-of-life care.
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Affiliation(s)
- Katharina Allers
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Rieke Schnakenberg
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Economos G, Tholly F, Rhondali W, Ruer M, Tricou C, Fawoubo A, Perceau-Chambard É, Filbet M. Nursing home hospital transfers in the terminally ill: night shift nurses matter! BMJ Support Palliat Care 2019; 10:228-233. [PMID: 31530555 DOI: 10.1136/bmjspcare-2019-001832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/05/2019] [Accepted: 09/04/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND French demographic projection expects an increasing number of older, dependent patients in the next few years. A large proportion of this population lives in nursing homes and their transfer to hospitals at the end of life is an ongoing issue. OBJECTIVE This study explored the factors influencing the transfer of patients living in nursing homes to hospital at the end of life. DESIGN We used a mixed-methods questionnaire developed by an expert group and assessing different characteristics of the nursing homes. PARTICIPANTS All the nursing homes in the Rhône-Alpes area (n=680) were surveyed. RESULTS We obtained 466 (68%) answers. We found that a palliative care programme was present in 336 (72%) nursing homes. The majority had a coordinating physician 428 (82%) and a mean number of 6 nurses for 83 beds, with 83 (18%) having a night shift nurse. There was a mean number of 19 deaths per nursing home during the recorded year. The main cause of death was dementia (41%), cancer-related death (13%). Death occurred mostly in the nursing home (14 74%). Night shift nurse attendance was significantly associated with the place of death: 27 deaths occurred in nursing homes with a night shift nurse versus 12 in those without one (p<0001). CONCLUSIONS The location of the death of frail elderly patients is a major health issue that needs to be addressed. Our results suggests that the presence of a night shift nurse decreases the number of emergency transfers and deaths in the hospital.
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Affiliation(s)
| | | | | | - Murielle Ruer
- Palliative Care, Hospices Civils de Lyon, Lyon, France
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Hoffmann F, Strautmann A, Allers K. Hospitalization at the end of life among nursing home residents with dementia: a systematic review. BMC Palliat Care 2019; 18:77. [PMID: 31506100 PMCID: PMC6737675 DOI: 10.1186/s12904-019-0462-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 09/06/2019] [Indexed: 12/24/2022] Open
Abstract
Background Half of nursing home residents (NHR) suffer from dementia. End-of-life hospitalizations are often burdensome in residents with dementia. A systematic review was conducted to study the occurrence of hospitalizations at the end of life in NHR with dementia and to compare these figures to NHR without dementia. Methods A systematic literature search in MEDLINE, CINAHL and Scopus was conducted in May 2018. Studies were included if they reported proportions of in-hospital deaths or hospitalizations of NHR with dementia in the last month of life. Two authors independently selected studies, extracted data, and assessed quality of studies. Results Nine hundred forty-five citations were retrieved; 13 studies were included. Overall, 7 studies reported data on in-hospital death with proportions ranging between 0% in Canada and 53.3% in the UK. Studies reporting on the last 30 days of life (n = 8) varied between 8.0% in the Netherlands and 51.3% in Germany. Two studies each assessed the influence of age and sex. There seem to be fewer end-of-life hospitalizations in older age groups. The influence of sex is inconclusive. All but one study found that at the end of life residents with dementia were hospitalized less often than those without (n = 6). Conclusions We found large variations in end-of-life hospitalizations of NHR with dementia, probably being explained by differences between countries. The influence of sex and age might differ when compared to residents without dementia. More studies should compare NHR with dementia to those without and assess the influence of sex and age. Trial registration PROSPERO registration number CRD42018104263.
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Affiliation(s)
- Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Germany.
| | - Anke Strautmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Germany
| | - Katharina Allers
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Germany
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Hoffmann F, Allers K. Dying in hospital among nursing home residents with and without dementia in Germany. Arch Gerontol Geriatr 2019; 82:293-298. [PMID: 30909116 DOI: 10.1016/j.archger.2019.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Nursing home residents (NHR) often suffer from dementia. As end-of-life care of NHR with dementia and without might differ, our aim was to investigate patterns of in-hospital deaths in NHR with and without dementia. DESIGN Retrospective observational study. SETTING German nursing homes. PARTICIPANTS Deceased NHR. MEASUREMENTS Using data of a large German health insurance fund, we included NHR aged 65+ years who died between January 1, 2010, and December 31, 2014. We assessed proportions of in-hospital deaths stratified by dementia status as well as by age, sex, level of care and length of stay. Multiple logistic regression models were applied to explore the association of these variables with in-hospital death. RESULTS Data on 67,328 decedents were included (mean age 85.3 years, 69.8% female), of whom 43.1% suffered from dementia. Overall, 29.5% died in hospital, with similar figures found for those with dementia (29.2%) and those without (29.8%). Differences between NHR with and without dementia were noticeable regarding age and length of stay. In those with dementia, the proportion of in-hospital deaths decreased linearly with age from 37.0%-20.2% (65-74 to 95+ years). These results are supported by the multivariate analyses. The terminal hospital stay was up to 3 days in 32.6%. This length did not differ by dementia status. CONCLUSIONS Germany has a high proportion of NHR in-hospital deaths. Surprisingly, we found no differences in these figures between NHR with and without dementia, although predictors for in-hospital death seem to differ between these groups.
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Affiliation(s)
- Falk Hoffmann
- Carl von Ossietzky University Oldenburg, Department of Health Services Research, Oldenburg, Germany.
| | - Katharina Allers
- Carl von Ossietzky University Oldenburg, Department of Health Services Research, Oldenburg, Germany
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Sussman T, Kaasalainen S, Lee E, Akhtar-Danesh N, Strachan PH, Brazil K, Bonifas R, Bourgeois-Guérin V, Durivage P, Papaioannou A, Young L. Condition-Specific Pamphlets to Improve End-of-life Communication in Long-term Care: Staff Perceptions on Usability and Use. J Am Med Dir Assoc 2018; 20:262-267. [PMID: 30583908 DOI: 10.1016/j.jamda.2018.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/31/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This article reports findings on the usability and staff use of 5 condition- specific pamphlets of high prevalence in long-term care (LTC): dementia, heart failure, chronic obstructive pulmonary disease, renal failure, and frailty. The pamphlets were created in response to residents', families', and staff's recommendations for activating early reflections and communication about end-of-life care. DESIGN A mixed-method (qualitative and quantitative) survey design was used. Step 1 collected survey data on the usability of the pamphlets. Step 2 collected survey data on pamphlet use. SETTINGS AND PARTICIPANTS Two nurses with specialized palliative care training, 2 resident/family representatives, 10 condition-specific specialists, and 33 LTC palliative leads reviewed the pamphlets for usability prior to distribution. A total of 178 LTC home staff in 4 participating LTC homes reported on pamphlet use. MEASURES Specialists and resident/family representatives were asked to provide open comments and LTC home palliative leads were asked to complete a survey on the accuracy, readability, and relevance of the pamphlets. After 6 months of distribution, all staff in participating LTC homes were asked to complete a survey on pamphlet use, usefulness, and comfort with distribution. RESULTS The pamphlets were reportedly accurate, relevant, and easy to understand. Following 6 months of availability, most staff in LTC had read the pamphlets, found the information useful, and planned to share them. However, half of the staff questioned their role in pamphlet distribution and most had not distributed them. Regulated staff (ie, staff affiliated with a regulated profession) expressed more comfort sharing the pamphlets than care aides and support staff. CONCLUSIONS/IMPLICATIONS Condition-specific pamphlets appear to hold promise in providing residents and families with relevant information that may activate early reflections and conversations about end-of-life care. However, structured implementation strategies, training, and discussions are required to improve staff comfort with distribution and explore roles in distribution and follow-up.
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Affiliation(s)
| | | | - Eunyoung Lee
- School of Social Work, McGill University, Canada
| | | | | | - Kevin Brazil
- School of Nursing and Midwifery, Queens University Belfast, United Kingdom
| | | | | | - Patrick Durivage
- Montreal Central West University Affiliated Health and Social Service Network, Canada
| | | | - Laurel Young
- Creative Arts Therapies Department, Concordia University, Canada
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14
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Deaths in France: Characteristics, place of death, hospitalisations and use of palliative care during the year before death. Rev Epidemiol Sante Publique 2018; 66:33-42. [DOI: 10.1016/j.respe.2017.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/12/2017] [Accepted: 06/02/2017] [Indexed: 11/17/2022] Open
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15
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Regional Supply of Nursing Home and Hospital Beds Determine Discharge Destination of Nursing Home Residents in Japan. J Am Med Dir Assoc 2017; 17:672.e1-5. [PMID: 27346651 DOI: 10.1016/j.jamda.2016.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Japanese special nursing homes provide permanent residence to elderly people under the public long-term care insurance program. However, a quarter of discharges occur via death in hospital, and a fifth occur via admission to hospital. The objective was to identify factors associated with discharge destinations for residents of Japanese special nursing homes. DESIGN A retrospective design for data collected in 2007, 2010, and 2013. SETTING We used data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey that assessed discharge from special nursing homes in September every 3 years. PARTICIPANTS There were 2426 discharged residents included in the analysis. MEASUREMENTS Discharge destination was categorized as death at facility, death in hospital, hospital admission, and another care setting. Multivariate multinomial logistic regression analysis was conducted with discharge destination as the dependent variable. RESULTS Of the 2426 discharged residents included in the analysis, 874 (36.0%) were deceased at the facility, 773 (31.9%) were deceased in hospital, 652 (26.9%) were admitted to hospital, and 127 (5.2%) were admitted to another care setting. Residents of facilities in the regions with fewer nursing home beds or more hospital beds were more likely to be discharged via admittance to hospital or another care setting relative to being deceased at the facility. CONCLUSION The regional supply of nursing home and hospital beds could have affected end-of-life care locations for residents of special nursing homes. To promote end-of-life care in special nursing homes, regional supply of nursing home beds should be reinforced while controlling oversupply of hospital beds.
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16
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Abstract
This study aimed to (1) explore how palliative care in long-term care (LTC) addresses the tensions associated with caring for the living and dying within one care community, and (2) to inform how palliative care practices may be improved to better address the needs of all residents living and dying in LTC as well as those of the families and support staff. This article reports findings from 19 focus groups and 117 participants. Study findings reveal that LTC home staff, resident, and family perspectives of end-of-life comfort applied to those who were actively dying and to their families. Our findings further suggest that eliciting residents' perceptions of end-of-life comfort, sharing information about a fellow resident's death more personally, and ensuring that residents, families, and staff can constructively participate in providing comfort care to dying residents could extend the purview of end-of-life comfort and support expanded integration of palliative principles within LTC.
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17
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Nakanishi M, Niimura J, Nishida A. Factors associated with end-of-life by home-visit nursing-care providers in Japan. Geriatr Gerontol Int 2016; 17:991-998. [DOI: 10.1111/ggi.12822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/06/2016] [Accepted: 04/07/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Miharu Nakanishi
- Mental Health and Nursing Research Team, Department of Psychiatry and Behavioral Science; Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Junko Niimura
- Mental Health and Nursing Research Team, Department of Psychiatry and Behavioral Science; Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Atsushi Nishida
- Mental Health Promotion Project, Department of Psychiatry and Behavioral Science; Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
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