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Hopkins SA, Hoare SE, Polak L, Lovick R, Simpson R, Chhetri JK, Kelly MP, Barclay S, Harwood RH. Does frailty need a new name? BMJ 2024; 386:e076862. [PMID: 38981648 DOI: 10.1136/bmj-2023-076862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Affiliation(s)
- Sarah A Hopkins
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah E Hoare
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Louisa Polak
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Rhian Simpson
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jagadish K Chhetri
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Michael P Kelly
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rowan H Harwood
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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Pivodic L, Van den Block L, Pivodic F. Social connection and end-of-life outcomes among older people in 19 countries: a population-based longitudinal study. THE LANCET. HEALTHY LONGEVITY 2024; 5:e264-e275. [PMID: 38490235 PMCID: PMC10978496 DOI: 10.1016/s2666-7568(24)00011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Social connection is a key determinant of health, but its role in shaping end-of-life outcomes is poorly understood. We examined changes in structure, function, and quality components of social connection in older people's last years of life, and the extent to which social connection predicts end-of-life outcomes (ie, symptoms, health-care utilisation, and place of death). METHODS This study used longitudinal data of representative samples from across 18 European countries and Israel in the Survey of Health, Ageing, and Retirement in Europe (SHARE), the largest European cohort study of people aged 50 years or older. We included deceased participants of waves 4 and 6 (which contained social network modules) for whom a proxy provided an end-of-life interview. We did paired sample t-tests (for continuous variables), Wilcoxon signed-rank tests (for ordinal variables), and McNemar's tests (for non-ordinal categorical variables) to assess changes in structure, function, and quality components of social connection between waves 4 and 6. To examine social connection as a predictor of end-of-life outcomes, we used social connection data from wave 6 core interviews and end-of-life interviews from wave 7, conducted with a proxy respondent covering the deceased participant's last year of life. End-of-life outcomes included symptoms (pain, breathlessness, and anxiety or sadness) in the last month of life, health-care utilisation in the last year of life, and place of death. We conducted a mixed-effects logistic regression analysis per social connection measure, for each end-of-life outcome. FINDINGS Data were collected in 2011-12 for wave 4, 2015-16 for wave 6, and 2017-18 for wave 7. We studied 3356 individuals (mean age at death was 79·7 years [SD 10·2]), with interviews conducted, on average, 4·6 (1·2) years (wave 4) and 1·1 (0·7) years (wave 6) before death. From wave 4 to wave 6, the following changes in social connection were observed: proportion of married or partnered participants (from 1406 [60·9%] of 2310 to 1438 [57·1%] of 2518; p<0·0001), receiving personal care or practical help (from 781 [37·2%] of 2099 to 1334 [53·1%] of 2512; p<0·0001), loneliness (from mean 1·4 [SD 0·5] to 1·5 [0·6]; p<0·0001; scale 1-3), satisfaction with social network (from 8·8 [1·67] to 8·7 [1·7]; p=0·037; scale 0-10), and emotional closeness to social network (eg, from 1883 [88·8%] of 2121 to 1710 [91·3%] of 1872 participants who indicated being either very close or extremely close to social network members; p<0·0001). Higher levels of loneliness at wave 6 predicted a greater likelihood of experiencing symptoms in the last month of life (odds ratio range across symptoms: 1·29 [95% CI 1·08-1·55] to 1·58 [1·32-1·89]). Being married (1·32 [1·03-1·68]) or receiving personal care or practical help (1·25 [1·04-1·49]) predicted death in hospital. INTERPRETATION Social connection undergoes multifaceted changes towards older people's end of life, countering prevalent ideas of generally declining social trajectories. Loneliness in the final months of life might be a risk factor for end-of-life symptoms. Further research is needed to substantiate a causal relationship and to identify underpinning mechanisms, which could inform screening and prevention measures. FUNDING Research Foundation-Flanders and European Union.
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Affiliation(s)
- Lara Pivodic
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-Life Care Research Group, Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Family Medicine & Chronic Care, Brussels, Belgium.
| | - Lieve Van den Block
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-Life Care Research Group, Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Family Medicine & Chronic Care, Brussels, Belgium
| | - Fedja Pivodic
- World Bank, Health, Nutrition and Population Division; Washington DC, USA
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Murray SA, Boyd K, Moine S, Kendall M, Macpherson S, Mitchell G, Amblàs-Novellas J. Using illness trajectories to inform person centred, advance care planning. BMJ 2024; 384:e067896. [PMID: 38428953 DOI: 10.1136/bmj-2021-067896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Scott A Murray
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Kirsty Boyd
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Sebastien Moine
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
- Health Education and Practices Laboratory, University of Paris 13, Bobigny, France
| | - Marilyn Kendall
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Stella Macpherson
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
- patient author, UK
| | | | - Jordi Amblàs-Novellas
- Central Catalonia Chronicity Research Group, Faculty of Medicine, University of Vic-Central University of Catalonia, 08500 Vic, Spain
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Voie KS, Wiles J, Mæhre KS, Kristiansen M, Helgesen AK, Blix BH. The timescapes of older adults living alone and receiving home care: An interview study. J Aging Stud 2024; 68:101212. [PMID: 38458730 DOI: 10.1016/j.jaging.2024.101212] [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: 08/26/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/10/2024]
Abstract
In this study, we drew on Barbara Adam's (1998) timescape perspective and applied a timescape lens to our analysis of how nine older adults who live alone, receive home care and are considered by home care professionals to be frail, experience living (in) time. Over a period of eight months, we conducted three interviews with each of the nine participants. We analysed the data using reflexive thematic analysis and drew on timescapes to further interpret our preliminary analysis. Our results show that situated everyday time, place across time, and large-scale time interact in the framing and shaping of older adults' everyday lives. Older adults' embodied experiences of being of advanced age, living alone and receiving home care influenced their timescapes. We propose that paying attention to older adults' timescapes can enable home care professionals and other supporters to consider older adults' health, well-being, vulnerabilities and strengths from a broader perspective than the 'here and now' and thereby enhance the provision of person-centred care.
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Affiliation(s)
- Kristin S Voie
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Janine Wiles
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Kjersti Sunde Mæhre
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Margrethe Kristiansen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Ann Karin Helgesen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway; Faculty of Health, Welfare and Organisation, Østfold University College, Halden 1757, Norway.
| | - Bodil H Blix
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway; Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Bergen 5063, Norway.
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Bradley N, Dowrick C, Lloyd-Williams M. Explaining how and why social support groups in hospice day services benefit palliative care patients, for whom, and in what circumstances. Palliat Care Soc Pract 2023; 17:26323524231214549. [PMID: 38044931 PMCID: PMC10693225 DOI: 10.1177/26323524231214549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
Background Palliative care aims to provide holistic support for people with life-limiting illness, responding to psychological, social and spiritual needs, as well as to clinical and physical. In the United Kingdom, hospice day services (including day care, group interventions, group activities, and social events for palliative care outpatients) aim to provide opportunities for patients to gain social support, which is thought to improve their quality of life. Objectives This research explored social support within hospice day services, to explain in detail how and why social support obtained within a hospice day service could be beneficial to palliative care patients. Design Qualitative research using observations of hospice day services and interviews with service providers. Methods Data collection involved nineteen interviews with hospice service providers (n = 19) and researcher observations of hospice day services. The findings detail how patient and hospice context interact to produce mechanisms that lead to outcomes beyond the hospice day service. Results Practical, clinical and social aspects of the hospice day service are important for patients feeling welcome and safe in the setting. The opportunity to connect with other people and work towards personal goals can boost self-confidence for patients who have lost access to meaningful activity. New friendships between patients encourages reciprocal support and feelings of belonging. It is beneficial to have permission to speak freely about topics deemed inappropriate elsewhere, because honest communication is helpful in accepting and adapting to their circumstances. Conclusion Hospice day services facilitate group settings for reciprocal social support. This research proposes an initial programme theory that can be further developed and tested. It explains how and why, in some contexts, social support increases personal and practical resources to cope with illness and death, leading to changes outside of the hospice (to mood, interpersonal interactions and behaviour) that could improve quality of life.
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Affiliation(s)
- Natasha Bradley
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT7 1NN, UK
- Centre for Health & Clinical Research, University of the West of England (UWE), Bristol BS16 1DD, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Jonasson LL, Bångsbo A, Billhult A, Wolmesjö M. Older adults' experiences of participation in daily activities in Swedish assisted living. BMC Geriatr 2023; 23:762. [PMID: 37990295 PMCID: PMC10662507 DOI: 10.1186/s12877-023-04484-y] [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] [Received: 03/10/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND According to Swedish law, older adults in Sweden should be able to live a good, safe, and independent life with social and healthcare provided, based on their individual needs. In assisted living in Swedish eldercare the environment affects the older adults' ability to participate in decision-making and strengthens their ability to feel meaningfulness. The ability of staff working in social and healthcare to invite older adults to participate varies. It is important to examine how older adults perceive their situation, as caregivers in eldercare tend to focus on routine work and experience difficulties in meeting the individual needs of older adults. The aim of this study was to explore how older adults in assisted living experienced participation in daily activities. METHODS A qualitative interview study was conducted in two municipalities in the western part of Sweden. An exploratory and inductive design was used. Individual interviews were conducted with 11 older adults living in two different assisted living facilities. The data were analysed using thematic analysis. RESULTS The interviews resulted in three themes: Being involved, Sense of well-being, and Influenced by the context. The older adults' experiences of participation were interpreted as feelings of being involved in daily life activities, and how they felt involved in their own care and nursing. Participation created prerequisites for well-being. Sense of well-being could be related to feelings of security and social community. The organisation and work environment of the healthcare staff had a great impact on their ability to increase the participation of the older adults. The older adults were aware of the everyday work situation of the providers of social and healthcare and were Influenced by the context. DISCUSSION/CONCLUSION Important conditions for a good quality of life and participation for the older adults are to be treated with respect, receive information, and be able to choose. The older adults expressed several good ideas for improvements and a willingness to be involved in the development of the organisation at different levels. It is essential to invite older adults in assisted living to participate in the design of care and nursing.
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Affiliation(s)
- Lise-Lotte Jonasson
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Angela Bångsbo
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Annika Billhult
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Maria Wolmesjö
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Ghiglieri C, Dempster M, Wright S, Graham-Wisener L. Psychosocial functioning in individuals with advanced oesophago-gastric cancer: a mixed methods systematic review. BMC Palliat Care 2023; 22:164. [PMID: 37891568 PMCID: PMC10612179 DOI: 10.1186/s12904-023-01288-0] [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] [Received: 09/05/2022] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Oesophago-gastric cancer is an aggressive disease with a high rate of recurrence and mortality across the disease trajectory. Reduced psychosocial functioning has been evidenced amongst those with advanced disease, however little is known about the contributing factors. Determining these factors is an important clinical consideration to inform assessment and intervention. This review aimed to synthesise the available evidence on the psychosocial functioning of individuals with advanced oesophago-gastric cancer and their carers. METHODS A JBI mixed-methods systematic review. Four bibliographic databases, MEDLINE, Embase, PsycINFO, and CINAHL, were searched. Quantitative and qualitative studies were screened for inclusion and critically appraised for methodological quality. Both types of data were extracted using JBI tools for mixed-methods systematic reviews. A convergent segregated approach to synthesis and integration was used. The findings of the synthesis have been configured according to JBI methodology. RESULTS A total of 12 studies were included in this review, including 6 quantitative studies and 6 qualitative studies. The quantitative results provide preliminary indication of several physical, biological, psychological and macro-level contextual factors associated with psychosocial functioning in this clinical population. The qualitative findings shed light on a range of physical, psychosocial, and existential challenges faced by advanced oesophago-gastric cancer patients. These multiple and often persistent challenges appear to cause considerable distress; however, patients describe the importance of maintaining a sense of normality and control over their illness and its effects. Patients value continuity and structure, however many report shortcomings when accessing care. No findings reporting the experiences from the perspective of carers were found, therefore all findings represent the perspective of the patient. CONCLUSIONS Further high-quality research is needed to understand how best to support and manage the palliative care needs of individuals living with advanced oesophago-gastric cancer. Implications for practice are discussed, suggesting that psychosocial interventions, complex symptom management and continuity of care could improve the psychosocial functioning of individuals in this setting. PRE-REGISTRATION The systematic review was pre-registered at the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020181273) and the protocol can be viewed on the OSF ( http://osf.io/exuzf ).
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Affiliation(s)
- Cara Ghiglieri
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland.
| | - Martin Dempster
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland
| | - Sam Wright
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland
| | - Lisa Graham-Wisener
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland
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Seeley A, Glogowska M, Hayward G. 'Frailty as an adjective rather than a diagnosis'-identification of frailty in primary care: a qualitative interview study. Age Ageing 2023; 52:afad095. [PMID: 37366329 PMCID: PMC10294554 DOI: 10.1093/ageing/afad095] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION In 2017, NHS England introduced proactive identification of frailty into the General Practitioners (GP) contract. There is currently little information as to how this policy has been operationalised by front-line clinicians, their working understanding of frailty and impact of recognition on patient care. We aimed to explore the conceptualisation and identification of frailty by multidisciplinary primary care clinicians in England. METHODS Qualitative semi-structured interviews were conducted with primary care staff across England including GPs, physician associates, nurse practitioners, paramedics and pharmacists. Thematic analysis was facilitated through NVivo (Version 12). RESULTS Totally, 31 clinicians participated. Frailty was seen as difficult to define, with uncertainty about its value as a medical diagnosis. Clinicians conceptualised frailty differently, dependant on job-role, experience and training. Identification of frailty was most commonly informal and opportunistic, through pattern recognition of a frailty phenotype. Some practices had embedded population screening and structured reviews. Visual assessment and continuity of care were important factors in recognition. Most clinicians were familiar with the electronic frailty index, but described poor accuracy and uncertainty as to how to interpret and use this tool. There were different perspectives amongst professional groups as to whether frailty should be more routinely identified, with concerns of capacity and feasibility in the current climate of primary care workload. CONCLUSIONS Concepts of frailty in primary care differ. Identification is predominantly ad hoc and opportunistic. A more cohesive approach to frailty, relevant to primary care, together with better diagnostic tools and resource allocation, may encourage wider recognition.
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Affiliation(s)
- Anna Seeley
- Address correspondence to: Anna Seeley. Tel: 01865 617855.
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Patel V, Lindenmeyer A, Gao F, Yeung J. A qualitative study exploring the lived experiences of patients living with mild, moderate and severe frailty, following hip fracture surgery and hospitalisation. PLoS One 2023; 18:e0285980. [PMID: 37200345 DOI: 10.1371/journal.pone.0285980] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/07/2023] [Indexed: 05/20/2023] Open
Abstract
It is well recognised that hip fracture surgery is associated with a negative impact on short and long-term post-operative physical health and emotional well-being for patients. Furthermore, these patients are known to be frail with multiple co-morbidities. This study explores how frailty shapes the lived experiences of rehabilitation and recovery for patients who have undergone hip fracture surgery. Semi-structured interviews were conducted with sixteen participants, recently discharged from hospital following hip fracture surgery. Interpretative phenomenological analysis was applied to explore the lived experiences of frail patients and ascertain important themes. Patient experiences were captured in seven overarching themes: 1) the hospital as a place of "safety", 2) placing trust in others, 3) the slow recovery journey impeded by attitude and support, 4) maintaining autonomy and dignity whilst feeling vulnerable, 5) seeking a new normal, 6) loneliness and social isolation and 7) the ageing body. Based on our study findings, we have been able to suggest a number of opportunities to improve support for frailer patients in finding a new routine to their everyday lives, these include on-going physical and psychological support, information and education and a robust pathway for transition of care into the community. A conceptual thematic diagram is presented which helps to understand the experience and the complex needs of frail older people undergoing hip fracture surgery.
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Affiliation(s)
- Vanisha Patel
- Department of Anaesthetics, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Antje Lindenmeyer
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Fang Gao
- Birmingham Acute Care Research Centre, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Birmingham, United Kingdom
| | - Joyce Yeung
- Warwick Medical School, Warwick Clinical Trials Unit, University of Warwick, Warwick, United Kingdom
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Hanson S, Nissen SK, Nielsen D, Lassen A, Brabrand M, Forero R, Jensen JS, Ryg J. What matters and influence resuscitation preference? Development, field testing, and structural validation of items among older patients in the emergency department. BMC Geriatr 2022; 22:995. [PMID: 36564759 PMCID: PMC9783719 DOI: 10.1186/s12877-022-03707-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Decisions about resuscitation preference is an essential part of patient-centered care but a prerequisite is having an idea about which questions to ask and understand how such questions may be clustered in dimensions. The European Resuscitation Council Guidelines 2021 encourages resuscitation shared decision making in emergency care treatment plans and needs and experiences of people approaching end-of-life have been characterized within the physical, psychological, social, and spiritual dimensions. We aimed to develop, test, and validate the dimensionality of items that may influence resuscitation preference in older Emergency Department (ED) patients. METHODS A 36-item questionnaire was designed based on qualitative interviews exploring what matters and what may influence resuscitation preference and existing literature. Items were organized in physical, psychological, social, and spiritual dimensions. Initial pilot-testing to assess content validity included ten older community-dwelling persons. Field-testing, confirmatory factor analysis and post-hoc bifactor analysis was performed on 269 older ED patients. Several model fit indexes and reliability coefficients (explained common variance (ECV) and omega values) were computed to evaluate structural validity, dimensionality, and model-based reliability. RESULTS Items were reduced from 36 to 26 in field testing. Items concerning religious beliefs from the spiritual dimension were misunderstood and deemed unimportant by older ED patients. Remaining items concerned physical functioning in daily living, coping, self-control in life, optimism, overall mood, quality of life and social participation in life. Confirmatory factor analysis displayed poor fit, whereas post-hoc bifactor analysis displayed satisfactory goodness of fit (χ2 =562.335 (p<0.001); root mean square error of approximation=0.063 (90% CI [0.055;0.070])). The self-assessed independence may be the bifactor explaining what matters to older ED patients' resuscitation preference. CONCLUSIONS We developed a questionnaire and investigated the dimensionality of what matters and may influence resuscitation preference among older ED patients. We could not confirm a spiritual dimension. Also, in bifactor analysis the expected dimensions were overruled by an overall explanatory general factor suggesting independence to be of particular importance for clinicians practicing resuscitation discussions in EDs. Studies to investigate how independence may relate to patients' choice of resuscitation preference are needed.
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Affiliation(s)
- Stine Hanson
- grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, Center-Esbjerg, University of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Søren Kabell Nissen
- grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, Center-Esbjerg, University of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Dorthe Nielsen
- grid.7143.10000 0004 0512 5013Center for Global Health, Migrant Health Clinic, Odense University Hospital, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense, Denmark ,grid.7143.10000 0004 0512 5013Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense, Denmark
| | - Annmarie Lassen
- grid.7143.10000 0004 0512 5013Department of Emergency Medicine, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense, Denmark
| | - Mikkel Brabrand
- grid.414576.50000 0001 0469 7368Department of Emergency, Medicine, Hospital of South-west Jutland, Esbjerg, Denmark ,grid.10825.3e0000 0001 0728 0170University of Southern Denmark, Institute of Regional Health Research, Center-Esbjerg, University of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Roberto Forero
- grid.1005.40000 0004 4902 0432Simpson Centre for Health Services Research, University of NSW, Liverpool BC,, NSW 1871 Australia ,grid.415994.40000 0004 0527 9653Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool BC, NSW 1871 Australia
| | - Jens Søndergaard Jensen
- grid.154185.c0000 0004 0512 597XThe Research Clinic for Functional Disorders and psychosomatics, Aarhus University Hospital. Nordre Ringgade, 1,8000 Aarhus, Denmark
| | - Jesper Ryg
- grid.7143.10000 0004 0512 5013Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense, Denmark
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Miller S, Lee DA, Muhimpundu S, Maxwell CA. Developing and pilot testing a frailty-focused education and communication training workshop. PEC INNOVATION 2022; 1:100013. [PMID: 37364013 PMCID: PMC10194190 DOI: 10.1016/j.pecinn.2021.100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 06/28/2023]
Abstract
Objective To describe development and pilot testing of a multi-modal frailty-focused education and communication training workshop for health care clinicians. Methods Pilot testing was conducted via two workshops (#1:face-to-face [2019], #2:virtual [2020]). Participants: convenience sample of clinicians and students who volunteered. Workshop #1 included registered nurses working in an acute care and one medical student (N=14); #2: nursing students enrolled in an APRN program. Design: Pre/post observational study. Data analysis: descriptive statistics, paired t-tests and Wilcoxon rank test. Results Statistically significant increases in frailty knowledge (#1: p = 0.02, d = 0.44; #2: p = 0.006, d = 0.55) and self-reported competency with older adult interactions (#1: p < 0.001, d = 0.62; #2: p = 0.001, d = 0.63) were reported for both workshops. Post course evaluations of the workshop were positive, with scores ranging from 3.5-3.9 (range: 0-4) for increased understanding of the concept of frailty, communication to support health-related behavior, and best practice empathic communication skills. Conclusion The FCOM workshop was successful. Participants gained knowledge and skills for use in working with older adults across the aging continuum from non-frail to frail. Innovation Our FCOM training workshop expands prior communication training on shared decision-making with frail individuals to a broader population of all older adults.
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Affiliation(s)
- Sally Miller
- Vanderbilt University School of Nursing, 461 21 Ave South, Nashville, TN 37240, USA
| | - Deborah A. Lee
- Middle Tennessee State University, 1301 East Main Street, Murfreesboro, TN 37132, USA
| | - Sylvie Muhimpundu
- Vanderbilt University School of Nursing, 461 21 Ave South, Nashville, TN 37240, USA
| | - Cathy A. Maxwell
- Vanderbilt University School of Nursing, 461 21 Ave South, Nashville, TN 37240, USA
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Dark-Freudeman A, Bensadon BA. Advance care planning: End-of-life hopes and fears among community dwelling adults. J Health Psychol 2022; 27:3177-3189. [PMID: 35445612 DOI: 10.1177/13591053221089726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
End-of-life (EOL) medical care in the United States often does not align with patients' goals and preferences. This study explored EOL hopes and fears among 86 community-dwelling adults and examined medical and psychological predictors of death anxiety. Common EOL hopes included absence of suffering, closure, and personal fulfillment. Common EOL fears included suffering, lack of competence, and specific types of death. Fear of the dying process was greater than fear of death itself. Health predicted death anxiety; age alone, did not. Advance care planning and clinical decision making should include these psychological insights and explicitly address EOL hopes and fears.
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Sjöberg M, Rasmussen BH, Edberg AK, Beck I. Existential aspects documented in older people’s patient records in the context of specialized palliative care: a retrospective review. BMC Health Serv Res 2022; 22:1356. [PMID: 36384554 PMCID: PMC9667671 DOI: 10.1186/s12913-022-08753-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Documentation of older people’s end-of-life care should cover the care given and provide an overview of their entire situation. Older people approaching the end of life often have complex symptoms, live with bodily losses, and face an unknown future in which existential aspects come to the forefront. Knowledge of the existential aspects recorded in palliative care documentation is sparse and merits improvement. This knowledge is relevant to the development of more holistic documentation and is necessary in order to promote reflection on and discussion of documentation of the sensitive existential considerations arising in palliative care. The aim of this study was to describe the documentation of existential aspects in the patient records of older people receiving specialized palliative care. Methods Data were obtained from a retrospective review of the free-text notes in 84 records of randomly selected patients aged ≥75 years enrolled in specialized palliative care units who died in 2017. The notes were analysed using an inductive qualitative content analysis. Results The notes documented existential aspects in terms of connotations of well-being and ill-being. Documented existential aspects were related to the patients’ autonomy concerning loss of freedom and self-determination, social connectedness concerning loneliness and communion, emotional state concerning anxiety and inner peace, and state of being concerning despair and hope. The notes on existential aspects were, however, not recorded in a structured way and no care plans related to existential aspects were found. Conclusions Existential aspects concerning both ill-being and well-being were sparsely and unsystematically documented in older people’s patient records, but when notes were extracted from these records and analysed, patterns became evident. Existential aspects form an important basis for delivering person-centred palliative care. There is a need to develop structured documentation concerning existential aspects; otherwise, patients’ thoughts and concerns may remain unknown to healthcare professionals.
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Bradley N, Dowrick C, Lloyd-Williams M. Feasibility of Patient Reported Outcome Measures in Psychosocial Palliative Care: Observational Cohort Study of Hospice Day Care and Social Support Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13258. [PMID: 36293835 PMCID: PMC9603547 DOI: 10.3390/ijerph192013258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Palliative care patients can be at risk of social isolation or loneliness. Interventions that can provide effective social support, and particularly emotional support, could facilitate healthy coping that bolsters quality of life and reduces depression in palliative care patients. This is an observational cohort study which recruited thirty patients (n = 30) from the day services of four independent hospices in England. Participants completed patient reported outcome measures in perceived social support, loneliness, and depression, at up to three time points. Age range was 56-91 years, males and females were equally represented, and the sample was 93% white British. In participants that provided two or more timepoints, perceived social support increased, and loneliness and depression decreased. Largest changes with the least variation between participants was in emotional support (p = 0.165) and loneliness (p = 0.104). These results suggest that the psychosocial patient reported outcome measures used (MOS-SS, UCLA, BEDS) could be sensitive to change aligned with the goals of this intervention in palliative care. Participants in this study were observed to derive psychosocial benefit from attending the hospice day service.
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Affiliation(s)
- Natasha Bradley
- Centre for Health & Clinical Research, University of the West of England, Bristol BS16 1DD, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Mari Lloyd-Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool L69 3BX, UK
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15
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Prado E, Marcon S, Kalinke L, da Silva M, Barreto M, Takemoto A, Birolim M, Laranjeira C. Meanings and Experiences of End-of-Life Patients and Their Family Caregivers in Hospital-to-Home Transitions: A Constructivist Grounded Theory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12987. [PMID: 36293568 PMCID: PMC9602127 DOI: 10.3390/ijerph192012987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
This study explored the meanings and experiences of patients with terminal chronic diseases and their caregivers, who face the imminence of death in the home environment after hospital discharge. The qualitative study used constructivist grounded theory. The participants were individuals with a terminal chronic illness, discharged to home, and their family caregivers. Data were gathered from in-depth interviews and field notes, and a comparative analysis was conducted to identify categories and codes, according to Charmaz's theory. The sample consisted of 21 participants. Three inter-related data categories emerged: "Floating between acceptance and resistance: Perceiving the proximity of death", "Analysing the end from other perspectives: it is in the encounter with death that life is understood" and "Accepting the path: between the love of letting go and the love of wanting to stay". The categories translate the reconstruction of those facing end-of-life occurring in the home environment. It is amid the imminence of death that life gains intensity and talking about the finitude of life configures an opportunity to see life from other perspectives. Giving voice to individuals facing the mishaps of a terminal illness fosters the path to a comfortable death. For health professionals, it is an opportunity to provide structured and humanized care with an ethical attitude, in defence of human dignity.
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Affiliation(s)
- Eleandro Prado
- Postgraduate Program in Nursing, Nursing Department, State University of Maringá, Maringá 87020-900, Brazil
| | - Sonia Marcon
- Postgraduate Program in Nursing, Nursing Department, State University of Maringá, Maringá 87020-900, Brazil
| | - Luciana Kalinke
- Nursing Department, Federal University of Paraná, Curitiba 80210-170, Brazil
| | - Marcelle da Silva
- Anna Nery Nursing School, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Mayckel Barreto
- Postgraduate Program in Nursing, Nursing Department, State University of Maringá, Maringá 87020-900, Brazil
| | - Angelica Takemoto
- Nursing Department, Guairacá University Center, Guarapuava 85010-000, Brazil
| | - Marcela Birolim
- Nursing Department, Guairacá University Center, Guarapuava 85010-000, Brazil
| | - Carlos Laranjeira
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology, Rua de Santo André 66-68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal
- Research in Education and Community Intervention, Piaget Institute, 3515-776 Viseu, Portugal
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16
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Bradley NM, Dowrick CF, Lloyd-Williams M. A survey of hospice day services in the United Kingdom & Republic of Ireland : how did hospices offer social support to palliative care patients, pre-pandemic? Palliat Care 2022; 21:170. [PMID: 36195870 PMCID: PMC9532229 DOI: 10.1186/s12904-022-01061-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Social support is described by patients and other stakeholders to be a valuable component of palliative day care. Less is known about the range of hospice services that have been used in practice that facilitate social support. An online survey aimed to gain an overview of all hospice day services that facilitated social support for adults outside of their own homes. METHODS An online survey was distributed via email to people involved in managing hospice day services. Questions were asked on hospice characteristics, including staff and volunteer roles. Respondents were asked to identify services they felt offered social support to patients. Data collection took place between August 2017 and May 2018. RESULTS Responses were received from 103 hospices in the UK and ROI (response rate 49.5%). Results provide an overview of hospice day and outpatient services that offer social support to patients. These are: multi-component interventions, activity groups, formal support groups, befriending, and informal social activities. Multi-component interventions, such as palliative day care, were the most commonly reported. Their stated aims tend to focus on clinical aspects, but many survey respondents considered these multicomponent interventions to be the 'most social' service at their hospice. The survey also identified a huge variety of activity groups, as well as formal therapeutic support groups. Informal 'social-only' activities were present, but less common. Over a third of all the services were described as 'drop in'. Most responding hospices did not routinely use patient reported outcome measures in their 'most social' services. CONCLUSIONS The survey documents hospice activity in facilitating social support to be diverse and evolving. At the time of data collection, many hospices offered multiple different services by which a patient might obtain social support outside of their own home and in the presence of other patients.
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Affiliation(s)
- N M Bradley
- Research Fellow in Realist Evaluation, Centre for Health & Clinical Research, University of the West of England, Glenside Campus, BS16 1DD., Bristol, United Kingdom.
| | - C F Dowrick
- Emeritus Professor, Department of Primary Care and Mental Health, University of Liverpool, Waterhouse Building, L69 3BX., Liverpool, United Kingdom
| | - M Lloyd-Williams
- Professor & Honorary Consultant in Palliative Medicine, Department of Primary Care and Mental Health, University of Liverpool, Waterhouse Building, L69 3BX, Liverpool, United Kingdom
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Martín-Abreu CM, Hernández R, Cruz-Castellanos P, Fernández-Montes A, Lorente-Estellés D, López-Ceballos H, Ostios-Garcia L, Antoñanzas M, Jiménez-Fonseca P, García-García T, Calderon C. Dignity and psychosocial related variables in elderly advanced cancer patients. BMC Geriatr 2022; 22:732. [PMID: 36064353 PMCID: PMC9446795 DOI: 10.1186/s12877-022-03423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/30/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Most cancers occur in older individuals, who are more vulnerable due to functional impairment, multiple comorbidities, cognitive impairment, and lack of socio-familial support. These can undermine patients' sense of dignity. This study seeks to compare dignity scores in older patients with advanced cancer on sociodemographic and clinical variables and analyze the predictive value of anxiety, depression, functional limitations, and social support on dignity scores. METHODS A prospective, multicenter, observational study conducted with participation of 15 hospitals in Spain from February 2020 to October 2021. Patients with newly-diagnosed, advanced cancer completed the dignity (PPDS), anxiety and depression (BSI), Social Support (Duke-UNC-11), and functional limitations (EORTC-C30) scales. Lineal regression analyses explored the effects of anxiety, depression, functional status, and social support on dignity, adjusting for sociodemographic and clinical variables. RESULTS A total of 180 subjects participated in this study. The results of the correlation analysis revealed that dignity correlated negatively with anxiety, depression, and sex, and positively with social support, functional status, and longer estimated survival. Thus, women, and more anxious and depressed individuals scored lower on the dignity scale, whereas patients with more social support, fewer functional limitations, and longer estimated survival scored higher. CONCLUSION In conclusion, being female, having a lower educational level, lower estimated survival, depression, anxiety, less social support, and limited functionality are correlated with less dignity in the elderly with advanced cancer. It is a priority to manage both physical and psychological symptoms in patients with unresectable advanced cancer to mitigate psychological distress and increase their sense of dignity.
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Affiliation(s)
- Carla M Martín-Abreu
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Ana Fernández-Montes
- Department of Medical Oncology, Complejo Hospitalario Universitario de Ourense - CHUO, Ourense, Spain
| | - David Lorente-Estellés
- Department of Medical Oncology, Hospital Provincial de Castellón, Castelló de la Plana, Spain
| | | | | | - Mónica Antoñanzas
- Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Teresa García-García
- Department of Medical Oncology, Hospital Universitario Santa Lucia, Cartagena, Spain
| | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.
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18
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Swan S, Meade R, Cavers D, Kimbell B, Lloyd A, Carduff E. Factors influencing adult carer support planning for unpaid caregiving at the end of life in Scotland: Qualitative insights from triangulated interviews and focus groups. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1422-1432. [PMID: 34427355 PMCID: PMC9290463 DOI: 10.1111/hsc.13472] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 02/24/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
Caring for a relative or friend at the end of life can be rewarding but all-encompassing. These caregivers are often not identified, meaning their diverse needs remain unmet, and the lack of assessment, support and planning increases the likelihood of crisis and burnout. The Carers (Scotland) Act 2016 places responsibility on local authorities to implement such a plan, which will be fast-tracked for carers supporting someone at the end of life. Our research described the factors which might influence this planning, triangulating primary focus groups with 15 carers and secondary qualitative data from transcripts with 30 carers, all of whom who had looked after someone with a terminal illness. Analysis was iterative, and constant comparative analysis of the secondary data informed the primary focus groups. Three main themes were identified; 1. The importance of early identification as a carer to enable timely assessment and support. 2. Carers experience isolation and loneliness which limits opportunities for support. 3. Responding in a timely fashion to carer assessment and support is vital to avoid crises. This research confirms that identifying carers early in the illness trajectory, ideally at diagnosis, is vital to avoid carer burnout. Health and social care providers have a key role in identification and should ensure, where possible, that carer needs are dynamically assessed, supported and documented. Finally, caring does not end after death, it extends into bereavement. Thus, we need to consider system and cultural change to ensure the experiences and needs of carers are addressed and valued.
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Affiliation(s)
| | | | - Debbie Cavers
- Usher InstituteUniversity of EdinburghOld Medical SchoolEdinburghUK
| | - Barbara Kimbell
- Usher InstituteUniversity of EdinburghOld Medical SchoolEdinburghUK
| | - Anna Lloyd
- Usher InstituteUniversity of EdinburghOld Medical SchoolEdinburghUK
- St Columba's HospiceEdinburghUK
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19
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Exploring the type of social support available to aged male hypertensive clients in Ghana. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
To explores the social support available to aged hypertensive male clients in a municipality in Ghana.
Methods
The inclusion criteria were as follows: age ≥60 years and are known hypertensive patients. Data were collected from 186 selected aged male hypertensive patients for 3 months. The questionnaire was self-developed and open-ended. The data were processed and analyzed using SPSS version 23. Some of the variables were subjected to statistical tests and ranks in the order of importance to respondents. The enrolled respondents were allowed to participate in the study after their informed consent was obtained. It was evident that respondents do not obtain much support or help in taking care of their condition.
Results
The result revealed that the repondents has no support to help take care of their condition as evident by the responses in the study. The scores on average mean for some variables are (AM = 2.25, SD = 0.381) more than the test value of 2.50. Some of these supports were on feeding support (M = 3.97, SD = 0.278, n = 186), health support (M = 2.87, SD = 0.167, n = 186), and cleaning support (M = 2.59, SD = 0.868, n = 186). Supports such as clothing, socialization, medication, washing, transportation, and financial support were lacking.
Conclusions
Based on the finding that certain forms of support were lacking, the study concludes that steps undertaken by the government, community, religious bodies, and family toward improving these supports can be of immense help for aged male hypertensive patients living in the Ejura-Sekyedumase municipality.
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Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063195. [PMID: 35328881 PMCID: PMC8954932 DOI: 10.3390/ijerph19063195] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 12/30/2022]
Abstract
Although numerous studies have been conducted previously on the needs of cancer patients at the end of their life, there is a lack of studies focused on older patients with non-oncological complex chronic multipathologies. Examining these needs would help to gain a greater understanding of the profile of this specific population within the palliative care (PC) pathway and how the health and care systems can address them. The aim of this review was to identify the needs influencing PC among older patients with multimorbidities, their relatives or informal caregivers, and the health professionals who provide care for these patients. A scoping literature review guided by the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was carried out with literature searched in the Medline, Embase, CINAHL, WoS, Cochrane Library, PsycINFO, and Scopus databases from 2009 to 2022. Eighty-one studies were included, demonstrating a great variety of unaddressed needs for PC among chronic older patients and the complexity in detecting those needs and how to refer them to PC pathways. This review also suggested a scarcity of tools and limited pathways for professionals to satisfy their needs for these patients and their families, who often felt ignored by the system. Substantial changes will be needed in health and care systems at the institutional level, providing more specialized PC environments and systematizing PC processes.
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21
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Michaels J, Chen C, Ann Meeker M. Navigating the caregiving abyss: A metasynthesis of how family caregivers manage end-of-life care for older adults at home. Palliat Med 2022; 36:81-94. [PMID: 34477025 DOI: 10.1177/02692163211042999] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Demographic changes (global aging, decreased fertility, increased home deaths) will present a critical need for end-of-life family caregivers of older adults at home. In order to support these family caregivers, we need to better understand their experiences, struggles, and needs. AIM To describe and explain the process of end-of-life caregiving as experienced by family caregivers of older adults residing in the home setting. DESIGN The Preferred Reporting Items for Systematic Reviews and Metaanalysis (PRISMA) guidelines and Sandelowski and Barroso's procedural steps for a metasynthesis review guided this study. DATA SOURCES Qualitative and mixed methods literature from CINAHL, Medline, PsycINFO, and EMBASE databases and information from professional organizations were reviewed for studies that focused on family caregivers providing end-of-life care to older adults residing in the home setting. RESULTS A total of 24 studies were identified. Family caregivers engaged in the process of "navigating a caregiving abyss" when providing and managing end-of-life-care for older adults at home. The "caregiving abyss" consisted of four phases: (1) managing multiple roles, (2) encountering challenges, (3) mobilizing resources, and (4) acknowledging death is near. During the process family caregivers strived to "live day by day" and "maintain normalcy" to achieve the goals of honoring life's final wishes and provide home death. CONCLUSION Family caregivers of older adults at the end of life navigate a variety of challenges. The findings provide a conceptual framework to help guide the development of education, interventions, and health policy to meet family caregivers' needs in providing quality end-of-life care.
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Affiliation(s)
- Jacqueline Michaels
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Chiahui Chen
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Mary Ann Meeker
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA
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22
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Ahmed HK, Eisa IM, Abdallah EI, Hamouda DG, Omer AE, Eltayeb LB. Appraisal of Biosafety Measures in Governmental Medical Laboratory Personnel: Knowledge, Attitude, Practice (KAP) Study. JOURNAL OF BIOCHEMICAL TECHNOLOGY 2022. [DOI: 10.51847/eohg7ngyvx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Frailty is a geriatric syndrome characterized by decreased daily living activity, weight loss, weakness, and dependency caused by the cumulative decline in many physiological systems over the life span. This study examined older adults' perceptions of frailty. The study used a descriptive qualitative design. Data were collected using semistructured interviews with 14 older adults admitted to the geriatrics outpatient clinic in one Turkish institution from September to December 2019. The interviews were transcribed and analyzed using the MAXQDA data analysis software. Codes were combined into themes. The respondents were aged 74.5 ± 8.7 years. Two themes emerged from the qualitative data: (i) the conceptualization of frailty; and (ii) coping with frailty. Some of the participants self-identified as frail, a natural consequence of aging. Another group of participants emphasized the feelings of hopelessness and hopefulness in coping with frailty in their remaining lives. This study provides insights into older Turkish adults' opinions regarding frailty, including the development of frailty and its relationship with health status and daily life. This understanding may be used to detect frailty in older adults and to improve frail older adults' care interventions.
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Affiliation(s)
- Cigdem Canbolat Seyman
- Cigdem Canbolat Seyman, PhD, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Yasemin Sara, MSc, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Selçuk University, Konya, Turkey
| | - Yasemin Sara
- Cigdem Canbolat Seyman, PhD, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Yasemin Sara, MSc, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Selçuk University, Konya, Turkey
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24
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Beer N, Riffat A, Volkmer B, Wyatt D, Lambe K, Sheehan KJ. Patient perspectives of recovery after hip fracture: a systematic review and qualitative synthesis. Disabil Rehabil 2021; 44:6194-6209. [PMID: 34428389 DOI: 10.1080/09638288.2021.1965228] [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: 10/20/2022]
Abstract
PURPOSE The purpose of the current review is to synthesize the evidence of patients' perspectives of recovery after hip fracture across the care continuum. METHODS A systematic search was conducted, focusing on qualitative data from hip fracture patients. Screening, quality appraisal, and a subset of articles for extraction were completed in duplicate. Themes were generated using a thematic synthesis of data from original studies. RESULTS Fourteen high-quality qualitative studies were included. Four review themes were identified: recovery as participation, feelings of vulnerability, driving recovery, and reliance on support. Patients considered recovery as a return to pre-fracture activities or "normal" enabling independence. Feelings of vulnerability were observed irrespective of the time since hip fracture and only diminished when recovery of function and activities enabled participation in valued activities, e.g., outdoor mobility. Participants expressed a desire to engage in recovery with realistic expectations and the benefits of meaningful feedback reported. While reliance on healthcare professionals decreased towards a later stage of recovery, reliance on social support persisted until recovery was perceived to have been achieved. CONCLUSION Patient perspectives highlighted hip fracture as a major life event requiring health professional and social support to overcome feelings of vulnerability and enable active engagement in recovery.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals should ensure expectations and goals are set early in the recovery process.Rehabilitation professionals should ensure goals set with patients are tailored to the individual's pre-fracture activities or "normal" promoting independence.Rehabilitation professionals should monitor goals ensuring they are providing support, motivation, and managing expectations across the care continuum.Rehabilitation professionals should address patients' feelings of vulnerability, particularly in the absence of social support, and ensure appropriate ongoing input to maximize recovery.
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Affiliation(s)
- Natasha Beer
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Aleena Riffat
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Brittannia Volkmer
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - David Wyatt
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Kate Lambe
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London, UK
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25
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Combes S, Gillett K, Norton C, Nicholson CJ. The importance of living well now and relationships: A qualitative study of the barriers and enablers to engaging frail elders with advance care planning. Palliat Med 2021; 35:1137-1147. [PMID: 33934669 PMCID: PMC8189003 DOI: 10.1177/02692163211013260] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The population of frail elders is growing, and due to their vulnerability to sudden deterioration, advance care planning is particularly important. However, advance care planning is uncommon for multiple reasons, some of which are linked to the perceptions of frail elders and their families. AIM To explore the barriers and enablers to advance care planning engagement with frail elders. DESIGN Qualitative in-depth interviews with thematic analysis. SETTING/PARTICIPANTS Purposive sample of 10 frail elders and 8 nominated family members using a community-based older persons' service run by a large urban UK hospice. Frail elders had capacity, were ⩾65 (median 85, range 71-95), scored 6 or 7 (median 6.5) on the Clinical Frailty Scale, and 70% were female. RESULTS Key barriers were: Advance care planning is unclear, in terms of meaning and the language used; Lack of relevance, with frail elders preferring to focus on living well now; and the Importance of family, relationships and home, and the influence of relationship on end of life decision-making. Engagement strategies included preparing the frail elder for advance care planning conversations and using a gentle, honest, individualised approach. CONCLUSIONS Essential enablers for frail elders are understanding what advance care planning is and why it may be relevant to them. For professionals, enablers include recognising the importance of living well now and relational decision-making. To further support advance care planning, recommendations include early engagement and re-conceptualising advance care planning as an ongoing process which encompasses current and future care. Further research is needed in different cultures and care contexts.
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Affiliation(s)
- Sarah Combes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,St Christopher's Hospice, London, UK
| | - Karen Gillett
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Caroline Jane Nicholson
- St Christopher's Hospice, London, UK.,Faculty of Health and Medical Sciences, Surrey University, Guildford, UK
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Evans CJ, Bone AE, Yi D, Gao W, Morgan M, Taherzadeh S, Maddocks M, Wright J, Lindsay F, Bruni C, Harding R, Sleeman KE, Gomes B, Higginson IJ. Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care: A randomised controlled single-blind mixed method trial. Int J Nurs Stud 2021; 120:103978. [PMID: 34146843 DOI: 10.1016/j.ijnurstu.2021.103978] [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: 01/25/2021] [Revised: 04/18/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Globally, a rising number of people live into advanced age and die with multimorbidity and frailty. Palliative care is advocated as a person-centred approach to reduce health-related suffering and promote quality of life. However, no evidence-based interventions exist to deliver community-based palliative care for this population. AIM To evaluate the impact of the short-term integrated palliative and supportive care intervention for older people living with chronic noncancer conditions and frailty on clinical and economic outcomes and perceptions of care. DESIGN Single-blind trial with random block assignment to usual care or the intervention and usual care. The intervention comprised integrated person-centred palliative care delivered by multidisciplinary palliative care teams working with general practitioners and community nurses. Main outcome was change in five key palliative care symptoms from baseline to 12-weeks. Data analysis used intention to treat and complete cases to examine the mean difference in change scores and effect size between the trial arms. Economic evaluation used cost-effectiveness planes and qualitative interviews explored perceptions of the intervention. SETTING/PARTICIPANTS Four National Health Service general practices in England with recruitment of patients aged ≥75 years, with moderate to severe frailty, chronic noncancer condition(s) and ≥2 symptoms or concerns, and family caregivers when available. RESULTS 50 patients were randomly assigned to receive usual care (n = 26, mean age 86.0 years) or the intervention and usual care (n = 24, mean age 85.3 years), and 26 caregivers (control n = 16, mean age 77.0 years; intervention n = 10, mean age 77.3 years). Participants lived at home (n = 48) or care home (n = 2). Complete case analysis (n = 48) on the main outcome showed reduced symptom distress between the intervention compared with usual care (mean difference -1.20, 95% confidence interval -2.37 to -0.027) and medium effect size (omega squared = 0.071). Symptom distress reduced with decreased costs from the intervention compared with usual care, demonstrating cost-effectiveness. Patient (n = 19) and caregiver (n = 9) interviews generated themes about the intervention of 'Little things make a big difference' with optimal management of symptoms and 'Care beyond medicines' of psychosocial support to accommodate decline and maintain independence. CONCLUSIONS This palliative and supportive care intervention is an effective and cost-effective approach to reduce symptom distress for older people severely affected by chronic noncancer conditions. It is a clinically effective way to integrate specialist palliative care with primary and community care for older people with chronic conditions. Further research is indicated to examine its implementation more widely for people at home and in care homes. TRIAL REGISTRATION Controlled-Trials.com ISRCTN 45837097 Tweetable abstract: Specialist palliative care integrated with district nurses and GPs is cost-effective to reduce symptom distress for older people severely affected by chronic conditions.
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Affiliation(s)
- Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England; Martlets Hospice, Wayfield Avenue, Hove BN3 7LW, England; Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Anna E Bone
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, England.
| | - Shamim Taherzadeh
- Northbourne Medical Centre, 193A Upper Shoreham Road, Shoreham-by-Sea, BN43 6BT, England.
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Juliet Wright
- University of Sussex, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9RH, England.
| | - Fiona Lindsay
- Martlets Hospice, Wayfield Avenue, Hove BN3 7LW, England; Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Carla Bruni
- Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Richard Harding
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Katherine E Sleeman
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Barbara Gomes
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
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Ermers DJM, van Beuningen-van Wijk MPH, Rit EP, Stalpers-Konijnenburg SC, Taekema DG, Bosch FH, Engels Y, van Mierlo PJWB. Life-sustaining treatment preferences in older patients when referred to the emergency department for acute geriatric assessment: a descriptive study in a Dutch hospital. BMC Geriatr 2021; 21:58. [PMID: 33446116 PMCID: PMC7807792 DOI: 10.1186/s12877-020-02002-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/29/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In many cases, life-sustaining treatment preferences are not timely discussed with older patients. Advance care planning (ACP) offers medical professionals an opportunity to discuss patients' preferences. We assessed how often these preferences were known when older patients were referred to the emergency department (ED) for an acute geriatric assessment. METHODS We conducted a descriptive study on patients referred to the ED for an acute geriatric assessment in a Dutch hospital. Patients were referred by general practitioners (GPs), or in the case of nursing home residents, by elderly care physicians. The referring physician was asked if preferences regarding life-sustaining treatments were known. The primary outcome was the number of patients for whom preferences were known. Secondary outcomes included which preferences, and which variables predict known preferences. RESULTS Between 2015 and 2017, 348 patients were included in our study. At least one preference regarding life-sustaining treatments was known at referral in 45.4% (158/348) cases. In these cases, cardiopulmonary resuscitation (CPR) policy was always included. Preferences regarding invasive ventilation policy and ICU admission were known in 17% (59/348) and 10.3% (36/348) of the cases respectively. Known preferences were more frequent in cases referred by the elderly care physician than the GP (P < 0.001). CONCLUSIONS In less than half the patients, at least one preference regarding life-sustaining treatments was known at the time of referral to the ED for an acute geriatric assessment; in most cases it concerned CPR policy. We recommend optimizing ACP conversations in a non-acute setting to provide more appropriate, desired, and personalized care to older patients referred to the ED.
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Affiliation(s)
- Daisy J M Ermers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, PO Box 9101, Nijmegen, HB, 6500, The Netherlands.
| | | | - Evi Peters Rit
- Department of Geriatrics, Meander medical center, Amersfoort, The Netherlands
| | | | - Diana G Taekema
- Department of Geriatrics, Rijnstate, Arnhem, The Netherlands
| | - Frank H Bosch
- Department of Intensive Care Medicine, Rijnstate, Arnhem, The Netherlands.,Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, PO Box 9101, Nijmegen, HB, 6500, The Netherlands
| | - Patricia J W B van Mierlo
- Department of Geriatrics, Rijnstate, Arnhem, The Netherlands.,Center of Supportive and Palliative Care, Rijnstate, Arnhem, The Netherlands
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Palliative Care in COPD. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Maxwell CA, Rothman R, Wolever R, Simmons S, Dietrich MS, Miller R, Patel M, Karlekar MB, Ridner S. Development and testing of a frailty-focused communication (FCOM) aid for older adults. Geriatr Nurs 2020; 41:936-941. [PMID: 32709372 PMCID: PMC7738367 DOI: 10.1016/j.gerinurse.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 01/16/2023]
Abstract
The concept of frailty as it pertains to aging, health and well-being is poorly understood by older adults and the public-at-large. We developed an aging and frailty education tool designed to improve layperson understanding of frailty and promote behavior change to prevent and/or delay frailty. We subsequently tested the education tool among adults who attended education sessions at 16 community sites. Specific aims were to: 1) determine acceptability (likeability, understandability) of content, and 2) assess the likelihood of behavior change after exposure to education tool content. Results: Over 90% of participants "liked" or "loved" the content and found it understandable. Eighty-five percent of participants indicated that the content triggered a desire to "probably" or "definitely" change behavior. The desire to change was particularly motivated by information about aging, frailty and energy production. Eight focus areas for proactive planning were rated as important or extremely important by over 90% of participants.
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Affiliation(s)
- Cathy A Maxwell
- Vanderbilt University School of Nursing (VUSN), 461 21st Ave. South, Godchaux Hall 420, Nashville 37240, TN, United States.
| | - Russell Rothman
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Ruth Wolever
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Sandra Simmons
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Mary S Dietrich
- Vanderbilt University School of Nursing (VUSN), 461 21st Ave. South, Godchaux Hall 420, Nashville 37240, TN, United States.
| | - Richard Miller
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Mayur Patel
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Mohana B Karlekar
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Sheila Ridner
- Vanderbilt University School of Nursing (VUSN), 461 21st Ave. South, Godchaux Hall 420, Nashville 37240, TN, United States.
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The difference an end-of-life diagnosis makes: qualitative interviews with providers of community health care for frail older people. Br J Gen Pract 2020; 70:e757-e764. [PMID: 32958536 PMCID: PMC7510843 DOI: 10.3399/bjgp20x712805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/07/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Increasing numbers of people die of the frailty and multimorbidity associated with old age, often without receiving an end-of-life diagnosis. Compared to those with a single life-limiting condition such as cancer, frail older people are less likely to access adequate community care. To address this inequality, guidance for professional providers of community health care encourages them to make end-of-life diagnoses more often in such people. These diagnoses centre on prognosis, making them difficult to establish given the inherent unpredictability of age-related decline. This difficulty makes it important to ask how care provision is affected by not having an end-of-life diagnosis. AIM To explore the role of an end-of-life diagnosis in shaping the provision of health care outside acute hospitals. DESIGN AND SETTING Qualitative interviews with 19 healthcare providers from community-based settings, including nursing homes and out-of-hours services. METHOD Semi-structured interviews (nine individual, three small group) were conducted. Data were analysed thematically and using constant comparison. RESULTS In the participants' accounts, it was unusual and problematic to consider frail older people as candidates for end-of-life diagnosis. Participants talked of this diagnosis as being useful to them as care providers, helping them prioritise caring for people diagnosed as 'end-of-life' and enabling them to offer additional services. This prioritisation and additional help was identified as excluding people who die without an end-of-life diagnosis. CONCLUSION End-of-life diagnosis is a first-class ticket to community care; people who die without such a diagnosis are potentially disadvantaged as regards care provision. Recognising this inequity should help policymakers and practitioners to mitigate it.
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31
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Bickel KE, Levy C, MacPhee ER, Brenner K, Temel JS, Arch JJ, Greer JA. An Integrative Framework of Appraisal and Adaptation in Serious Medical Illness. J Pain Symptom Manage 2020; 60:657-677.e6. [PMID: 32446974 PMCID: PMC7483912 DOI: 10.1016/j.jpainsymman.2020.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
Multiple randomized clinical trials have demonstrated that palliative care improves the quality of life of individuals with serious medical illness. Research also suggests that in patients with advanced cancer, palliative care's focus on symptom management, coping with illness, goals of care, and treatment decisions may be associated with improved patient quality of life in part by increasing patients' use of active (vs. passive) and approach-oriented (vs. avoidant) coping strategies. However, without a framework outlining the process that individuals with serious medical illness and their loved ones undergo, it is challenging to discern exactly where, how, and why palliative care may affect the serious medical illness experience. To address this gap, we propose a clinically applicable framework, derived from existing theory and research in the social and behavioral sciences. This framework, called the Integrative Framework of Appraisal and Adaptation in Serious Medical Illness, describes how patients and their loved ones cognitively and emotionally process the various events that may occur as they navigate serious medical illness and the end of life. The framework also describes how individuals and their loved ones use that event processing to determine next steps, while considering the impact of their surrounding external environment, their individual social roles, and their connections on this decision making. The framework presented in this article is intended to improve our ability to understand and care for individuals with serious medical illness and their loved ones, while stimulating further discussion and research to test and refine these ideas.
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Affiliation(s)
- Kathleen E Bickel
- VA Eastern Colorado Healthcare System, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Cari Levy
- Palliative Medicine Section Chief, VA Eastern Colorado Healthcare System, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Research, Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Edward R MacPhee
- Psychiatry Section Chief, VA Eastern Colorado Healthcare System, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Keri Brenner
- Medicine-Section of Palliative Care, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer S Temel
- Medicine, Harvard Medical School, Cancer Outcomes Research & Education Program, Massachusetts General Hospital Cancer Center, Thoracic Oncology, Boston, Massachusetts, USA
| | - Joanna J Arch
- Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Joseph A Greer
- Psychology, Harvard Medical School, Center for Psychiatric Oncology & Behavioral Science, Cancer Outcomes Research & Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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Lee HJ, Small BJ, Haley WE. Health and Well-Being in the Year before Death: The Association with Quality of Life and Care at the End-of-Life. J Aging Health 2020; 32:1475-1485. [PMID: 32618482 DOI: 10.1177/0898264320935297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: We examined whether older adults' health and well-being during their final year of life predicts end-of-life (EOL) quality of life (QOL) and quality of care (QOC). Methods: Using data from deceased participants (n = 1125) in the 2011-2015 National Health and Aging Trends Study, we performed latent class analysis to identify profiles of health and well-being, and we examined the association between these classes and EOL QOL and QOC. Results: Four classes were identified: healthy/happy (20%), frail/happy (37%), cognitively impaired/moderately distressed (27%), and highly impaired/highly distressed (16%). Persons in the highly impaired/highly distressed class showed a poorer QOL at the EOL, whereas those in the healthy/happy class reported a lower level of QOC at the EOL. Discussion: The benefits of maintaining health and well-being often carry forward to EOL. Older adults with high impairment and distress merit greater attention such as assuring care and advance care plans.
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Affiliation(s)
- Hyo Jung Lee
- 54761Nanyang Technological University, Singapore
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Lambotte D, Smetcoren AS, Zijlstra GAR, De Lepeleire J, De Donder L, Kardol MJM. Meanings of Care Convoys: The Structure, Function, and Adequacy of Care Networks Among Frail, Community-Dwelling Older Adults. QUALITATIVE HEALTH RESEARCH 2020; 30:583-597. [PMID: 31303115 DOI: 10.1177/1049732319861934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Researchers propose that the convoy of care model should be used to study care networks of frail, older individuals. Care convoys are defined as the evolving collection of individuals who may or may not have close personal connections to the recipient or to one another, but who provide care, including help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), socio-emotional care, skilled health care, monitoring, and advocacy. This study reports on community-dwelling older adults' experiences of their care convoy, how care convoys change over time, and perceived (positive) outcomes. A qualitative analysis among 65 semi-structured interviews with frail, community-dwelling older adults demonstrates a great variety in the composition of care convoys. Participants were often actively involved in their care convoy and valued the social/relational aspect of care. Care and support covered a wide range of activities, with some activities being provided by specific types of caregivers. Participants expressed the adequacy of their care convoy in terms of satisfaction and sufficiency. Noteworthy, participants who were satisfied with their care convoy did not necessarily receive sufficient help. Policies and practice should recognize the relational aspect of care, the complex interplay between all actors, and the dynamic character of care convoys.
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Seng Beng T, Ting Ting T, Karupiah M, Xin Ni C, Li Li H, Chong Guan N, Ee Chin L, Chee Loong L, Maw Pin T. Patterns of Suffering in Palliative Care: A Descriptive Study. OMEGA-JOURNAL OF DEATH AND DYING 2020; 84:512-524. [PMID: 32019387 DOI: 10.1177/0030222820903221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suffering experiences are common phenomena in palliative care. In this study, we aim to explore the different patterns of suffering in palliative care. Adult palliative care patients were recruited from the University of Malaya Medical Centre. Suffering scores were charted 3 times a day for a week. The characteristics of the suffering charts were analyzed using SPSS. The patterns of suffering were analyzed using structural pattern recognition. A total of 53 patients participated. The overall trends of suffering were downward (64%), upward (19%), and stable (17%). Median minimum and maximum suffering scores were 2/10 and 6/10, with an average of 3.6/10. Nine patterns of suffering were recognized from categorizing two key characteristics of suffering (intensity and fluctuation)-named S1 to S9. Understanding the different patterns of suffering may lead to better suffering management.
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Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Tan Ting Ting
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Malathi Karupiah
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Cheah Xin Ni
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Hong Li Li
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Lam Chee Loong
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Tan Maw Pin
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Anantapong K, Tinker A. Attitudes towards frailty assessment in clinical practice among psychiatrists in the UK. ACTA ACUST UNITED AC 2019. [DOI: 10.1108/wwop-09-2019-0023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose
Although there is substantial evidence about the association between frailty and mental illnesses in older people, there is currently little evidence about how this is integrated into psychiatric clinical practice. The purpose of this paper is to explore the attitudes of a sample of psychiatrists in the UK about the concept and assessment of frailty in their clinical practice.
Design/methodology/approach
This research used a qualitative approach with semi-structured interviews. Interview schedules and transcripts were analysed using thematic analysis. NVivo software and an audit trail were used for the data analysis.
Findings
There were ten respondents (all psychiatrists) in this study. From the interviews, it appeared that some respondents were not be fully familiar with existing concepts of frailty. However, from their perspectives, frailty appeared to be multidimensional, reversible and for some could be enhanced by older people’s ability. Negative stereotypes of being frail could undermine the accessibility to appropriate assessment and care. Existing multidisciplinary assessments, with some adjustments to the particular needs of psychiatric patients, can be used to establish a frailty index.
Originality/value
The concept of frailty, especially those concerning its multidimensional and homeostatic nature, should be further examined to make it more applicable to psychiatric practice. Without much more effort, frailty could be assessed within current psychiatric practices. This could constitute a care plan tailored for frail people with a psychiatric illness, so as to improve the outcomes of their treatment and quality of life.
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Abstract
AbstractWe describe the findings of a qualitative longitudinal interview study of a group of initially community-dwelling frail older people, and their informal and formal carers. We used a narrative approach to explore the role that narrative may have for people living with frailty. This has been less explored comparative to the experiences of those living with chronic illness. The frail older people told stories of their experiences that revealed three distinct shapes or typologies. These were either stable, unbalancing or overwhelmed, and related to how the person managed to adapt to increasing challenges and losses, and to reintegrate their sense of self into a cohesive narrative. Each is illustrated by an individual case story. Frailty is described as both biographically anticipated yet potentially biographically disruptive as older people may struggle to make sense of their circumstances without a clear single causative factor. Findings are discussed in relation to biographical disruption and reconstruction in chronic illness and the rhetoric around ‘successful ageing’. We conclude by drawing attention to the complex individual and social factors that contribute to the experience of living with frailty in later life.
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Combes S, Nicholson CJ, Gillett K, Norton C. Implementing advance care planning with community-dwelling frail elders requires a system-wide approach: An integrative review applying a behaviour change model. Palliat Med 2019; 33:743-756. [PMID: 31057042 PMCID: PMC6620766 DOI: 10.1177/0269216319845804] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Facilitating advance care planning with community-dwelling frail elders can be challenging. Notably, frail elders' vulnerability to sudden deterioration leads to uncertainty in recognising the timing and focus of advance care planning conversations. AIM To understand how advance care planning can be better implemented for community-dwelling frail elders and to develop a conceptual model to underpin intervention development. DESIGN A structured integrative review of relevant literature. DATA SOURCES CINAHL, Embase, Ovid Medline, PsycINFO, Cochrane Library, and University of York Centre for Reviews and Dissemination. Further strategies included searching for policy and clinical documents, grey literature, and hand-searching reference lists. Literature was searched from 1990 until October 2018. RESULTS From 3043 potential papers, 42 were included. Twenty-nine were empirical, six expert commentaries, four service improvements, two guidelines and one theoretical. Analysis revealed nine themes: education and training, personal ability, models, recognising triggers, resources, conversations on death and dying, living day to day, personal beliefs and experience, and relationality. CONCLUSION Implementing advance care planning for frail elders requires a system-wide approach, including providing relevant resources and clarifying responsibilities. Early engagement is key for frail elders, as is a shift from the current advance care planning model focussed on future ceilings of care to one that promotes living well now alongside planning for the future. The proposed conceptual model can be used as a starting point for professionals, organisations and policymakers looking to improve advance care planning for frail elders.
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Affiliation(s)
- Sarah Combes
- Florence Nightingale Faculty of Nursing,
Midwifery and Palliative Care, King’s College London, London, UK
- St Christopher’s Hospice, London,
UK
| | - Caroline Jane Nicholson
- Florence Nightingale Faculty of Nursing,
Midwifery and Palliative Care, King’s College London, London, UK
- St Christopher’s Hospice, London,
UK
| | - Karen Gillett
- Florence Nightingale Faculty of Nursing,
Midwifery and Palliative Care, King’s College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing,
Midwifery and Palliative Care, King’s College London, London, UK
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Gaignard ME, Hurst S. A qualitative study on existential suffering and assisted suicide in Switzerland. BMC Med Ethics 2019; 20:34. [PMID: 31088444 PMCID: PMC6515594 DOI: 10.1186/s12910-019-0367-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/17/2019] [Indexed: 11/16/2022] Open
Abstract
Background In Switzerland, people can be granted access to assisted suicide (AS) on condition that the person whose wish is to die performs the fatal act, that he has his decisional capacity and that the assisting person’s conduct is not selfishly motivated. No restrictions relating to the ground of suffering are mentioned in the act. Existential suffering as a reason for wanting to die, however, gives raise to controversial issues. Moreover, existential suffering lacks definition and no consensus exists on how to evaluate and manage it. This study explores the perspectives of care professionals and volunteers from a “right-to-die organization” on existential suffering as a motive for assisted suicide requests. Methods A qualitative study based on face-to-face interviews was conducted with twenty-six participants: palliative care and primary care providers as well as EXIT right-to-die organization volunteers. Elements from the grounded theory approach were used. Results The twenty-six participants described existential suffering in a multiplicity of individual ways. In total, sixty-three stories were recounted. Their representations were grouped into eight categories: physical decline and its consequences, loneliness, fear of the future, life is over, loss of social significance, loss of hope for a better future, being a financial burden and loss of pleasurable activities. According to all participants, suffering coming from the loss of self-identity was always linked to physical decline, as if one’s image completely defined someone’s identity. Society’s perception of old people and vulnerable people were also often questioned. Another interesting point was that only four stories referring to a “pure” existential suffering were found. This suffering was related to a feeling that life has come to an end, without identification of any other related restriction or suffering. Conclusions Existential suffering is multifaceted. Legislators and right-to-die organisations have to address the question of what make a AS acceptable. The plurality of existential suffering implies the need of a very personalized care. A better understanding of what it is made of could provide a “toolbox” to people concerned by these requests, helping them to explore it in order to offer suffering people a wider range of alternatives. Electronic supplementary material The online version of this article (10.1186/s12910-019-0367-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie-Estelle Gaignard
- Institute for Ethics, History, and the Humanities, Institute for Biomedical Ethics, Geneva University Medical School, Rue Michel-Servet, 1, 1211, Geneva, Switzerland. .,Department of Oncology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, Institute for Biomedical Ethics, Geneva University Medical School, Rue Michel-Servet, 1, 1211, Geneva, Switzerland
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Sundström M, Blomqvist K, Edberg AK, Rämgård M. The context of care matters: Older people's existential loneliness from the perspective of healthcare professionals-A multiple case study. Int J Older People Nurs 2019; 14:e12234. [PMID: 31025806 DOI: 10.1111/opn.12234] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/20/2019] [Accepted: 03/07/2019] [Indexed: 01/11/2023]
Abstract
AIM To explore existential loneliness among older people in different healthcare contexts from the perspective of healthcare professionals. BACKGROUND Professionals meet and care for older people in most care contexts and need to be prepared to address physical, psychological, social and existential needs. Addressing existential loneliness can be both challenging and meaningful for professionals and is often not prioritised in times of austerity. DESIGN A multiple case study design was used. METHODS Focus group interviews were conducted with healthcare professionals (n = 52) in home, residential, hospital and palliative care settings. The analysis was performed in two steps: firstly, a within-case analysis of each context was conducted, followed by a cross-case analysis. FINDINGS Differences and similarities were observed among the care contexts, including for the origin of existential loneliness. In home care and residential care, the focus was on life, the present and the past, compared to hospital and palliative care, in which existential loneliness mainly related to the forthcoming death. The older person's home, as the place where home care or palliative care was received, helped preserve the older person's identity. In hospital and palliative care, as in institutional care, the place offered security, while in residential care, the place could make older people feel like strangers. Creating relationships was considered an important part of the professionals' role in all four care contexts, although this had different meanings, purposes and conditions. CONCLUSIONS The context of care matters and influences how professionals view existential loneliness among older people and the opportunities they have to address existential loneliness. IMPLICATIONS FOR PRACTICE Support for professionals must be tailored to their needs, their education levels and the context of care. Professionals need training and appropriate qualifications to address existential loneliness related to existential aspects of ageing and care.
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Affiliation(s)
- Malin Sundström
- Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Kerstin Blomqvist
- Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Anna-Karin Edberg
- Research Platform for Collaboration for Health, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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40
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Hamano J, Haruta J, Ishimaru N, Otsuka T, Den N, Sakato K, Kimura T, Yamamoto R. A comprehensive view to reflection on the palliative care approach for family medicine residents: A modified Delphi method. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1704137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Junji Haruta
- Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan
| | - Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, Akashi, Japan
| | | | - Naoko Den
- Tokyo Hokuto Medical cooperative association Oji co-op hospital, Japan
| | | | - Takuma Kimura
- Department of Community Medicine, Kitasato University School of Medicine, Japan
| | - Ryo Yamamoto
- Department of Palliative Medicine, Saku Central Hospital Advanced Care Center, Japan
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Walshe C, Preston N, Payne S, Dodd S, Perez Algorta G. Quality of Life Trends in People With and Without Cancer Referred to Volunteer-Provided Palliative Care Services (ELSA): A Longitudinal Study. J Pain Symptom Manage 2018; 56:689-698. [PMID: 30096440 DOI: 10.1016/j.jpainsymman.2018.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT Trends in symptoms and functional ability are known toward the end of life, but less is understood about quality of life, particularly prospectively following service referral. OBJECTIVES This study compares quality of life trajectories of people with and without cancer, referred to volunteer-provided palliative care services. METHODS A secondary analysis of the ELSA trial (n = 85 people with cancer and n = 72 without cancer) was performed. Quality of life data (WHOQOL-BREF) were collected at baseline (referral), four weeks, eight weeks, and 12 weeks. Sociodemographic data were collected at baseline. We specified a series of joint models to estimate differences on quality of life trajectories between groups adjusting for participants who die earlier in the study. RESULTS People with cancer had a significantly better quality of life at referral to the volunteer-provided palliative care services than those with nonmalignant disease despite similar demographic characteristics (Cohen d's = 0.37 to 0.45). More people with cancer died during the period of the study. We observed significant differences in quality of life physical and environmental domain trajectories between groups (b = -2.35, CI -4.49, -0.21, and b = -4.11, CI -6.45, -1.76). People with cancer experienced a greater decline in quality of life than those with nonmalignant disease. CONCLUSION Referral triggers for those with and without cancer may be different. People with cancer can be expected to have a more rapid decline in quality of life from the point of service referral. This may indicate greater support needs, including from volunteer-provided palliative care services.
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Affiliation(s)
- Catherine Walshe
- The International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
| | - Nancy Preston
- The International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Sheila Payne
- The International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Steven Dodd
- The International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
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van der Vorst A, Zijlstra GAR, De Witte N, Vogel RGM, Schols JMGA, Kempen GIJM. [Explaining discrepancies in self-reported quality of life in frail older people: a mixed-methods study]. Tijdschr Gerontol Geriatr 2018; 49:174-186. [PMID: 30206788 DOI: 10.1007/s12439-018-0261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/31/2018] [Indexed: 06/08/2023]
Abstract
Most research on (multidimensional) frailty focuses on deficits and risks of adverse outcomes. However, frail older people can still report positive outcomes, such as a relatively high QoL. In order to develop more positively oriented prevention strategies, this exploratory study aimed (a) to identify characteristics related to QoL among frail older people; and (b) to explain discrepancies between higher and lower levels of QoL, with a specific focus on strengths frail older people with a higher QoL still may have. Quantitative and qualitative data was gathered by means of semi-structured interviews with Flemish community-dwelling, frail older people with higher (n = 16) and lower QoL levels (n = 18). Quantitative analyses showed that frail older people with a higher QoL were older, had lower levels of psychological frailty, and reported higher meaning in life compared to those with a lower QoL. Outcomes of qualitative analysis showed that participants in the high QoL subgroup adapted more effectively to difficulties, had more things in prospect, performed more activities, and were more satisfied with their social network compared to the low QoL subgroup. To conclude, this exploratory study suggests possibilities to promote and improve QoL by strengthening specific resources among frail older people.Please note that an English version of this article has been published in BMC Geriatrics: van der Vorst A, Zijlstra GAR, De Witte N, Vogel RGM, Schols JMGA, Kempen GIJM, D‑SCOPE Consortium. Explaining discrepancies in self-reported quality of life in frail older people: a mixed-methods study. BMC Geriatr. 2017;17(1): 251. https://doi.org/10.1186/s12877-017-0641-y .
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Affiliation(s)
- Anne van der Vorst
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Nederland.
| | - G A Rixt Zijlstra
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Nederland
| | - Nico De Witte
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussel, België
- Faculty of Education, Health and Social Work, Hogeschool Gent, Gent, België
| | - Ruth G M Vogel
- Research Centre for Community Care, Zuyd Hogeschool, Heerlen, Nederland
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Nederland
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Nederland
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Nederland
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Tilburgs B, Vernooij-Dassen M, Koopmans R, Weidema M, Perry M, Engels Y. The importance of trust-based relations and a holistic approach in advance care planning with people with dementia in primary care: a qualitative study. BMC Geriatr 2018; 18:184. [PMID: 30115008 PMCID: PMC6097199 DOI: 10.1186/s12877-018-0872-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/06/2018] [Indexed: 11/17/2022] Open
Abstract
Background ACP enables individuals to define and discuss goals and preferences for future medical treatment and care with family and healthcare providers, and to record these goals and preferences if appropriate. Because general practitioners (GPs) often have long-lasting relationships with people with dementia, GPs seem most suited to initiate ACP. However, ACP with people with dementia in primary care is uncommon. Although several barriers and facilitators to ACP with people with dementia have already been identified in earlier research, evidence gaps still exist. We therefore aimed to further explore barriers and facilitators for ACP with community-dwelling people with dementia. Methods A qualitative design, involving all stakeholders in the care for community-dwelling people with dementia, was used. We conducted semi-structured interviews with community dwelling people with dementia and their family caregivers, semi structured interviews by telephone with GPs and a focus group meeting with practice nurses and case managers. Content analysis was used to define codes, categories and themes. Results Ten face to face interviews, 10 interviews by telephone and one focus group interview were conducted. From this data, three themes were derived: development of a trust-based relationship, characteristics of an ACP conversation and the primary care setting. ACP is facilitated by a therapeutic relationship between the person with dementia/family caregiver and the GP built on trust, preferably in the context of home visits. Addressing not only medical but also non-medical issues soon after the dementia diagnosis is given is an important facilitator during conversation. Key barriers were: the wish of some participants to postpone ACP until problems arise, GPs’ time restraints, concerns about the documentation of ACP outcomes and concerns about the availability of these outcomes to other healthcare providers. Conclusions ACP is facilitated by an open relationship based on trust between the GP, the person with dementia and his/her family caregiver, in which both medical and non-medical issues are addressed. GPs’ availability and time restraints are barriers to ACP. Transferring ACP tasks to case managers or practice nurses may contribute to overcoming these barriers. Electronic supplementary material The online version of this article (10.1186/s12877-018-0872-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bram Tilburgs
- Department of IQ healthcare, Radboudumc, Nijmegen, The Netherlands.
| | | | - Raymond Koopmans
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.,Radboudumc Alzheimer Centre, Nijmegen, The Netherlands.,Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Marije Weidema
- Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.,Radboudumc Alzheimer Centre, Nijmegen, The Netherlands.,Department of Geriatric Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
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Walters K, Frost R, Kharicha K, Avgerinou C, Gardner B, Ricciardi F, Hunter R, Liljas A, Manthorpe J, Drennan V, Wood J, Goodman C, Jovicic A, Iliffe S. Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT. Health Technol Assess 2018; 21:1-128. [PMID: 29214975 DOI: 10.3310/hta21730] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. OBJECTIVES (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). DESIGN Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. INTERVENTION DEVELOPMENT Two systematic reviews (including systematic searches of 14 databases and registries, 1990-2016 and 1980-2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65-94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the 'HomeHealth' intervention in collaboration with older people and multidisciplinary stakeholders. 'HomeHealth' comprised 3-6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. FEASIBILITY RCT Single-blind RCT, individually randomised to 'HomeHealth' or treatment as usual (TAU). SETTING Community settings in London and Hertfordshire, UK. PARTICIPANTS A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. MAIN OUTCOME MEASURES Feasibility - recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. RESULTS We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire -3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. CONCLUSIONS Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. FUTURE WORK A large, definitive RCT of the HomeHealth service is warranted. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London, UK
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Federico Ricciardi
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ann Liljas
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Vari Drennan
- Centre for Health and Social Care Research, Kingston University and St George's, University of London, London, UK
| | - John Wood
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Ana Jovicic
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
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Åvik Persson H, Sandgren A, Fürst CJ, Ahlström G, Behm L. Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team's perspective. BMC Geriatr 2018; 18:134. [PMID: 29898674 PMCID: PMC6000966 DOI: 10.1186/s12877-018-0825-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team's perspective. METHODS The focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey. RESULTS The analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category "Going into a bubble" illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category "The body begins to shut down" illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death. CONCLUSIONS This study conveys new knowledge concerning the multidisciplinary team's collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.
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Affiliation(s)
- Helene Åvik Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 221 00, Lund, Sweden.
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Carl-Johan Fürst
- The Institute for Palliative Care, Lund University and Region Skåne, 221 00, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 221 00, Lund, Sweden
| | - Lina Behm
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 221 00, Lund, Sweden
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Bradley N, Lloyd‐Williams M, Dowrick C. Effectiveness of palliative care interventions offering social support to people with life-limiting illness-A systematic review. Eur J Cancer Care (Engl) 2018; 27:e12837. [PMID: 29573500 PMCID: PMC6001732 DOI: 10.1111/ecc.12837] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2018] [Indexed: 11/03/2022]
Abstract
Individuals managing the challenges of life-limiting illness require adequate social support to maintain quality of life. Qualitative research reports that patients value highly the social support obtained in palliative care interventions such as day care and group therapies. This systematic review aims to summarise existing quantitative evidence on palliative care interventions that facilitate social support. Research literature was systematically searched using electronic databases and key journals. Searches returned a total of 6,247 unique titles of which sixteen were eligible for inclusion. Interventions include group therapies, group practical interventions and palliative day care. Outcome measures and study designs were heterogeneous. Only one study used a validated outcome measure of social support. Benefits were influenced by participant characteristics such as baseline distress. Partial economic evaluation was attempted by two studies. Methodological challenges include attrition and use of outcome measures that were insensitive to change. Statistically significant results were reported in psychological and physical domains. Evidence is limited due to methodological issues and a scarcity of quantitative research, particularly regarding long-term benefits and cost-effectiveness. Interventions may be more beneficial to some groups than others.
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Affiliation(s)
- N. Bradley
- Academic Palliative and Supportive Care Studies GroupInstitute of Psychology Health and SocietyUniversity of LiverpoolLiverpoolUK
| | - M. Lloyd‐Williams
- Academic Palliative and Supportive Care Studies GroupInstitute of Psychology Health and SocietyUniversity of LiverpoolLiverpoolUK
| | - C. Dowrick
- Academic Palliative and Supportive Care Studies GroupInstitute of Psychology Health and SocietyUniversity of LiverpoolLiverpoolUK
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Frost R, Kharicha K, Jovicic A, Liljas AEM, Iliffe S, Manthorpe J, Gardner B, Avgerinou C, Goodman C, Drennan VM, Walters K. Identifying acceptable components for home-based health promotion services for older people with mild frailty: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:393-403. [PMID: 29210136 DOI: 10.1111/hsc.12526] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 06/07/2023]
Abstract
Mild frailty is common in later life, increasing the risk of hospitalisation, loss of independence and premature death. Targeted health promotion services may reduce adverse outcomes and increase quality of life; however, effective, well-developed theory-based interventions are lacking. We aimed to explore perceptions of health promotion behaviours undertaken by older people with mild frailty, barriers and facilitators to engagement, and identify potential components for new home-based health promotion services. We carried out 17 semi-structured qualitative interviews and six focus groups with 53 stakeholders, including 14 mildly frail older people, 12 family carers, 19 community health and social care professionals, and 8 homecare workers, in one urban and one semi-rural area of England. Transcripts were thematically analysed. Older people with mild frailty reported engaging in a variety of lifestyle behaviours to promote health and well-being. Key barriers or facilitators to engaging in these included transport, knowledge of local services, social support and acceptance of personal limitations. Older people, carers and professionals agreed that any new service should address social networks and mobility and tailor other content to each individual. Services should aim to increase motivation through focussing on independence and facilitate older people to continue carrying out behaviours that improve their well-being, as well as provide information, motivation, psychological support and practical support. Stakeholders agreed services should be delivered over a sustained period by trained non-specialist workers. New services including these components are likely to be acceptable to older people with mild frailty.
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Affiliation(s)
- Rachael Frost
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kalpa Kharicha
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ana Jovicic
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ann E M Liljas
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Vari M Drennan
- Centre for Health and Social Care Research, Kingston University & St Georges, University of London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
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48
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Dury S, Dierckx E, van der Vorst A, Van der Elst M, Fret B, Duppen D, Hoeyberghs L, De Roeck E, Lambotte D, Smetcoren AS, Schols J, Kempen G, Zijlstra GAR, De Lepeleire J, Schoenmakers B, Verté D, De Witte N, Kardol T, De Deyn PP, Engelborghs S, De Donder L. Detecting frail, older adults and identifying their strengths: results of a mixed-methods study. BMC Public Health 2018; 18:191. [PMID: 29378540 PMCID: PMC5789734 DOI: 10.1186/s12889-018-5088-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/17/2018] [Indexed: 01/07/2023] Open
Abstract
Background The debate on frailty in later life focuses primarily on deficits and their associations with adverse (health) outcomes. In addition to deficits, it may also be important to consider the abilities and resources of older adults. This study was designed to gain insights into the lived experiences of frailty among older adults to determine which strengths can balance the deficits that affect frailty. Methods Data from 121 potentially frail community-dwelling older adults in Flemish-speaking Region of Belgium and Brussels were collected using a mixed-methods approach. Quantitative data were collected using the Comprehensive Frailty Assessment Instrument (CFAI), Montreal Cognitive Assessment (MoCA), and numeric rating scales (NRS) for quality of life (QoL), care and support, meaning in life, and mastery. Bivariate analyses, paired samples t-tests and means were performed. Qualitative data on experiences of frailty, frailty balance, QoL, care and support, meaning in life, and mastery were collected using semi-structured interviews. Interviews were subjected to thematic content analysis. Results The “no to mild frailty” group had higher QoL, care and support, meaning in life, and mastery scores than the “severe frailty” group. Nevertheless, qualitative results indicate that, despite being classified as frail, many older adults experienced high levels of QoL, care and support, meaning in life, and mastery. Respondents mentioned multiple balancing factors for frailty, comprising individual-level circumstances (e.g., personality traits, coping strategies, resilience), environmental influences (e.g., caregivers, neighborhood, social participation), and macro-level features (e.g., health literacy, adequate financial compensation). Respondents also highlighted that life changes affected their frailty balance, including changes in health, finances, personal relationships, and living situation. Conclusion The findings indicate that frailty among older individuals can be considered as a dynamic state and, regardless of frailty, balancing factors are important in maintaining a good QoL. The study investigated not only the deficits, but also the abilities, and resources of frail, older adults. Public policymakers and healthcare organizations are encouraged to include these abilities, supplementary or even complementary to the usual focus on deficits.
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Affiliation(s)
- Sarah Dury
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium. .,Research Foundation Flanders (FWO), Egmontstraat 5, 1000, Brussels, Belgium.
| | - Eva Dierckx
- Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Anne van der Vorst
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, The Netherlands
| | - Michaël Van der Elst
- Department of Public Health and Primary Care University of Leuven, Kapucijnenvoer 33 blok J postbus 7001, 3000, Leuven, Belgium
| | - Bram Fret
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Daan Duppen
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Lieve Hoeyberghs
- Faculty of Education, Health and Social Work, University College Ghent, Keramiekstraat 80, 9000, Ghent, Belgium
| | - Ellen De Roeck
- Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.,Laboratory of Neurochemistry and Behavior, University of Antwerp, Universiteitsplein 1, DT.652, 2610, Antwerp, Belgium
| | - Deborah Lambotte
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - An-Sofie Smetcoren
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Jos Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Gertrudis Kempen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - G A Rixt Zijlstra
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Jan De Lepeleire
- Department of Public Health and Primary Care University of Leuven, Kapucijnenvoer 33 blok J postbus 7001, 3000, Leuven, Belgium
| | - Birgitte Schoenmakers
- Department of Public Health and Primary Care University of Leuven, Kapucijnenvoer 33 blok J postbus 7001, 3000, Leuven, Belgium
| | - Dominique Verté
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Nico De Witte
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.,Faculty of Education, Health and Social Work, University College Ghent, Keramiekstraat 80, 9000, Ghent, Belgium
| | - Tinie Kardol
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Peter Paul De Deyn
- Laboratory of Neurochemistry and Behaviour, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Sebastiaan Engelborghs
- Laboratory of Neurochemistry and Behaviour, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Liesbeth De Donder
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
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49
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Findlay C, Lloyd A, Finucane AM. Experience of emotion in frail older people towards the end of life: A secondary data analysis. Br J Community Nurs 2017; 22:586-592. [PMID: 29189057 DOI: 10.12968/bjcn.2017.22.12.586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
People are living longer, but with increased age comes greater frailty and multi-morbidity. This secondary data analysis examines transcripts from interviews with 11 frail older people and 6 informal carers to explore emotion in relation to frailty and deteriorating health. Anger and frustration were frequently experienced with declining functional ability; sadness occurred with social isolation, loss of autonomy and independence; anxiety was evident when transition to a care home was discussed; and contentment was described when connecting with others. Reluctant acceptance emerged as a coping strategy. Insights gained from analysing emotion may inform communications training courses for community nurses, though further research is required.
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Affiliation(s)
- Caitlin Findlay
- Medical Student, School of Medicine, University of Edinburgh
| | | | - Anne M Finucane
- Research Lead, Marie Curie Hospice Edinburgh and Honorary Fellow, Usher Institute, University of Edinburgh
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50
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van der Vorst A, Zijlstra GAR, De Witte N, Vogel RGM, Schols JMGA, Kempen GIJM. Explaining discrepancies in self-reported quality of life in frail older people: a mixed-methods study. BMC Geriatr 2017; 17:251. [PMID: 29073908 PMCID: PMC5659025 DOI: 10.1186/s12877-017-0641-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/11/2017] [Indexed: 12/05/2022] Open
Abstract
Background Most research on multidimensional frailty focuses on deficits and risks of adverse outcomes. However, although some frail older people report a low quality of life (QoL), others still report a relatively high QoL. More knowledge about these discrepancies might give new insight into developing frailty prevention strategies. Therefore, this mixed-method study aimed (a) to identify characteristics related to QoL among frail older people; and (b) to explain discrepancies between higher and lower levels of QoL, with a specific interest in identifying strengths frail older people with a higher QoL still have. Methods Semi-structured interviews were held with community-dwelling, frail older people with higher (n = 16) and lower levels of QoL (n = 18). Frailty was assessed with the Comprehensive Frailty Assessment Instrument, which measures environmental, physical, psychological, and social frailty. Other quantitative measures included socio-demographic characteristics, overall QoL, meaning in life, and mastery. The qualitative part focused on the meaning and maintenance of QoL (among other factors), despite being frail. Possible explanations for discrepancies in QoL were explored. Results Frail older people with a higher QoL were older, had lower levels of psychological frailty, and reported higher meaning in life compared to those with a lower QoL. Outcomes of qualitative analysis showed that participants in the high QoL subgroup adapted more effectively to difficulties, had more things in prospect, performed more activities, and were more satisfied with their social network compared to the low QoL subgroup. Conclusion This exploratory study suggests possibilities to promote and improve QoL by strengthening specific resources among frail older people. Electronic supplementary material The online version of this article (10.1186/s12877-017-0641-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne van der Vorst
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands.
| | - G A Rixt Zijlstra
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Nico De Witte
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium.,Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Ruth G M Vogel
- Research Centre for Community Care, Zuyd Hogeschool, Heerlen, the Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
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