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Kim D, Chang SO. How do nurses advocate for the remaining time of nursing home residents? A critical discourse analysis. Int J Nurs Stud 2024; 156:104807. [PMID: 38797042 DOI: 10.1016/j.ijnurstu.2024.104807] [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] [Received: 09/15/2023] [Revised: 04/10/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Due to the global aging trend, the number of older people who will spend the last years of their lives in nursing homes is increasing. However, nursing homes have long confronted negative social and public discourses, including stigmas on dementia and life in such facilities. Nevertheless, the remaining time of residents with dementia holds significance, for them and their families, as they seek respect and the ability to make meaningful end-of-life decisions. OBJECTIVE To explore how nursing home nurses advocate for the remaining lifetimes of residents with dementia. DESIGN A qualitative research design. SETTING(S) Four nursing homes in Korea from January 2023 to February 2023. PARTICIPANTS Twenty nurses who provide direct caregiving for residents with dementia and have a minimum of two years' experience in nursing homes were recruited. METHODS This study employed a critical discourse analysis. Twenty interviews conducted with nursing home nurses were examined to explore the connections between the grammatical and lexical aspects of the language used by the nurses to construct their identities as advocates for residents with dementia and the broader sociocultural context. FINDINGS Four discourses regarding nursing home nurses advocating for the value of life of residents with dementia were identified: (1) Bridging perspectives: I am a negotiator between medical treatment and residents' families with differing views; (2) Embracing a shared humanity: Residents are no different from me; they just need professional help; (3) Affirming belongingness: Residents still belong to their families, even when care has been delegated; and (4) Empowering voices for change: We are struggling to provide better care in a challenging reality. CONCLUSIONS This paper highlights the importance of nursing advocacy in safeguarding the remaining time and dignity of individuals with dementia, challenging the stigma surrounding dementia and nursing homes and calling for greater societal and political recognition of the efforts nurses make to preserve the personhood and well-being of these older adults.
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Affiliation(s)
- Dayeong Kim
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea.
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Kim D, Hong Y, Chang SO. Ways of interdisciplinary approaches to advocating for nursing home residents with dementia. J Adv Nurs 2024. [PMID: 38771071 DOI: 10.1111/jan.16251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/04/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024]
Abstract
AIM To explore how nursing home staff advocate for residents with dementia. DESIGN Phenomenographic qualitative research. METHODS Twenty nursing home staff from four disciplines (six nurses, four physical therapists, five social workers and five care workers) were purposively recruited from three different nursing homes. Data were collected through semi-structured interviews conducted from February 2023 to March 2023, and the analysis followed the sequential steps of phenomenographic analysis. RESULTS The analysis identified five categories of description: focusing on what happened, finding the gaps in perspectives, how to bridge for finding a common perspective, how to tailor care such that each resident receives equitable care and how to establish interdisciplinary sharing for a consistent advocative pattern. Their structural relationship was also identified as an outcome space. CONCLUSION The cyclical advocacy structure illustrated that nursing home staff engage in an ongoing process of advocacy during conflict situations as part of interdisciplinary care, emphasizing continuity of care rather than separate occurrences of care. IMPLICATIONS FOR THE PROFESSION This study revealed that, in advocating for residents with dementia, nursing home staff adopted an approach that fosters consistent care and proactive prevention, achieved through the formation of shared knowledge applicable uniformly across similar situations. IMPACT This study contributes significantly to the continuing education or training of interdisciplinary staff in nursing homes. The revelations of the study hold significance not only for the practical application but also for the theoretical advancement of concepts related to safeguarding the dignity, human rights and personhood of residents with dementia, with the ultimate goal of enhancing their quality of life within nursing homes. REPORTING METHOD Reporting complied with the COREQ criteria for qualitative research. PATIENT OR PUBLIC CONTRIBUTION Nursing home directors have contributed to the validation of data analysis and interpretation.
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Affiliation(s)
- Dayeong Kim
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Youjung Hong
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
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3
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Zhu Y, Olchanski N, Cohen JT, Freund KM, Faul JD, Fillit HM, Neumann PJ, Lin PJ. Life-Sustaining Treatments Among Medicare Beneficiaries with and without Dementia at the End of Life. J Alzheimers Dis 2023; 96:1183-1193. [PMID: 37955089 PMCID: PMC10777481 DOI: 10.3233/jad-230692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Older adults with dementia including Alzheimer's disease may have difficulty communicating their treatment preferences and thus may receive intensive end-of-life (EOL) care that confers limited benefits. OBJECTIVE This study compared the use of life-sustaining interventions during the last 90 days of life among Medicare beneficiaries with and without dementia. METHODS This cohort study utilized population-based national survey data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims. Our sample included Medicare fee-for-service beneficiaries aged 65 years or older deceased between 2000 and 2016. The main outcome was receipt of any life-sustaining interventions during the last 90 days of life, including mechanical ventilation, tracheostomy, tube feeding, and cardiopulmonary resuscitation. We used logistic regression, stratified by nursing home use, to examine dementia status (no dementia, non-advanced dementia, advanced dementia) and patient characteristics associated with receiving those interventions. RESULTS Community dwellers with dementia were more likely than those without dementia to receive life-sustaining treatments in their last 90 days of life (advanced dementia: OR = 1.83 [1.42-2.35]; non-advanced dementia: OR = 1.16 [1.01-1.32]). Advance care planning was associated with lower odds of receiving life-sustaining treatments in the community (OR = 0.84 [0.74-0.96]) and in nursing homes (OR = 0.68 [0.53-0.86]). More beneficiaries with advanced dementia received interventions discordant with their EOL treatment preferences. CONCLUSIONS Community dwellers with advanced dementia were more likely to receive life-sustaining treatments at the end of life and such treatments may be discordant with their EOL wishes. Enhancing advance care planning and patient-physician communication may improve EOL care quality for persons with dementia.
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Affiliation(s)
- Yingying Zhu
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Joshua T. Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Karen M. Freund
- Center for Health Equity Research, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Jessica D. Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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Schnakenberg R, Fassmer AM, Allers K, Hoffmann F. Characteristics and place of death in home care recipients in Germany - an analysis of nationwide health insurance claims data. BMC Palliat Care 2022; 21:172. [PMID: 36203168 PMCID: PMC9535886 DOI: 10.1186/s12904-022-01060-w] [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] [Received: 04/08/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background Most care-dependent people live at home, where they also would prefer to die. Unfortunately, this wish is often not fulfilled. This study aims to investigate place of death of home care recipients, taking characteristics and changes in care settings into account. Methods We retrospectively analysed a cohort of all home-care receiving people of a German statutory health insurance who were at least 65 years and who deceased between January 2016 and June 2019. Next to the care need, duration of care, age, sex, and disease, care setting at death and place of death were considered. We examined the characteristics by place of care, the proportion of dying in hospital by care setting and characterised the deceased cohort stratified by their actual place of death. Results Of 46,207 care-dependent people initially receiving home care, 57.5% died within 3.5 years (n = 26,590; mean age: 86.8; 66.6% female). More than half of those moved to another care setting before death with long-term nursing home care (32.3%) and short-term nursing home care (11.7%) being the most frequent transitions, while 48.1% were still cared for at home. Overall, 36.9% died in hospital and in-hospital deaths were found most often in those still receiving home care (44.7%) as well as care in semi-residential arrangements (43.9%) at the time of death. People who died in hospital were younger (mean age: 85.5 years) and with lower care dependency (low care need: 28.2%) as in all other analysed care settings. Conclusion In Germany, changes in care settings before death occur often. The proportion of in-hospital death is particularly high in the home setting and in semi-residential arrangements. These settings should be considered in interventions aiming to decrease the number of unwished care transitions and hospitalisations at the end of life.
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Affiliation(s)
- Rieke Schnakenberg
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
| | - Alexander Maximilian Fassmer
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Katharina Allers
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Yuyama EK, Lima NKDC, Ferrioli E, Dos Santos AFJ, Amorim RS, Moriguti JC. Palliative Care in Advanced Alzheimer's Disease Dementia: Evaluation of the Answers Given by Caregivers and Physicians to the Accuracy of Surprise Question, as a Prognostic Tool. Am J Hosp Palliat Care 2022:10499091221121328. [PMID: 35961638 DOI: 10.1177/10499091221121328] [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: 11/16/2022] Open
Abstract
Introduction: Alzheimer's disease (AD) dementia is the sixth leading cause of death in the United States. The surprise question (SQ) "Would you be surprised if this patient were to die within the next 12 months?" was used to identify death-risk patients, who could benefit from palliative care. Objective: To examine the prognostic accuracy of the SQ by physicians and caregivers in outpatients with AD dementia. Methods: This is a longitudinal and prospective study involving 101 patients along 1 year, applying the SAS 9.2 software and adopting a .05 P-value to assess the variables that influenced answers to the accuracy of SQ using the chi-square test. Results: 27 patients (26.7%) died during the follow-up. When caregivers answered the SQ, it presented a 51.8% sensitivity (CI 31.9 - 71.3), a 66.7% negative predictive value (20.7 - 63.6), a 56.2% specificity (CI 29.8 - 80.2), and a 40.9% positive predictive value of (CI 43.0 - 85.4) with a 53.4% accuracy (CI 38.5 - 68.4). When physicians answered, the SQ had an 88.8% sensitivity (CI 70.8 - 97.6), a 40% negative predictive value (CI 5.2 - 85.3), a 12.5% specificity (CI 1.5 - 38.3), a 63.1% positive predictive value (CI 45.9 - 78.1) with a 60.4% accuracy (CI 45.8 - 75). Conclusion: SQ remains a good tool with high sensitivity for the identification of patients with advanced AD dementia when presented to the attending physician for planning palliative advanced care with accuracy of 60.4% and caregivers' accuracy of 53.4%.
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Affiliation(s)
- Erika Kiyomi Yuyama
- Ribeirão Preto Medical School of the University of São Paulo [USP], Ribeirão Preto, Brazil
| | | | - Eduardo Ferrioli
- Ribeirão Preto Medical School of the University of São Paulo [USP], Ribeirão Preto, Brazil
| | | | | | - Julio Cesar Moriguti
- Ribeirão Preto Medical School of the University of São Paulo [USP], Ribeirão Preto, Brazil
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Pellico-López A, Herrero-Montes M, Cantarero Prieto D, Fernández-Feito A, Cayon-De las Cuevas J, Parás-Bravo P, Paz-Zulueta M. Patient deaths during the period of prolonged stay in cases of delayed discharge for nonclinical reasons at a university hospital: a cross sectional study. PeerJ 2022; 10:e13596. [PMID: 35734637 PMCID: PMC9208369 DOI: 10.7717/peerj.13596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/25/2022] [Indexed: 01/17/2023] Open
Abstract
Background Delayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care. Methods A descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007-2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student's T test and Pearson's chi-square test (χ 2) were used. Results A total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital.
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Affiliation(s)
- Amada Pellico-López
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,Cantabria Health Service, Santander, Spain
| | - Manuel Herrero-Montes
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,IDIVAL, Grupo de Investigación en Enfermería, Santander, Spain
| | - David Cantarero Prieto
- IDIVAL, Research Group of Health Economics and Health Services Management–Research Institute Marqués de Valdecilla, Santander, Spain,Departamento de Economía, Universidad de Cantabria, Santander, Spain
| | - Ana Fernández-Feito
- Facultad de Medicina y Ciencias de la Salud, Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Área de Investigación en Cuidados, Grupo de Procesos Asistenciales de Enfermería, Oviedo, Spain
| | - Joaquin Cayon-De las Cuevas
- IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, Santander, Spain,Departamento de Derecho Privado, Universidad de Cantabria, Santander, Spain
| | - Paula Parás-Bravo
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,IDIVAL, Grupo de Investigación en Enfermería, Santander, Spain
| | - María Paz-Zulueta
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, Santander, Spain
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Leniz J, Gulliford M, Higginson IJ, Bajwah S, Yi D, Gao W, Sleeman KE. Primary care contacts, continuity, identification of palliative care needs, and hospital use: a population-based cohort study in people dying with dementia. Br J Gen Pract 2022; 72:BJGP.2021.0715. [PMID: 35817583 PMCID: PMC9282808 DOI: 10.3399/bjgp.2021.0715] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Reducing hospital admissions among people dying with dementia is a policy priority. AIM To explore associations between primary care contacts, continuity of primary care, identification of palliative care needs, and unplanned hospital admissions among people dying with dementia. DESIGN AND SETTING This was a retrospective cohort study using the Clinical Practice Research Datalink linked with hospital records and Office for National Statistics data. Adults (>18 years) who died between 2009 and 2018 with a diagnosis of dementia were included in the study. METHOD The association between GP contacts, Herfindahl-Hirschman Index continuity of care score, palliative care needs identification before the last 90 days of life, and multiple unplanned hospital admissions in the last 90 days was evaluated using random-effects Poisson regression. RESULTS In total, 33 714 decedents with dementia were identified: 64.1% (n = 21 623) female, mean age 86.6 years (SD 8.1), mean comorbidities 2.2 (SD 1.6). Of these, 1894 (5.6%) had multiple hospital admissions in the last 90 days of life (increase from 4.9%, 95% confidence interval [CI] = 4.2 to 5.6 in 2009 to 7.1%, 95% CI = 5.7 to 8.4 in 2018). Participants with more GP contacts had higher risk of multiple hospital admissions (incidence risk ratio [IRR] 1.08, 95% CI = 1.05 to 1.11). Higher continuity of care scores (IRR 0.79, 95% CI = 0.68 to 0.92) and identification of palliative care needs (IRR 0.66, 95% CI = 0.56 to 0.78) were associated with lower frequency of these admissions. CONCLUSION Multiple hospital admissions among people dying with dementia are increasing. Higher continuity of care and identification of palliative care needs are associated with a lower risk of multiple hospital admissions in this population, and might help prevent these admissions at the end of life.
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Affiliation(s)
- Javiera Leniz
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
| | - Martin Gulliford
- Department of Population Health Sciences, Faculty of Life Science & Medicine, King's College London, London
| | - Irene J Higginson
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
| | - Sabrina Bajwah
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
| | - Deokhee Yi
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
| | - Wei Gao
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
| | - Katherine E Sleeman
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
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Spacey A, Scammell J, Board M, Porter S. A critical realist evaluation of advance care planning in care homes. J Adv Nurs 2021; 77:2774-2784. [PMID: 33751625 DOI: 10.1111/jan.14822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate care planning in advance of end-of-life care in care homes. DESIGN A qualitative study. METHODS Qualitative data were collected from January 2018-July 2019 (using focus groups and semi-structured interviews) from three care homes in the South West of England. The data were analysed using thematic analysis followed by Critical Realist Evaluation. RESULTS Participants comprised of registered nurses (N = 4), care assistants (N = 8), bereaved relatives (N = 7), and domiciliary staff (N = 3). Although the importance of advance care planning was well recognized, the emotional labour of frequently engaging in discussions about death and dying was highlighted as a problem by some care home staff. It was evident that in some cases care home staff's unmet emotional needs led them to rushing and avoiding discussions about death and dying with residents and relatives. A sparsity of mechanisms to support care home staff's emotional needs was noted across all three care homes. Furthermore, a lack of training and knowledge appeared to inhibit care home staff's ability to engage in meaningful care planning conversations with specific groups of residents such as those living with dementia. The lack of training was principally evident amongst non-registered care home staff and those with non-formal caring roles such as housekeeping. CONCLUSION There is a need for more focused education to support registered and non-registered care home staff to effectively engage in sensitive discussions about death and dying with residents. Furthermore, greater emotional support is necessary to help build workforce resilience and sustain change. IMPACT Knowledge generated from this study can be used to inform the design and development of future advance care planning interventions capable of supporting the delivery of high-quality end-of-life care in care homes.
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Affiliation(s)
- Adam Spacey
- School of Health and Society, University of Salford, Salford, UK
| | - Janet Scammell
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Michele Board
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Bournemouth, UK
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Tark A, Agarwal M, Dick AW, Song J, Stone PW. Impact of the Physician Orders for Life-Sustaining Treatment (POLST) Program Maturity Status on the Nursing Home Resident's Place of Death. Am J Hosp Palliat Care 2020; 38:812-822. [PMID: 32878457 DOI: 10.1177/1049909120956650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Physician Orders for Life-Sustaining Treatment (POLST) program was developed to enhance quality of care delivered at End-of-Life (EoL). Although positive impacts of the POLST program have been identified, the association between a program maturity status and nursing home resident's likelihood of dying in their current care settings remain unanswered. This study aims to evaluate the impact of the POLST program maturity status on nursing home residents' place of death. Using multiple national-level datasets, we examined total 595,152 residents and their place of death. The result showed that the long-stay residents living in states where the program was mature status had 12% increased odds of dying in nursing homes compared that of non-conforming status. Individuals residing in states with developing program status showed 11% increase in odds of dying in nursing homes. The findings demonstrate that a well-structured and well-disseminated POLST program, combined with a continued effort to meet high standards of quality EoL care, can bring out positive health outcomes for elderly patients residing in care settings.
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Affiliation(s)
- Aluem Tark
- Columbia University School of Nursing, New York, NY, USA.,4083University of Iowa College of Nursing, Iowa City, IA, USA
| | - Mansi Agarwal
- Columbia University School of Nursing, New York, NY, USA
| | | | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA
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10
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Forma L, Aaltonen M, Raitanen J, Anthun KS, Kalseth J. Place of death among older people in Finland and Norway. Scand J Public Health 2020; 48:817-824. [PMID: 32757709 PMCID: PMC7678340 DOI: 10.1177/1403494820944073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aims: This study aimed to find out how place of death varied between countries with different health and social service systems. This was done by investigating typical groups (concerning age, sex and end-of-life trajectory) of older people dying in different places in Finland and Norway. Methods: The data were derived from national registers. All those who died in Finland or Norway at the age of ⩾70 years in 2011 were included. Place of death was analysed by age, sex, end-of-life trajectory and degree of urbanisation of the municipality of residence. Two-proportion z-tests were performed to test the differences between the countries. Multinomial logistic regression analyses were performed separately for both countries to find the factors associated with place of death. Results: The data consisted of 68,433 individuals. Deaths occurred most commonly in health centres in Finland and in nursing homes in Norway. Deaths in hospital were more common in Norway than they were in Finland. In both countries, deaths in hospital were more common among younger people and men. Deaths in nursing homes were commonest among frail older people, while most of those who had a terminal illness died in health centres in Finland and in nursing homes in Norway. Conclusions: Both Finland and Norway have a relatively low share of hospital deaths among older people. Both countries have developed alternatives to end-of-life care in hospital, allowing for spending the last days or weeks of life closer to home. In Finland, health centres play a key role in end-of-life care, while in Norway nursing homes serve this role.
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Affiliation(s)
- Leena Forma
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Finland.,Faculty of Social Sciences, University of Helsinki, Finland
| | - Mari Aaltonen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Finland
| | - Jani Raitanen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Finland.,UKK Institute for Health Promotion Research, Finland
| | | | - Jorid Kalseth
- Department of Health Research, SINTEF Digital, Norway
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11
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Rwabihama JP, Belmin J, Rakotoarisoa DR, Hagege M, Audureau E, Benzengli H, Ambime G, Rabus MT, Bastuji-Garin S, Paillaud E, Oubaya N. Promoting patients' rights at the end of life in a geriatric setting in France: The healthcare professionals' level of knowledge about surrogate decision-makers and advance directives. PATIENT EDUCATION AND COUNSELING 2020; 103:1390-1398. [PMID: 32070651 DOI: 10.1016/j.pec.2020.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess levels of knowledge about patients' rights, surrogate decision-makers, and advance directives among healthcare professionals at three hospitals in France. METHODS A multicenter, cross-sectional study in three geriatric hospitals in the Paris area (France) in 2015. The participants' level of knowledge was assessed via an 18-item self-questionnaire on surrogate decision-makers, advance directives, and end-of-life decision-making. The characteristics associated with a good level of knowledge were assessed using logistic regression. RESULTS Among the 301 healthcare professionals (median ± standard deviation age: 40.4 ± 10.2 years; women: 73.4 %), only 15.0 % (95 % confidence interval (CI): [19.7-29.5]) correctly answered at least 75 % of the questions on patients' rights. Respectively 24.6 % [19.7-29.5], 36.5 % [31.1-42.0] and 37.5 % [32.0-43.0] had sufficient knowledge regarding "surrogate decision-maker", "advance directives", and "decision-making at the end of life". In a multivariable analysis, the only factor significantly associated with a good level of knowledge about end-of-life policy was employment in a university hospital, with a non-significant trend for status as a physician. CONCLUSIONS Our survey of staff working in geriatric care units highlighted the poor overall level of knowledge about healthcare surrogates and advance directives; the results suggest that additional training in these concepts is required. PRACTICE IMPLICATIONS Continuing education of healthcare professionals on advance directives and surrogate decision-maker should be promoted to ensure rights of elderly patients at the end of life.
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Affiliation(s)
- Jean Paul Rwabihama
- Inserm U955, Université Paris Est Créteil (UPEC), Institut Mondor de Recherche Biomédicale (IMRB), équipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France; Assistance Publique-Hôpitaux de Paris, Joffre-Dupuytren Hospital, Geriatric Department, Draveil, F- 91210, France.
| | - Joël Belmin
- Assistance Publique-Hôpitaux de Paris, Charles Foix Hospital, Geriatric Department, Ivry-sur-seine, F- 94200, France
| | - De Rozier Rakotoarisoa
- Assistance Publique-Hôpitaux de Paris, George Clemenceau Hospital, Geriatric Department, Champceuil, F- 91750, France
| | - Meoïn Hagege
- Inserm U955, Université Paris Est Créteil (UPEC), Institut Mondor de Recherche Biomédicale (IMRB), équipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Etienne Audureau
- Inserm U955, Université Paris Est Créteil (UPEC), Institut Mondor de Recherche Biomédicale (IMRB), équipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France; Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Department of Public Health, Créteil, F- 94000, France
| | - Hind Benzengli
- Assistance Publique-Hôpitaux de Paris, Joffre-Dupuytren Hospital, Pharmacy Department, Draveil, F- 91210, France
| | - Gabin Ambime
- Assistance Publique-Hôpitaux de Paris, Joffre-Dupuytren Hospital, Geriatric Department, Draveil, F- 91210, France
| | - Marie-Thérèse Rabus
- Assistance Publique-Hôpitaux de Paris, Joffre-Dupuytren Hospital, Geriatric Department, Draveil, F- 91210, France
| | - Sylvie Bastuji-Garin
- Inserm U955, Université Paris Est Créteil (UPEC), Institut Mondor de Recherche Biomédicale (IMRB), équipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France; Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Department of Public Health, Créteil, F- 94000, France
| | - Elena Paillaud
- Inserm U955, Université Paris Est Créteil (UPEC), Institut Mondor de Recherche Biomédicale (IMRB), équipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France; Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Geriatric Departement, Créteil, F- 94000, France
| | - Nadia Oubaya
- Inserm U955, Université Paris Est Créteil (UPEC), Institut Mondor de Recherche Biomédicale (IMRB), équipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France; Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Department of Public Health, Créteil, F- 94000, France
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Scheibl F, Farquhar M, Buck J, Barclay S, Brayne C, Fleming J. When Frail Older People Relocate in Very Old Age, Who Makes the Decision? Innov Aging 2020; 3:igz030. [PMID: 32274424 PMCID: PMC7127322 DOI: 10.1093/geroni/igz030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Older people are likely to transition to a new home closer to family who can provide assistance or to long-term residential care as their health declines and their care needs increase. A minority choose to move to "age-friendly" housing before the onset of disability, but the majority prefer to "age in place" and defer moving until health crises compel a transition. Older people living with dementia are likely to move into residential care, but not much is known about the role they play in decision making around these moves. This qualitative study addresses this gap in knowledge by examining how a rare cohort of "older old" people, most with some level of cognitive impairment, were involved in decisions surrounding assistance seeking and moving to a care home. Research Design and Methods Thematic analysis of qualitative interview data from Cambridge City over-75s Cohort (CC75C) study participants aged 95 years and older, who had moved in later life, and their proxy informants (n = 26). Results Moves at such an old age were made due to a complexity of push and pull factors which had layered dynamics of decision making. In most cases (n = 22), decision making involved other people with varying degrees of decision ownership. Only four older people, who moved voluntarily, had full ownership of the decision to move. Many relatives reported being traumatized by events leading up to the move. Discussion and Implications "Older old" people are sometimes unable to make their own decisions about moving due to the urgency of health crisis and cognitive decline. There is a need to support relatives to discuss moving and housing options at timely junctures before health crises intervene in an effort to optimize older people's participation in decision making.
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Affiliation(s)
- Fiona Scheibl
- Cambridge Institute of Public Health, University of Cambridge, UK, Norwich, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Jackie Buck
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Barclay
- Cambridge Institute of Public Health, University of Cambridge, UK, Norwich, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, UK, Norwich, UK
| | - Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, UK, Norwich, UK
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Scheibl F, Fleming J, Buck J, Barclay S, Brayne C, Farquhar M. The experience of transitions in care in very old age: implications for general practice. Fam Pract 2019; 36:778-784. [PMID: 31219151 PMCID: PMC6859521 DOI: 10.1093/fampra/cmz014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It can be challenging for general practitioners to support their oldest old patients through the complex process of relocation. OBJECTIVE To provide a typology of the experiences of moving in very old age that is clinically useful for practitioners navigating very old people's relocation. METHODS Qualitative analysis of data from a mixed-methods UK population-based longitudinal study, Cambridge City over-75s Cohort (CC75C), from Year 21 follow-up onwards. Interviews with participants aged ≥95 years old and proxy informants (Year 21: 44/48, 92%, subsequent attrition all deaths). Thematic analysis of qualitative data available from 26/32 participants who moved before they died. RESULTS Individuals who moved voluntarily in with family experienced gratitude, and those who moved into sheltered house or care homes voluntarily had no regrets. One voluntary move into care was experienced with regret, loss and increased isolation as it severed life-long community ties. Regret and loss were key experiences for those making involuntary moves into care, but acceptance, relief and appreciation of increased company were also observed. The key experience of family members was trauma. Establishing connections with people or place ahead of moving, for example through previous respite care, eased moving. A checklist for practitioners based on the resulting typology of relocation is proposed. CONCLUSIONS Most of the sample moved into residential care. This study highlights the importance of connections to locality, people and place along with good family relationships as the key facilitators of a healthy transition into care for the oldest old. The proposed checklist may have clinical utility.
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Affiliation(s)
- Fiona Scheibl
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Jane Fleming
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Jackie Buck
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
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Gonella S, Basso I, De Marinis MG, Campagna S, Di Giulio P. Good end-of-life care in nursing home according to the family carers' perspective: A systematic review of qualitative findings. Palliat Med 2019; 33:589-606. [PMID: 30969160 DOI: 10.1177/0269216319840275] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Nursing homes are becoming a common site where delivering end-of-life care for older adults. They often represent the junction between the curative and the palliative phase. AIM To identify the elements that nursing home residents' family carers perceive as good end-of-life care and develop a conceptual model of good end-of-life care according to the family perspective. DESIGN Systematic review (PROSPERO no. 95581) with meta-aggregation method. DATA SOURCES Five electronic databases were searched from inception between April and May 2018. Published qualitative studies (and mixed-method designs) of end-of-life care experience of nursing home family carers whose relative was dead or at the end-of-life were included. No language or temporal limits were applied. RESULTS In all, 18 studies met inclusion criteria. A 'life crisis' often resulted in a changed need of care, and the transition towards palliative care was sustained by a 'patient-centered environment'. Family carers described good end-of-life care as providing resident basic care and spiritual support; recognizing and treating symptoms; assuring continuity in care; respecting resident's end-of-life wishes; offering environmental, emotional and psychosocial support; keeping family informed; promoting family understanding; and establishing a partnership with family carers by involving and guiding them in a shared decision-making. These elements improved the quality of end-of-life of both residents and their family, thus suggesting a common ground between good end-of-life care and palliative care. CONCLUSION The findings provide a family-driven framework to guide a sensitive and compassionate transition towards palliative care in nursing home.
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Affiliation(s)
- Silvia Gonella
- 1 Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.,2 Azienda Ospedaliero Universitaria Città della Salute e della Scienza of Turin, Corso Bramante 88-90, 10126 Turin, Italy
| | - Ines Basso
- 3 Department of Public Health and Pediatrics, University of Turin, via Santena 5 bis, 10126 Turin, Italy
| | - Maria Grazia De Marinis
- 4 Nursing Research Unit. University Campus Bio Medico of Rome, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Sara Campagna
- 3 Department of Public Health and Pediatrics, University of Turin, via Santena 5 bis, 10126 Turin, Italy
| | - Paola Di Giulio
- 3 Department of Public Health and Pediatrics, University of Turin, via Santena 5 bis, 10126 Turin, Italy
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EVANS CATHERINEJ, ISON LUCY, ELLIS‐SMITH CLARE, NICHOLSON CAROLINE, COSTA ALESSIA, OLUYASE ADEJOKEO, NAMISANGO EVE, BONE ANNAE, BRIGHTON LISAJANE, YI DEOKHEE, COMBES SARAH, BAJWAH SABRINA, GAO WEI, HARDING RICHARD, ONG PAUL, HIGGINSON IRENEJ, MADDOCKS MATTHEW. Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review. Milbank Q 2019; 97:113-175. [PMID: 30883956 PMCID: PMC6422603 DOI: 10.1111/1468-0009.12373] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Policy Points We identified two overarching classifications of integrated geriatric and palliative care to maximize older people's quality of life at the end of life. Both are oriented to person-centered care, but with differing emphasis on either function or symptoms and concerns. Policymakers should both improve access to palliative care beyond just the last months of life and increase geriatric care provision to maintain and optimize function. This would ensure that continuity and coordination for potentially complex care needs across the continuum of late life would be maintained, where the demarcation of boundaries between healthy aging and healthy dying become increasingly blurred. Our findings highlight the urgent need for health system change to improve end-of-life care as part of universal health coverage. The use of health services should be informed by the likelihood of benefits and intended outcomes rather than on prognosis. CONTEXT In an era of unprecedented global aging, a key priority is to align health and social services for older populations in order to support the dual priorities of living well while adapting to a gradual decline in function. We aimed to provide a comprehensive synthesis of evidence regarding service delivery models that optimize the quality of life (QoL) for older people at the end of life across health, social, and welfare services worldwide. METHODS We conducted a rapid scoping review of systematic reviews. We searched MEDLINE, CINAHL, EMBASE, and CDSR databases from 2000 to 2017 for reviews reporting the effectiveness of service models aimed at optimizing QoL for older people, more than 50% of whom were older than 60 and in the last one or two years of life. We assessed the quality of these included reviews using AMSTAR and synthesized the findings narratively. RESULTS Of the 2,238 reviews identified, we included 72, with 20 reporting meta-analysis. Although all the World Health Organization (WHO) regions were represented, most of the reviews reported data from the Americas (52 of 72), Europe (46 of 72), and/or the Western Pacific (28 of 72). We identified two overarching classifications of service models but with different target outcomes: Integrated Geriatric Care, emphasizing physical function, and Integrated Palliative Care, focusing mainly on symptoms and concerns. Areas of synergy across the overarching classifications included person-centered care, education, and a multiprofessional workforce. The reviews assessed 117 separate outcomes. A meta-analysis demonstrated effectiveness for both classifications on QoL, including symptoms such as pain, depression, and psychological well-being. Economic analysis and its implications were poorly considered. CONCLUSIONS Despite their different target outcomes, those service models classified as Integrated Geriatric Care or Integrated Palliative Care were effective in improving QoL for older people nearing the end of life. Both approaches highlight the imperative for integrating services across the care continuum, with service involvement triggered by the patient's needs and likelihood of benefits. To inform the sustainability of health system change we encourage economic analyses that span health and social care and examine all sources of finance to understand contextual inequalities.
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Affiliation(s)
- CATHERINE J. EVANS
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
- Sussex Community NHS Foundation TrustBrighton General Hospital
| | - LUCY ISON
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - CLARE ELLIS‐SMITH
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - CAROLINE NICHOLSON
- King's College London, Florence Nightingale Faculty of NursingMidwifery & Palliative Care
- St Christopher's Hospice
| | - ALESSIA COSTA
- King's College London, Florence Nightingale Faculty of NursingMidwifery & Palliative Care
| | - ADEJOKE O. OLUYASE
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - EVE NAMISANGO
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - ANNA E. BONE
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - LISA JANE BRIGHTON
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - DEOKHEE YI
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - SARAH COMBES
- King's College London, Florence Nightingale Faculty of NursingMidwifery & Palliative Care
| | - SABRINA BAJWAH
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - WEI GAO
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - RICHARD HARDING
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - PAUL ONG
- World Health Organisation Centre for Health Development
| | - IRENE J. HIGGINSON
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
| | - MATTHEW MADDOCKS
- King's College London, Cicely Saunders Institute of Palliative CarePolicy and Rehabilitation
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Bloomer MJ, Botti M, Runacres F, Poon P, Barnfield J, Hutchinson AM. End-of-life care for older people in subacute care: A retrospective clinical audit. Collegian 2019. [DOI: 10.1016/j.colegn.2018.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bloomer MJ, Botti M, Runacres F, Poon P, Barnfield J, Hutchinson AM. Communicating end-of-life care goals and decision-making among a multidisciplinary geriatric inpatient rehabilitation team: A qualitative descriptive study. Palliat Med 2018; 32:1615-1623. [PMID: 30074431 PMCID: PMC6238176 DOI: 10.1177/0269216318790353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND In geriatric inpatient rehabilitation settings, where the goal is to optimise function, providing end-of-life care can be challenging. AIM The aim of this study is to explore how end-of-life care goals and decision-making are communicated in a geriatric inpatient rehabilitation setting. DESIGN The design is a qualitative descriptive design using semi-structured individual and group interviews. SETTING/PARTICIPANTS This study was conducted in a 154-bed facility in metropolitan Melbourne, Australia, providing geriatric inpatient rehabilitation for older patients; medical, nursing and allied health clinicians, who had cared for an inpatient who died, were recruited. DATA COLLECTION Participants were interviewed using a conversational approach, guided by an 'aide memoire'. RESULTS A total of 19 clinicians participated in this study, with 12 interviewed individually and the remaining 7 clinicians participating in group interviews. The typical patient was described as older, frail and with complex needs. Clinicians described the challenge of identifying patients who were deteriorating towards death, with some relying on others to inform them. How patient deterioration and decision-making was communicated among the team varied. Communication with the patient/family about dying was expected but did not always occur, nor was it always documented. Some clinicians relied on documentation, such as commencement of a dying care pathway to indicate when a patient was dying. CONCLUSION Clinicians reported difficulties recognising patient deterioration towards death. Uncertainty and inconsistent communication among clinicians about patient deterioration negatively impacted team understanding, decision-making, and patient and family communication. Further education for all members of the multidisciplinary team focusing on how to recognise and communicate impending death will aid multidisciplinary teams to provide quality end-of-life care when required.
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Affiliation(s)
- Melissa J Bloomer
- 1 Deakin University, Burwood, VIC, Australia.,2 Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia.,3 Epworth/Deakin Centre for Clinical Nursing Research, Richmond, VIC, Australia.,4 Centre for Nursing Research, Deakin University and Monash Health Partnership, Monash Health, Clayton, VIC, Australia
| | - Mari Botti
- 1 Deakin University, Burwood, VIC, Australia.,2 Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia.,3 Epworth/Deakin Centre for Clinical Nursing Research, Richmond, VIC, Australia
| | - Fiona Runacres
- 5 Supportive and Palliative Care Unit, Monash Health, Clayton, VIC, Australia.,6 School of Medicine, Monash University, Clayton, VIC, Australia.,7 Department of Palliative Care, Calvary Health Care Bethlehem, South Caulfield, VIC, Australia.,8 The University of Notre Dame, Darlinghurst, NSW, Australia
| | - Peter Poon
- 5 Supportive and Palliative Care Unit, Monash Health, Clayton, VIC, Australia.,6 School of Medicine, Monash University, Clayton, VIC, Australia.,9 Eastern Palliative Care Association, Melbourne, VIC, Australia
| | - Jakqui Barnfield
- 10 Rehabilitation, Aged Persons Mental Health and Residential Services, Clayton, VIC, Australia.,11 School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Alison M Hutchinson
- 1 Deakin University, Burwood, VIC, Australia.,2 Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia.,4 Centre for Nursing Research, Deakin University and Monash Health Partnership, Monash Health, Clayton, VIC, Australia
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Schoonover KL, Lapid MI. Clinical Phenomenology and Characteristics of Centenarians in Hospice. J Palliat Care 2018; 34:47-51. [PMID: 30229699 DOI: 10.1177/0825859718800491] [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: 11/17/2022]
Abstract
OBJECTIVES: Little is known about the hospice experience of centenarians. As the population of centenarians is projected to increase, understanding their unique end-of-life needs will be important to inform delivery of quality end-of-life care. Our objective was to characterize the hospice experience of centenarians. METHODS: A retrospective single-institution cohort study of centenarians enrolled in hospice from January 1, 2015, to December 31, 2017, was conducted to collect demographic and clinical information. RESULTS: Seventeen centenarians, who comprised 1.4% of hospice admissions, had an average age of 102 years, were mostly female (71%) and widowed (76%), and all caucasian. Upon hospice admission, centenarians resided in nursing (8, 47%) and assisted living (4, 24%) residencies as well as at home (4, 24%) and in senior independent living (1, 6%). Sixty percent of centenarians died in a nursing home. The most common hospice admission diagnosis was dementia (35%). Median length of stay on hospice was 41 days (range: 16-85) for 15 persons who died or discharged live. CONCLUSIONS: In this group of centenarians, dementia was the most common condition for hospice enrollment. Slightly less than half resided in nursing homes on admission, although death occurred most frequently in a nursing home. Centenarians were generally able to remain out of the hospital at their time of death.
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Affiliation(s)
| | - Maria I Lapid
- 1 Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA.,2 Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.,3 Mayo Clinic Hospice, Mayo Clinic, Rochester, MN, USA
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Wilson DM, Birch S. A scoping review of research to assess the frequency, types, and reasons for end-of-life care setting transitions. Scand J Public Health 2018; 48:376-381. [PMID: 30102574 DOI: 10.1177/1403494818785042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Most people approaching the end of life develop care needs, which typically change over time. Moves between care settings may be required as health deteriorates. However, in some cases, care setting transitions may have little to do with end-of-life care needs and instead reflect the needs, demands, availability, or funding provisions of the country or funding body and organizations providing care. This paper is a scoping review of the international peer-reviewed research literature to gain evidence on the frequency and types of end-of-life care setting transitions, and the reasons for these moves. Methods: All relevant print and open access research articles published in 2000+ were sought using the Directory of Open Access Journals and EBSCO Discovery Host. Results: A total of 39 research articles were identified and reviewed. However, minimal useful evidence was revealed. Most articles focused solely on hospital admissions near death, and some focused on nursing home admissions, with other moves infrequently studied. Conclusions: This review demonstrates the need to quantify and justify end-of-life care setting transitions as it appears dying people are frequently moved, often as death nears. This research is needed to distinguish transitions related to end-of-life care needs and those arising from pressures on or from care providers and others unrelated to the person's care needs.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Canada
- Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - Stephen Birch
- Centre for Health Economics and Policy Analysis, McMaster University, Canada
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Bähler C, Signorell A, Blozik E, Reich O. Intensity of treatment in Swiss cancer patients at the end-of-life. Cancer Manag Res 2018; 10:481-491. [PMID: 29588617 PMCID: PMC5858839 DOI: 10.2147/cmar.s156566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Current evidence on the care-delivering process and the intensity of treatment at the end-of-life of cancer patients is limited and remains unclear. Our objective was to examine the care-delivering processes in health care during the last months of life with real-life data of Swiss cancer patients. Patients and methods The study population consisted of adult decedents in 2014 who were insured at Helsana Group. Data on the final cause of death were provided additionally by the Swiss Federal Statistical Office. Of the 10,275 decedents, 2,710 (26.4%) died of cancer. Intensity of treatment and health care utilization (including transitions) at their end-of-life were examined. Intensity measures included the following: last dose of chemotherapy within 14 days of death, a new chemotherapy regimen starting <30 days before death, more than one hospital admission or spending >14 days in hospital in the last month, death in an acute care hospital, more than one emergency visit and ≥1 intensive care unit admission in the last month of life. Results In the last 6 months of life, 89.5% of cancer patients had ≥1 transition, with 87.2% being hospitalized. Within 30 days before death, 64.2% of the decedents had ≥1 intensive treatment, whereby 8.9% started a new chemotherapy. In the multinomial logistic regression model, older age, higher density of nursing home beds and home care nurses were associated with a decrease, while living in the Italian- or French-speaking part of Switzerland was associated with an increase in intensive care. Conclusion Swiss cancer patients insured by Helsana Group experience a considerable number of transitions and intensive treatments at the end-of-life, whereby treatment intensity declines with increasing age. Among others, increased home care nursing might be helpful to reduce unwarranted treatments and transitions, therefore leading to better care at the end-of-life.
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Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland.,Department of Medicine, University Medical Centre Freiburg, Freiburg im Breisgau, Germany
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
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Sugimoto K, Ogata Y, Kashiwagi M. Factors promoting resident deaths at aged care facilities in Japan: a review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e207-e224. [PMID: 27696541 DOI: 10.1111/hsc.12383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2016] [Indexed: 06/06/2023]
Abstract
Due to an increasingly ageing population, the Japanese government has promoted elderly deaths in aged care facilities. However, existing facilities were not designed to provide resident end-of-life care and the proportion of aged care facility deaths is currently less than 10%. Consequently, the present review evaluated the factors that promote aged care facility resident deaths in Japan from individual- and facility-level perspectives to exploring factors associated with increased resident deaths. To achieve this, MEDLINE, CINAHL, Web of Science and Ichushi databases were searched on 23 January 2016. Influential factors were reviewed for two healthcare services (insourcing and outsourcing facilities) as well as external healthcare agencies operating outside facilities. Of the original 2324 studies retrieved, 42 were included in analysis. Of these studies, five focused on insourcing, two on outsourcing, seven on external agencies and observed facility/agency-level factors. The other 28 studies identified individual-level factors related to death in aged care facilities. The present review found that at both facility and individual levels, in-facility resident deaths were associated with healthcare service provision, confirmation of resident/family end-of-life care preference and staff education. Additionally, while outsourcing facilities did not require employment of physicians/nursing staff to accommodate resident death, these facilities required visits by physicians and nursing staff from external healthcare agencies as well as residents' healthcare input. This review also found few studies examining outsourcing facilities. The number of healthcare outsourcing facilities is rapidly increasing as a result of the Japanese government's new tax incentives. Consequently, there may be an increase in elderly deaths in outsourcing healthcare facilities. Accordingly, it is necessary to identify the factors associated with residents' deaths at outsourcing facilities.
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Affiliation(s)
- Kentaro Sugimoto
- Nursing Course, School of Medicine, Yokohama-City University, Yokohama, Japan
- Department of Gerontological Nursing and Care System Development, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuko Ogata
- Department of Gerontological Nursing and Care System Development, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masayo Kashiwagi
- Nursing Course, School of Medicine, Yokohama-City University, Yokohama, Japan
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Martoni AA, Boltri B, Strocchi E, Pannuti F. The oldest old within the comprehensive home palliative care program of the ANT Foundation in Italy for advanced cancer patients. J Geriatr Oncol 2018; 9:174-176. [DOI: 10.1016/j.jgo.2017.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/13/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
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Hirooka K, Nakanishi M, Fukahori H, Nishida A. Hospital death in dementia patients and regional provision of palliative and end-of-life care: National patient data analysis. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1483097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Kayo Hirooka
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Miharu Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Kanagawa, Japan
| | - Atsushi Nishida
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Van den Block L, Ko W, Miccinesi G, Moreels S, Donker GA, Onwuteaka-Philipsen B, Alonso TV, Deliens L. Final transitions to place of death: patients and families wishes. J Public Health (Oxf) 2017; 39:e302-e311. [PMID: 27694347 DOI: 10.1093/pubmed/fdw097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/03/2016] [Indexed: 11/14/2022] Open
Abstract
Purpose This four-country study (Belgium, the Netherlands, Italy and Spain) examines prevalence and types of final transitions between care settings of cancer patients and the extent to which patient/family wishes are cited as a reason for the transition. Methods Data were collected from the EUROSENTI-MELC study over a 2-year period. General practitioners within existing Sentinel Networks registered weekly all deaths of patients within practices using a standardized questionnaire. This registration included place of care in the final 3 months and wishes for the final transition to place of death. All non-sudden deaths due to cancer (+18 years) were included in the analyses. Results We included 2048 non-sudden cancer deaths; 63% of patients had at least one transition between care settings in the final 3 months of life. 'Hospital death from home' (25-55%) and 'home death from hospital' (16-30%) were the most frequent types of final transitions in all countries. Patients' or families' wishes were mentioned as a reason for a final transition in 5-27% (P < 0.001) and 10-22% (P = 0.002) across countries. Conclusions 'Hospital deaths from home' is the most prevalent final transition in three of four countries studied, in a significant minority of cases because of patient/family wishes.
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Affiliation(s)
- Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Winne Ko
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, ISPO, Florence, Italy
| | - Sarah Moreels
- Public Health and Surveillance, Scientific Institute of Public Health , Brussels, Belgium
| | - Ge A Donker
- NIVEL Primary Care Database, Sentinel Practices, Netherlands Institute for Health Services Research , Utrecht, the Netherlands
| | - Bregje Onwuteaka-Philipsen
- EMGO Institute for Health and Care Research, Department of Public and Occupational Health, and Palliative Care Expertise Centre, VU University Medical Centre, Amsterdam, the Netherlands
| | - Tomas V Alonso
- Public Health Directorate General, Health Department, Valladolid, Spain
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
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Masuchi Y, Jylhä M, Raitanen J, Aaltonen M. Changes in place of death among people with dementia in Finland between 1998 and 2013: A register study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2017; 10:86-93. [PMID: 29255788 PMCID: PMC5724746 DOI: 10.1016/j.dadm.2017.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The place of death is suggested as a quality indicator for end-of-life care. We investigated how the place of death changed between 1998 and 2013 among people with dementia. METHODS Data from the Finnish national health and social care registers were extracted for all people with dementia, who had died at 70 years old during these years (N = 140,034). Descriptive analysis and logistic regression analysis were conducted. RESULTS In 2013, the most common place of death was the primary care hospital (39.8%), followed by nursing home and sheltered housing with 24-hour assistance (20.5%). Dying at home was rare (8.1%). During the study years, dying in the hospital decreased while dying in sheltered housing with 24-hour assistance increased. DISCUSSION The place of death for people with dementia has changed from institutions to noninstitutional care facilities. Further research on noninstitutional care facilities' ability to provide high-quality care at the end of life is needed.
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Affiliation(s)
- Yaeko Masuchi
- Faculty of Social Sciences and Gerontology Research Centre, University of Tampere, Tampere, Finland
- California Southland Chapter, Alzheimer's Association, Los Angeles, CA, USA
| | - Marja Jylhä
- Faculty of Social Sciences and Gerontology Research Centre, University of Tampere, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences and Gerontology Research Centre, University of Tampere, Tampere, Finland
| | - Mari Aaltonen
- Faculty of Social Sciences and Gerontology Research Centre, University of Tampere, Tampere, Finland
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Fleming J, Calloway R, Perrels A, Farquhar M, Barclay S, Brayne C. Dying comfortably in very old age with or without dementia in different care settings - a representative "older old" population study. BMC Geriatr 2017; 17:222. [PMID: 28978301 PMCID: PMC5628473 DOI: 10.1186/s12877-017-0605-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 09/01/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Comfort is frequently ranked important for a good death. Although rising numbers of people are dying in very old age, many with dementia, little is known about symptom control for "older old" people or whether care in different settings enables them to die comfortably. This study aims to examine, in a population-representative sample, associations between factors potentially related to reported comfort during very old people's final illness: physical and cognitive disability, place of care and transitions in their final illness, and place of death. METHODS Retrospective analyses linked three data sources for n = 180 deceased study participants (68% women) aged 79-107 in a representative population-based UK study, the Cambridge City over-75s Cohort (CC75C): i) prospective in-vivo dementia diagnoses and cognitive assessments, ii) certified place of death records, iii) data from interviews with relatives/close carers including symptoms and "How comfortable was he/she in his/her final illness?" RESULTS In the last year of life 83% were disabled in basic activities, 37% had moderate/severe dementia and 45% minimal/mild dementia or cognitive impairment. Regardless of dementia/cognitive status, three-quarters died following a final illness lasting a week or longer. 37%, 44%, 13% and 7% of the deceased were described as having been "very comfortable", "comfortable", "fairly comfortable" or "uncomfortable" respectively during their final illness, but reported symptoms were common: distress, pain, depression and delirium or confusion each affected 40-50%. For only 10% were no symptoms reported. There were ≥4-fold increased odds of dying comfortably associated with being in a care home during the final illness, dying in a care home, and with staying in place (dying at what death certificates record as "usual address"), whether home or care home, compared with hospital, but no significant association with disability or dementia/cognitive status, regardless of adjustment. CONCLUSIONS These findings are consistent with reports that care homes can provide care akin to hospice for the very old and support an approach of supporting residents to stay in their care home or own home if possible. Findings on reported high prevalence of multiple symptoms can inform policy and training to improve older old people's end-of-life care in all settings.
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Affiliation(s)
- Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
| | - Rowan Calloway
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- North East Thames Foundation School, London, UK
| | - Anouk Perrels
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Faculty of Medicine, Vrije Universiteit, Amsterdam, Netherlands
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Barclay
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
- Primary Care Unit, Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
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Hockley J, Harrison JK, Watson J, Randall M, Murray S. Fixing the broken image of care homes, could a 'care home innovation centre' be the answer? Age Ageing 2017; 46:175-178. [PMID: 27609210 DOI: 10.1093/ageing/afw154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 08/01/2016] [Indexed: 11/13/2022] Open
Abstract
The UK has many excellent care homes that provide high-quality care for their residents; however, across the care home sector, there is a significant need for improvement. Even though the majority of care homes receive a rating of 'good' from regulators, still significant numbers are identified as requiring 'improvement' or are 'inadequate'. Such findings resonate with the public perceptions of long-term care as a negative choice, to be avoided wherever possible-as well as impacting on the career choices of health and social care students. Projections of current demographics highlight that, within 10 years, the part of our population that will be growing the fastest will be those people older than 80 years old with the suggestion that spending on long-term care provision needs to rise from 0.6% of our Gross Domestic Product in 2002 to 0.96% by 2031. Teaching/research-based care homes have been developed in the USA, Canada, Norway, the Netherlands and Australia in response to scandals about care, and the shortage of trained geriatric healthcare staff. There is increasing evidence that such facilities help to reduce inappropriate hospital admissions, increase staff competency and bring increased enthusiasm about working in care homes and improve the quality of care. Is this something that the UK should think of developing? This commentary details the core goals of a Care Home Innovation Centre for training and research as a radical vision to change the culture and image of care homes, and help address this huge public health issue we face.
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Affiliation(s)
- Jo Hockley
- Usher Institute of Population Health Sciences and Informatics, Primary Palliative Care Research Group, Medical School, Edinburgh EH8 9AG, UK
| | - Jennifer Kirsty Harrison
- Alzheimer Scotland Dementia Research Centre & Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | | | | | - Scott Murray
- Usher Institute of Population Health Sciences and Informatics, Primary Palliative Care Research Group, Medical School, Edinburgh EH8 9AG, UK
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Soares LGL, Japiassu AM, Gomes LC, Pereira R. Post-Acute Care Facility as a Discharge Destination for Patients in Need of Palliative Care in Brazil. Am J Hosp Palliat Care 2017; 35:198-202. [PMID: 28135810 DOI: 10.1177/1049909117691280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions. In total, 205 consecutive patients were discharged from 6 different hospitals to our PACF. Palliative care patients were involved in 32% (n = 67) of these discharges. The most common conditions were terminal cancer (n = 42, 63%), advanced dementia (n = 17, 25%), and stroke (n = 5, 8%). During acute hospital stays, patients with cancer had significant shorter lengths of stay (13 vs 99 days, P = .004), a lower use of intensive care services (2% vs 64%, P < .001) and mechanical ventilation (2% vs 40%, P < .001), when compared to noncancer patients. Approximately one-third of discharges from hospitals to a PACF involved a heterogeneous group of patients in need of palliative care. Further studies are necessary to understand the trajectory of posthospitalized patients with life-limiting illnesses and what factors influence their decision to choose a PACF as a discharge destination and place of death. We advocate that palliative care should be integrated into the portfolio of post-acute services.
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Affiliation(s)
- Luiz Guilherme L Soares
- 1 Post-Acute Care Services and Palliative Care Program, Hospital Placi, Niterói, Rio de Janeiro, Brazil
| | - André M Japiassu
- 2 Instituto Nacional de Infectologia-Fundação Oswaldo Cruz, Research Laboratory of Intensive Care Medicine, Niterói, Rio de Janeiro, Brazil
| | - Lucia C Gomes
- 1 Post-Acute Care Services and Palliative Care Program, Hospital Placi, Niterói, Rio de Janeiro, Brazil
| | - Rogéria Pereira
- 1 Post-Acute Care Services and Palliative Care Program, Hospital Placi, Niterói, Rio de Janeiro, Brazil
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Watson J. Nursing home residents prefer fewer interventions and the nursing home instead of hospital for place of death. Evid Based Nurs 2016; 20:24. [PMID: 27934640 DOI: 10.1136/eb-2016-102522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Julie Watson
- Edinburgh Centre for Research on the Experience of Dementia, University of Edinburgh, Edinburgh, UK
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Bähler C, Signorell A, Reich O. Health Care Utilisation and Transitions between Health Care Settings in the Last 6 Months of Life in Switzerland. PLoS One 2016; 11:e0160932. [PMID: 27598939 PMCID: PMC5012658 DOI: 10.1371/journal.pone.0160932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 07/27/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many efforts are undertaken in Switzerland to enable older and/or chronically ill patients to stay home longer at the end-of-life. One of the consequences might be an increased need for hospitalisations at the end-of-life, which goes along with burdensome transitions for patients and higher health care costs for the society. AIM We aimed to examine the health care utilisation in the last six months of life, including transitions between health care settings, in a Swiss adult population. METHODS The study population consisted of 11'310 decedents of 2014 who were insured at the Helsana Group, the leading health insurance in Switzerland. Descriptive statistics were used to analyse the health care utilisation by age group, taking into account individual and regional factors. Zero-inflated Poisson regression model was used to predict the number of transitions. RESULTS Mean age was 78.1 in men and 83.8 in women. In the last six months of life, 94.7% of the decedents had at least one consultation; 61.6% were hospitalised at least once, with a mean length of stay of 28.3 days; and nursing home stays were seen in 47.4% of the decedents. Over the same time period, 64.5% were transferred at least once, and 12.9% experienced at least one burdensome transition. Main predictors for transitions were age, sex and chronic conditions. A high density of home care nurses was associated with a decrease, whereas a high density of ambulatory care physicians was associated with an increase in the number of transitions. CONCLUSIONS Health care utilisation was high in the last six months of life and a considerable number of decedents were being transferred. Advance care planning might prevent patients from numerous and particularly from burdensome transitions.
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Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081 Zürich, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081 Zürich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081 Zürich, Switzerland
- * E-mail:
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Smith C, Bosanquet N, Riley J, Koffman J. Loss, transition and trust: perspectives of terminally ill patients and their oncologists when transferring care from the hospital into the community at the end of life. BMJ Support Palliat Care 2016; 9:346-355. [PMID: 27259573 DOI: 10.1136/bmjspcare-2015-001075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/01/2016] [Accepted: 05/10/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Most people prefer to die at home. However, most continue to die in hospital. Little is known about the impact on the patient of transferring care from acute sector specialist follow-up to the community. In one cancer centre, a new service-Hospital2Home was set up to facilitate this transfer of care. This study aimed to explore patients' and oncologists' perspectives of the meanings involved in this transition. METHODS Qualitative study using semistructured one-to-one interviews with 8 terminally ill cancer patients and 13 oncologists. The interviews were audio recorded, transcribed verbatim and analysed using the framework approach. RESULTS 3 main themes were identified: loss, transition and community care. The theme of loss referred to losses associated with the end of treatment and losses associated with the familiar safe relationship between the patient and oncologist. Transition refers to the change from hospital-led to community-based care. Barriers to transition included patient and family acceptance, attachment and concerns about community services. Transition was more acceptable if initiated in a gradual manner. Community care: participants found the Hospital2Home service crucial in establishing new trustworthy relationships between community providers and the patient. CONCLUSIONS Transfer of care from the acute sector to the community represents a delicate crossroad where complex notions of loss should not be underestimated. A gradual transfer of care may improve this if the patient's condition allows. Therefore, introductions to the community team should be timely, and a staggered transfer should be planned. This would improve the experience of the patient, carer and oncologist.
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Affiliation(s)
- Clare Smith
- Royal Marsden and Royal Brompton Palliative Care Service, Royal Marsden NHS Foundation Trust, London, UK
| | | | - Julia Riley
- Royal Marsden and Royal Brompton Palliative Care Service, Royal Marsden NHS Foundation Trust, London, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
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Pocock LV, Ives A, Pring A, Verne J, Purdy S. Factors associated with hospital deaths in the oldest old: a cross-sectional study. Age Ageing 2016; 45:372-6. [PMID: 26946050 DOI: 10.1093/ageing/afw019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 10/21/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS/OBJECTIVES to study associations between the likelihood of hospital death with patient demographics, cause of death and co-morbidities for people aged ≥85 at death who have been previously admitted (within 12 months of death) to hospital. METHODS a cross-sectional study, using death registration data and hospital episode statistics, for 671,178 England residents who had been admitted to hospital during the 12 months before death and were aged 85 or over at death during 2008-12. The outcome variable was the likelihood of dying in hospital. Covariates included gender, age, social deprivation, care home residence, cause of death and co-morbidity. Potential associations were explored by multivariable regression analysis. RESULTS sixty-two per cent of the sample died in hospital. The likelihood of dying in hospital varies significantly with age, cause of death, deprivation, number of emergency hospital and co-morbidities. People aged over 90 at the time of death are less likely to die in hospital than those aged 85-89 [odds ratio (OR) for aged 90-94, 0.99; 95% confidence interval (CI) 0.98-1.00, OR for aged 95 and over, 0.91; 95% CI: 0.89-0.92]. People who are care home residents at the time of death are significantly less likely to die in hospital (OR 0.34; 95% CI: 0.34-0.35). Having a mention of dementia on the death certificate was significantly associated with a reduction in the likelihood of dying in hospital (OR 0.32; 95% CI: 0.31-0.32). CONCLUSIONS the likelihood of an older person dying in hospital is significantly associated with a number of socio-demographic factors, such as age and level of deprivation. Care home residence is significantly associated with a reduction in likelihood of hospital death.
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Affiliation(s)
- Lucy Victoria Pocock
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Alex Ives
- National End of Life Care Intelligence Network, Public Health England, Bristol, UK
| | - Andy Pring
- National End of Life Care Intelligence Network, Public Health England, Bristol, UK
| | - Julia Verne
- National End of Life Care Intelligence Network, Public Health England, Bristol, UK
| | - Sarah Purdy
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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Fleming J, Farquhar M, Brayne C, Barclay S. Death and the Oldest Old: Attitudes and Preferences for End-of-Life Care--Qualitative Research within a Population-Based Cohort Study. PLoS One 2016; 11:e0150686. [PMID: 27045734 PMCID: PMC4821585 DOI: 10.1371/journal.pone.0150686] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/18/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Increasing longevity means more people will be dying in very old age, but little is known about the preferences of the 'oldest old' regarding their care at the end of life. AIMS To understand very old people's preferences regarding care towards the end of life and attitudes towards dying, to inform policy and practice. METHODS Qualitative data collection for n = 42 population-based cohort study participants aged 95-101 (88% women, 42% in long-term-care): topic-guided interviews with n = 33 participants and n = 39 proxy informants, most with both (n = 30: 4 jointly + separate interviews for 26 dyads). RESULTS Death was a part of life: these very old people mainly live day-to-day. Most were ready to die, reflecting their concerns regarding quality of life, being a nuisance, having nothing to live for and having lived long enough. Contrasting views were rare exceptions but voiced firmly. Most were not worried about death itself, but concerned more about the dying process and impacts on those left behind; a peaceful and pain-free death was a common ideal. Attitudes ranged from not wanting to think about death, through accepting its inevitable approach to longing for its release. Preferring to be made comfortable rather than have life-saving treatment if seriously ill, and wishing to avoid hospital, were commonly expressed views. There was little or no future planning, some consciously choosing not to. Uncertainty hampered end-of-life planning even when death was expected soon. Some stressed circumstances, such as severe dependency and others' likely decision-making roles, would influence choices. Carers found these issues harder to raise but felt they would know their older relatives' preferences, usually palliative care, although we found two discrepant views. CONCLUSIONS This study's rare data show ≥95-year-olds are willing to discuss dying and end-of-life care but seldom do. Formal documentation of wishes is extremely rare and may not be welcome. Although being "ready to die" and preferring a palliative approach predominated, these preferences cannot be assumed.
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Affiliation(s)
- Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Morag Farquhar
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Barclay
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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Abstract
ABSTRACTThis paper examines some demographic and medical factors associated with the likelihood of residing in a care home during the last month of life for persons aged 70 and over in France and, if so, of remaining in the care home throughout or being transferred to hospital. The data are from the Fin de vie en France (End of Life in France) survey undertaken in 2010. During the last month of life, very old people are more likely to be living in a care home but are not less likely to be transferred to hospital. Medical conditions and residential trajectories are closely related. People with dementia or mental disorders are more likely to live in a care home and, if so, to stay there until they die. Compared to care homes, a more technical and medication-based approach is taken in hospitals and care home residents who are transferred to hospital more often receive medication while those remaining in care homes more often receive support from a psychologist. In hospitals as in care homes, few older persons had recourse to advance directives and hospice programmes were not widespread. Promoting these two factors may help to increase the quality of end of life and facilitate an ethical approach to end-of-life care.
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Où meurent les personnes âgées ? Étude nationale en France (1990–2010). MEDECINE PALLIATIVE 2015. [DOI: 10.1016/j.medpal.2015.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Morin L, Johnell K, Aubry R. Variation in the place of death among nursing home residents in France. Age Ageing 2015; 44:415-21. [PMID: 25605581 DOI: 10.1093/ageing/afu197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/24/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES recent studies have reported that hospitals have become a common place of death for nursing home residents. This study aimed to (i) measure variations in the proportion of in-hospital deaths across regions after adjustment for facility-level characteristics and (ii) identify environmental risk factors that might explain these variations in France. DESIGN a cross-sectional retrospective survey was conducted in 2013. SETTING AND PARTICIPANTS coordinating physicians in 3,705 nursing homes in France. MEASUREMENTS a regression model was used to construct risk-adjusted rates of in-hospital deaths considering the facilities' characteristics. At the regional level, the outcome was defined as the difference between the observed rate of in-hospital deaths and the expected risk-adjusted rate. Values exceeding zero indicated rates that exceeded the national predicted rate of in-hospital deaths and thus highlighted regions in which the risk-adjusted probability for nursing home residents to die in a hospital was greater than average. RESULTS among 70,119 nursing home decedents, 25.4% (n = 17,789) died in hospitals. The characteristics of the facilities had a significant influence on the proportion of in-hospital deaths among the nursing home decedents. However, after adjustment for these facility-level risk factors, the proportion of nursing homes that reported worse-than-average outcomes showed significant variation (range 26.0-79.6%). At the regional level, both the rate of acute hospital beds and the rate of general practitioners were found to be strongly correlated with the probability of reporting worse-than-average outcomes (P < 0.001). CONCLUSION our study demonstrates the existence of major differences across regions in France and highlights the need for targeted interventions regarding end-of-life care in nursing home facilities.
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Affiliation(s)
- Lucas Morin
- French National Observatory on End-of-Life Care, Paris, France Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Kristina Johnell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Régis Aubry
- University Hospital of Besancon, Besançon, France
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Van den Block L, Pivodic L, Pardon K, Donker G, Miccinesi G, Moreels S, Vega Alonso T, Deliens L, Onwuteaka-Philipsen B. Transitions between health care settings in the final three months of life in four EU countries. Eur J Public Health 2015; 25:569-75. [DOI: 10.1093/eurpub/ckv039] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reyniers T, Deliens L, Pasman HR, Morin L, Addington-Hall J, Frova L, Cardenas-Turanzas M, Onwuteaka-Philipsen B, Naylor W, Ruiz-Ramos M, Wilson DM, Loucka M, Csikos A, Rhee YJ, Teno J, Cohen J, Houttekier D. International Variation in Place of Death of Older People Who Died From Dementia in 14 European and non-European Countries. J Am Med Dir Assoc 2015; 16:165-71. [DOI: 10.1016/j.jamda.2014.11.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 11/25/2022]
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Affiliation(s)
- Alexia M Torke
- 1Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA
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