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Wang L, Li Y, Zhao R, Li J, Gong X, Li H, Chi Y. Influencing factors of home hospice care needs of the older adults with chronic diseases at the end of life in China: a cross-sectional study. Front Public Health 2024; 12:1348214. [PMID: 38859895 PMCID: PMC11163093 DOI: 10.3389/fpubh.2024.1348214] [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: 12/02/2023] [Accepted: 05/14/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Chronic diseases are becoming a serious threat to the physical and mental health of older people in China as their aging process picks up speed. Home hospice care addresses diverse needs and enhances the quality of life for older adult individuals nearing the end of life. To ensure the well-being of chronically ill older adults at the end of life, it is vital to explore and assess the multidimensional hospice needs of terminally ill older individuals in their homes. The aim of this study was to investigate the current situation of home hospice care needs of Chinese older adults with chronic diseases at the end of life, and to analyze the influencing factors (sociodemographic and disease-related factors). Methods In this cross-sectional study, 247 older adult people with chronic diseases at the end of life were selected from the communities of 4 community health service centers in Jinzhou City, Liaoning Province from June to October 2023 by random sampling method. A general information questionnaire and the home hospice care needs questionnaire developed by our research group were used to investigate. Independent samples t-test or one-way ANOVA was used to compare the differences in the scores of different characteristics, and the factors with significant differences were selected for multivariate linear regression analysis to determine the final influencing factors. Results The total score of home hospice needs of the dying older adult was 115.70 ± 12, with the mean scores for each dimension in descending order being Information Needs (3.96 ± 0.61), Social Support Needs (3.96 ± 0.44), Spiritual Needs (3.92 ± 0.43), Physical Needs (3.60 ± 0.59), Psychological Needs (3.37 ± 0.65). Status of residence, duration of illness (year), the type of disease, and self-care ability were influential factors in the total score of home hospice needs. Discussion The need for hospice care for the terminally ill older adult is high, and healthcare professionals should implement services according to the influencing factors of need to meet their multidimensional needs and improve their quality of life.
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Affiliation(s)
- Lei Wang
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Yaru Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Rui Zhao
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Jiangxu Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Xiangru Gong
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Hongyu Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Yuan Chi
- Department of Science and Technology, Jinzhou Medical University, Jinzhou, China
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Wu Y, Zhang X. Examining Conversation Analysis in Palliative Care: A Systematic Review. HEALTH COMMUNICATION 2024:1-12. [PMID: 38166606 DOI: 10.1080/10410236.2023.2301202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Communication is an integral component in palliative care. A number of studies have used conversation analysis (CA) to examine communication between healthcare professionals (HCPs) and patients/companions in palliative care. To the best of our knowledge, however, no work has been done to synthesize these studies. Thus, the review aimed to synthesize these conversation analytic studies in the setting of palliative care. The review included peer-reviewed studies that focused on communication between HCPs and patients/companions and that were published in English before September 10 2022. The database and manual search produced 16 eligible studies. The thematic analysis generated five themes: (1) promoting patient agency and autonomy; (2) practices for gathering pain-related information and navigating pain concerns (practices for gathering pain-related information and practices for navigating patients' pain concerns); (3) initiating and managing end-of-life discussions; (4) facilitating shared decision making in palliative care; and (5) navigating sensitive topics and uncertainty in prognostic talk. The review highlighted the potential of CA for research in palliative care and had implications for communication practice.
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Affiliation(s)
- Yijin Wu
- Center for Geriatric Healthcare Services and Health Education, Qufu Normal University
| | - Xin Zhang
- Center for Geriatric Healthcare Services and Health Education, Qufu Normal University
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Nigam K, Curseen KA, Beaussant Y. Psychedelics and Related Pharmacotherapies as Integrative Medicine for Older Adults in Palliative Care. Clin Geriatr Med 2023; 39:423-436. [PMID: 37385694 DOI: 10.1016/j.cger.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Psychological distress at the end of life is a common experience that lacks effective treatments. This is in part due to the multidimensional nature of psychological distress at the end of life, encompassing an interplay between psychosocial and existential distress as well as physical symptom burden. Research shows that psychedelic-assisted therapy is an effective treatment of end of life distress. Ketamine and cannabis may help with quick and effective treatment of symptom burden at the end of life. Although these novel interventions show promise, further data is needed, particularly in elderly populations.
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Affiliation(s)
- Kabir Nigam
- Department of Psychiatry, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School.
| | - Kimberly A Curseen
- Division of Palliative Care, Emory University, 1821 Clifton Road, NE, Suite 1017, Atlanta, GA 30329, USA
| | - Yvan Beaussant
- Harvard Medical School; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02115, USA
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Urmanche AA, Solomonov N, Sankin LS, Subramanyam A, Pedreza-Cumba M, Scaduto L, Garcia J, Jockers K, Wolf R, Sirey JA. Research-Practice Partnership to Develop and Implement Routine Mental Health Symptom Tracking Tool Among Older Adults During COVID-19. Am J Geriatr Psychiatry 2023; 31:326-337. [PMID: 36641298 PMCID: PMC9788852 DOI: 10.1016/j.jagp.2022.12.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Older adults are disproportionally impacted by the COVID-19 pandemic, causing a mental health crisis in late life, due to physical restrictions (e.g., quarantine), limited access to services, and lower literacy and access to technology. Despite established benefits, systematic screening of mental health needs of older adults in community and routine care settings is limited and presents multiple challenges. Cross-disciplinary collaborations are essential for identification and evaluation of mental health needs and service delivery. METHODS Using a research-practice partnership model, we developed and implemented a routine mental health needs identification and tracking tool at a community-based social services organization. Repeated screenings were conducted remotely over 5 months and included depression, anxiety, perceived loneliness, social support, and related domains such as sleep quality, resilience, and trauma symptoms linked to COVID-19. We examined symptomatic distress levels and associations between different domains of functioning. RESULTS Our project describes the process of establishing a research-practice partnership during the COVID-19 pandemic. We collected 292 screenings from 124 individuals; clients were mildly to moderately depressed and anxious, reporting large amounts of time alone and moderate levels of loneliness. Those reporting higher depressive symptoms reported higher anxiety symptoms, poorer sleep quality, lower quality of life, lower capacity to adapt to challenging situations, and greater trauma symptoms due to COVID-19. CONCLUSION Our routine screening tool can serve as a blueprint for case management agencies and senior centers nationwide, beyond the pressing mental health crisis due to COVID-19, to continue identifying needs as they emerge in the community.
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Affiliation(s)
- Adelya A Urmanche
- Weill Cornell Institute of Geriatric Psychiatry (AAU, NS, LSS, JAS), Weill Cornell Medical College, New York, NY; Mount Sinai Beth Israel (AAU), New York, NY
| | - Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry (AAU, NS, LSS, JAS), Weill Cornell Medical College, New York, NY
| | - Lindsey S Sankin
- Weill Cornell Institute of Geriatric Psychiatry (AAU, NS, LSS, JAS), Weill Cornell Medical College, New York, NY
| | | | | | | | | | - Ken Jockers
- Hudson Guild (AS, MPC, LS, JG, KJ, RW), New York, NY
| | - Robert Wolf
- Hudson Guild (AS, MPC, LS, JG, KJ, RW), New York, NY
| | - Jo Anne Sirey
- Weill Cornell Institute of Geriatric Psychiatry (AAU, NS, LSS, JAS), Weill Cornell Medical College, New York, NY.
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Nicholson CJ, Combes S, Mold F, King H, Green R. Addressing inequity in palliative care provision for older people living with multimorbidity. Perspectives of community-dwelling older people on their palliative care needs: A scoping review. Palliat Med 2022; 37:475-497. [PMID: 36002975 PMCID: PMC10074761 DOI: 10.1177/02692163221118230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Older people living with multimorbidity are projected to become the main recipients of palliative care in the coming decades, yet there is limited evidence regarding their expressed palliative care needs to inform person-centred care. AIM To understand the palliative care needs of community-dwelling people aged ⩾60 living with multimorbidity in the last 2 years of life. DESIGN A scoping review following Arksey and O'Malley. DATA SOURCES Three international electronic databases (CINAHL, Ovid Medline, PsycINFO) were searched from March 2018 to December 2021. Reference lists were hand searched. Eligible papers were those reporting empirical data on older people's needs. RESULTS From 985 potential papers, 28 studies were included, published between 2002 and 2020; sixteen quantitative, nine qualitative and three mixed methods. Data were extracted and presented under the holistic palliative care domains of need: physical, psychological, social, spiritual, and additionally practical needs. Different measurement tools (n = 29) were used, of which 20 were multidimensional. Primacy in reporting was given to physical needs, most commonly pain and function. Social and practical needs were often prioritised by older people themselves, including maintaining social connections and accessing and receiving individualised care. CONCLUSION Identifying the palliative care needs that matter most to older people with multimorbidity requires the recognition of their concerns, as well as their symptoms, across a continuum of living and dying. Available evidence is superficial. Supporting end of life provision for this growing and underserved population necessitates a shift to tailored multidimensional tools and community focussed integrated care services.
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Affiliation(s)
| | - Sarah Combes
- University of Surrey, Guildford, UK
- St Christopher's Hospice, London, UK
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Associations between unmet palliative care needs and cognitive impairment in a sample of diverse, community-based older adults. Palliat Support Care 2020; 19:41-45. [PMID: 32583759 DOI: 10.1017/s1478951520000395] [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: 11/06/2022]
Abstract
OBJECTIVE Given a large number of community-based older adults with mild cognitive impairment, it is essential to better understand the relationship between unmet palliative care (PC) needs and mild cognitive impairment in community-based samples. METHOD Participants consisted of adults ages 60+ receiving services at senior centers located in New York City. The Montreal Cognitive Assessment (MoCA) and the Unmet Palliative Care Needs screening tool were used to assess participants' cognitive status and PC needs. RESULTS Our results revealed a quadratic relationship between unmet PC needs and mild cognitive impairment, controlling for gender, living status, and age. Participants with either low or high MoCA scores reported lower PC needs than participants with average MoCA scores, mean difference of the contrast (low and high vs. middle) = 2.15, P = 0.08. SIGNIFICANCE OF RESULTS This study is a first step toward elucidating the relationship between cognitive impairment and PC needs in a diverse community sample of older adults. More research is needed to better understand the unique PC needs of older adults with cognitive impairment living in the community.
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Check DK, Kaufman BG, Kamal AH, Casarett DJ. Top Ten Tips Palliative Care Clinicians Should Know About Integrating Population Health Principles into Practice. J Palliat Med 2020; 23:568-572. [DOI: 10.1089/jpm.2020.0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Devon K. Check
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | | | - Arif H. Kamal
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - David J. Casarett
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
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