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[What are the effects of different places of death of old people?]. Rechtsmedizin (Berl) 2023; 33:40-51. [PMID: 35910857 PMCID: PMC9310373 DOI: 10.1007/s00194-022-00584-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 01/28/2023]
Abstract
Background Inadequate quality of medical postmortem examinations has been discussed in the forensic medical literature for many years. It is known that older deceased persons are less likely to have a non-natural cause of death certified and autopsies are performed less frequently compared to younger deceased persons. Methods Death certificates of all deaths that occurred in Munich with an age of ≥ 75 years during the death period 01/01/2013-31/12/2014 were analyzed. Standardized, anonymized data entry was performed. The collected data were analyzed descriptively. Results A total of 26,303 persons died during the study period. Of these deaths, 16,146 (60.7%) were ≥ 75 years. Most common places of death for the aged were hospital (56.1%), private address (21.8%), and nursing home (20.0%). A natural mode of death was reported in 88.5%, unexplained in 8.8%, and non-natural in 2.7%. Most common immediate causes of death were diseases of the circulatory system (23.5%), inaccurately designated or unknown causes of death (20.0%), and diseases of the respiratory system (16.3%). Autopsies were performed on 4.9%, largely judicial. The parameters studied showed large differences in the analyses depending on the place of death. Discussion This study again shows considerable quality deficiencies in the issuance of death certificates. Despite the dual approach of the Munich health authority (control, training), the quality of death certificates could not be sustainably improved in recent years. Types and causes of death showed partly considerable differences depending on the place of death and the doctor who issued the certificate. The deficits identified in the information provided under the heading "Causes of death" are also likely to have a negative impact on the cause of death statistics.
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Tobin J, Rogers A, Winterburn I, Tullie S, Kalyanasundaram A, Kuhn I, Barclay S. Hospice care access inequalities: a systematic review and narrative synthesis. BMJ Support Palliat Care 2022; 12:142-151. [PMID: 33608254 PMCID: PMC9125370 DOI: 10.1136/bmjspcare-2020-002719] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/09/2021] [Accepted: 01/17/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Inequalities in access to hospice care is a source of considerable concern; white, middle-class, middle-aged patients with cancer have traditionally been over-represented in hospice populations. OBJECTIVE To identify from the literature the demographic characteristics of those who access hospice care more often, focusing on: diagnosis, age, gender, marital status, ethnicity, geography and socioeconomic status. DESIGN Systematic literature review and narrative synthesis. METHOD Searches of Medline, PsycINFO, CINAHL, Web of Science, Assia and Embase databases from January 1987 to end September 2019 were conducted. Inclusion criteria were peer-reviewed studies of adult patients in the UK, Australia, New Zealand and Canada, receiving inpatient, day, outpatient and community hospice care. Of the 45 937 titles retrieved, 130 met the inclusion criteria. Narrative synthesis of extracted data was conducted. RESULTS An extensive literature search demonstrates persistent inequalities in hospice care provision: patients without cancer, the oldest old, ethnic minorities and those living in rural or deprived areas are under-represented in hospice populations. The effect of gender and marital status is inconsistent. There is a limited literature concerning hospice service access for the LGBTQ+ community, homeless people and those living with HIV/AIDS, diabetes and cystic fibrosis. CONCLUSION Barriers of prognostic uncertainty, institutional cultures, particular needs of certain groups and lack of public awareness of hospice services remain substantial challenges to the hospice movement in ensuring equitable access for all.
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Affiliation(s)
- Jake Tobin
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Alice Rogers
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Isaac Winterburn
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sebastian Tullie
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Walker W, Efstathiou N, Jones J, Collins P, Jennens H. Family experiences of in-hospital end-of-life care for adults: A systematic review of qualitative evidence. J Clin Nurs 2022; 32:2252-2269. [PMID: 35332593 DOI: 10.1111/jocn.16268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/29/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIM To systematically identify, appraise, aggregate and synthesise qualitative evidence on family members' experiences of end-of-life care (EoLC) in acute hospitals. METHODS A systematic review and qualitative evidence synthesis based on the Joanna Briggs Institute methodology. Primary research, published 2014 onwards was identified using a sequential strategy of electronic and hand searches. Six databases (CINAHL, Medline, Embase, EMCare, PsycINFO, BNI) were systematically searched. Studies that met pre-determined inclusion/exclusion criteria were uniformly appraised using the Critical Appraisal Skills Programme checklist for qualitative research, and synthesised using a meta-aggregative approach. The ENTREQ statement was used as a checklist for reporting the review. RESULTS Sixteen studies of European, Australasian and North American origin formed the review. The quality of each study was considered very good in view of a 'yes' response to most screening questions. Extracted findings were assembled into 12 categories, and five synthesised findings: Understanding of approaching end of life; essential care at the end of life; interpersonal interactions; environment of care; patient and family care after death. CONCLUSION Enabling and improving peoples' experience of EoLC must remain part of the vision and mission of hospital organisations. Consideration must be given to the fulfilment of family needs and apparent hallmarks of quality care that appear to influence experiential outcomes. RELEVANCE TO CLINICAL PRACTICE This review of qualitative research represents the first-stage development of a family-reported experience measure for adult EoLC in the hospital setting. The synthesised findings provide a Western perspective of care practices and environmental factors that are perceived to impact the quality of the care experience. Collectively, the review findings serve as a guide for evidence-informed practice, quality improvement, service evaluation and future research. A developed understanding of the families' subjective reflections creates reciprocal opportunity to transform experiential insights into practical strategies for professional growth and practice development.
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Affiliation(s)
- Wendy Walker
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Nursing, University of Birmingham, Birmingham, UK
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Lehmann KR, Banovski DC, Fernandes B, Oliveira DKD, Dal’Negro SH, Campos ACD. Where do older adults die in Brazil? An analysis of two decades. GERIATRICS, GERONTOLOGY AND AGING 2022. [DOI: 10.53886/gga.e0220019] [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
Objective: To describe the characteristics of older adult deaths reported in Brazil between 1998 and 2018. Methods: This is a retrospective, descriptive study performed using secondary data from the Brazilian Ministry of Health. Results: During the analyzed period, 14 145 686 older adults died in the country, of which 40.42% were over 80 years old. The main cause of death was circulatory system disease (21.50%), and the most frequent place of death was a hospital environment (68%). The Southeast region accounted for 52.83% of the country’s hospital deaths and 73.33% of those occurring in other health facilities, whereas 38.56% of the deaths that happened at home took place in the Northeast region. Conclusions: The hospital environment was the predominant place of death in all regions of the country, and the main causes of death were chronic noncommunicable diseases. Alternative care modalities emerge as a possibility of establishing accessible end-of-life care in scenarios other than the hospital.
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Gleich S, Turlik V, Schmidt S, Wohlrab D. [COVID-19 deaths among residents of inpatient nursing homes in Munich-causes and places of death]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1136-1145. [PMID: 34379132 PMCID: PMC8356210 DOI: 10.1007/s00103-021-03395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/01/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The new infectious disease COVID-19 first appeared in China in December 2019. So far, a systematic evaluation of death certificates of COVID-19-associated deaths of residents in inpatient nursing homes has not been presented. METHODS Death certificates of all deaths in Munich in the death period from 1 March to 31 July 2020 were analyzed. Inclusion criteria were the presence of "Corona, COVID-19, SARS-CoV-2" on the death certificates. Standardized, anonymized data entry was performed. The collected data were analyzed descriptively. RESULTS During the study period, a total of 5840 persons died, 281 (4.8%) of whom died of confirmed COVID-19 disease. Of those, 72 deaths involved residents of Munich nursing facilities. The most frequent causes of death were respiratory insufficiency (54 cases) and multiple organ failure (9 cases). On the death certificates, an average of two preexisting diseases had been reported; the average age at death was 88 years. All deaths of nursing home residents occurred in association with nosocomial COVID-19 outbreaks, which affected one-third of the facilities. The vast majority of these homes did not have a COVID-19 hygiene plan in place at the time. DISCUSSION One quarter of all COVID-19 deaths in Munich occurred in the context of nosocomial outbreaks in elderly, chronically ill residents of nursing facilities. Evidence of inadequate risk assessment and inadequate hygiene management emerged. In the opinion of the authors, the appropriate structures for adequate hygiene management must be created and a hygiene regulation must be issued in which the tasks and responsibilities of the facility operators are defined.
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Affiliation(s)
- Sabine Gleich
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland.
| | - Verena Turlik
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland
| | - Susann Schmidt
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland
| | - Doris Wohlrab
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland
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Gleich S, Schmidt S, Wohlrab D. [COVID-19- and influenza-associated deaths in Munich as of March 2020-a standardized analysis of death certificates]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1125-1135. [PMID: 34398246 PMCID: PMC8365291 DOI: 10.1007/s00103-021-03392-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/02/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In light of the current COVID-19 pandemic, the idea arose to conduct a study to comparatively evaluate deaths from two respiratory transmissible infectious diseases (pandemic COVID-19 and seasonal influenza) by means of death certificates received by the health department. METHODS Death certificates of all deaths in Munich in the death period from 1 March-31 December 2020 were analyzed. The predefined inclusion criteria were the indication of "Corona, COVID-19, SARS-CoV‑2, Influenza (A/B)" on the death certificates. Standardized data entry was performed. The collected data were analyzed descriptively in aggregated form. RESULTS A total of 12,441 persons died during the study period, 1029 (8.3%) from confirmed COVID-19 and 22 (0.1%) from influenza. The two collectives matched well in the parameters studied. The mean age at death was approximately 80 years and the most common site of death was in hospital. Infectious disease was the cause of death in more than 90% of cases. The most common causes of death were acute respiratory distress syndrome/respiratory failure and multiorgan failure. An average of two previous illnesses were reported, most commonly diseases of the circulatory system and nervous system. There was no influenza death in the second pandemic wave. DISCUSSION In this study, COVID-19- and influenza-associated deaths were compared for the first time. The deaths of both collectives matched well in the parameters studied, but still require verification in a larger study given the small numbers of influenza cases. An English full-text version of this article is available at SpringerLink as Supplementary Information.
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Affiliation(s)
- Sabine Gleich
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland.
| | - Susann Schmidt
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland
| | - Doris Wohlrab
- Gesundheitsreferat der LH München, Bayerstr. 28a, 80335, München, Deutschland
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Ceylan S, Guner Oytun M, Okyar Bas A, Kahyaoglu Z, Dogu BB, Cankurtaran M, Halil MG. Place of Death of Geriatric Population in Turkey: A 7-Year Observational Study. J Palliat Care 2021; 37:18-25. [PMID: 34402330 DOI: 10.1177/08258597211036579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND End-of-life care has become an important public health issue in recent years. Place of death is a major component of end-of-life care. Despite attempts to improve end-of-life care, there has not been published any data about place of deaths in Turkey. Aim: This retrospective, cross-sectional study investigates the place of death and trends over the years in geriatric age groups in Turkey. Methods: Patients who were admitted to geriatric outpatient clinic of a university hospital during a 7-year period were included. Place and date of death information were received from the death notification system and recorded as hospital or out-of-hospital death. Demographic and clinical data were collected from the hospital information system. Deaths occurring after March 1, 2020 were not included to eliminate the effect of coronavirus disease-2019 pandemic. Results: A total of 4025 (20.7%) patients were determined to be dead. Approximately three-quarters of deaths (73.0%) occurred in hospital. The number of deaths reported from nursing homes was only 13 (3.0%). Patients with dementia less frequently died in hospital, however, it was not statistically significant (12.4% vs 14.7%, P = .05). The prevalence of death in hospital was significantly higher in patients with chronic renal failure (3.1% vs 1.7%, P = .02). The presence of comorbid conditions such as heart failure, cerebrovascular disease, Parkinson's disease, chronic obstructive pulmonary disease/asthma, and cancer did not affect the place of death (P = .24, .21, .24, .51, and .18). Out-of-hospital mortality increased with advanced age (P < .001). No significant difference was found in the place of death over the years (P = .41). Conclusion: To the best of our knowledge, this is the first study examining the place of death in Turkey, an aging country. Our results may help to establish policies about end-of-life care in elderly people to improve quality of life by using resources effectively.
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Affiliation(s)
- Serdar Ceylan
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, 64005Hacettepe University, Ankara, Turkey
| | - Merve Guner Oytun
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, 64005Hacettepe University, Ankara, Turkey
| | - Arzu Okyar Bas
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, 64005Hacettepe University, Ankara, Turkey
| | - Zeynep Kahyaoglu
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, 64005Hacettepe University, Ankara, Turkey
| | - Burcu B Dogu
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, 64005Hacettepe University, Ankara, Turkey
| | - Mustafa Cankurtaran
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, 64005Hacettepe University, Ankara, Turkey
| | - Meltem G Halil
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, 64005Hacettepe University, Ankara, Turkey
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Socio-Economic Deprivation and Symptom Burden in UK Hospice Patients with Advanced Cancer-Findings from a Longitudinal Study. Cancers (Basel) 2021; 13:cancers13112537. [PMID: 34064172 PMCID: PMC8196745 DOI: 10.3390/cancers13112537] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary We know that socio-economic factors influence delay in presentation and diagnosis of cancer and that patients living in areas of greater socio-economic deprivation are less likely to be referred to palliative care services including hospice. However, very little is known regarding the impact of socio-economic deprivation on symptom burden in advanced cancer patients. Our study found that patients experiencing greater socio-economic deprivation were more likely to report depression and pain and greater global symptom burden than patients from less socio-economically deprived areas. We also found that reporting a lack of information at time of diagnosis was significantly associated with socio-economic deprivation. Although more than one-third of patients recruited into this study were diagnosed with cancer within the preceding 12 months, this was not associated with socio-economic factors and socio-economic factors did not appear to influence survival in our study. The impact of socio-economic factors on symptom burden and information needs should be acknowledged within palliative care settings. Abstract Socio-economic deprivation is known to impact on cancer diagnosis, treatment and access to services, but little is known of the impact of socio-economic deprivation on symptom burden in patients with advanced cancer. Patients with advanced cancer attending hospice day services were recruited into a 24 week longitudinal study. An area-based index of social deprivation was collected along with depression and symptom burden at baseline, 8, 16 and 24 weeks. Of the 595 patients included, with an age range of 33–89 years and a mean age of 68 years, 67% were female, and 37% were diagnosed with cancer in the last 12 months. Twenty nine percent lived in one of the most deprived 20% of neighbourhoods. Patients living in the most socio-economically deprived areas were significantly likely to report receiving insufficient information regarding their cancer at diagnosis (p = 0.007), greater pain (p = 0.02), moderate to severe depression (p = 0.04) and higher global symptom burden (p = 0.04). This study is the first to report that patients with advanced cancer attending hospice services, living in the most deprived neighbourhoods experience significantly greater symptom burden, notably depression and pain. We recommend using patient outcome measures in order to provide targeted support and thereby reduce the increased symptom burden that socio-economically disadvantaged patients experience at the end of life.
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Gleich S, Graw M, Viehöver S, Schmidt S, Wohlrab D. [COVID-19-associated deaths]. Rechtsmedizin (Berl) 2021; 31:408-417. [PMID: 33612978 PMCID: PMC7884065 DOI: 10.1007/s00194-021-00455-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In December 2019, the new infectious coronavirus disease 2019 (COVID-19) first appeared in China. So far, no systematic evaluation of death certificates of COVID-19-associated deaths has been presented. METHODS The death certificates of all deaths in Munich during the period from 1 March to 31 July 2020 were analyzed. The previously defined inclusion criteria were the indication of corona, COVID-19 and SARS-CoV‑2 in the death certificates. The variables were entered anonymously according to a developed key. The collected data were evaluated descriptively. RESULTS In the period under investigation, a total of 5840 people died in the Munich City area. Of these deaths 332 (5.7%) were COVID-19-associated. In 281 deaths (84.6%) there was a definite COVID-19 and in 51 deaths (15.4%) the suspicion of this disease. The most frequent causes of death were acute respiratory distress syndrome or respiratory insufficiency (59.1%), multiple organ failure (21.4%) and sepsis (10%). An average of 1.8 pre-existing illnesses were reported in the death certificates. Most frequently mentioned were diseases of the circulatory system (54.8%), the nervous system (22.8%) and metabolic diseases (18.9%). The average age at death was 79 years and the most frequent place of death was a hospital (85%). An autopsy was attempted by the doctors who issued the death certificates for 18.1% of the collective, most frequently in the case of unexplained or unnatural causes of death and young age of the deceased. Clinical pathological autopsies were performed on 11% of the collective and judicial autopsies on 1%. DISCUSSION This study is the first evaluation of death certificates with respect to the novel infectious COVID-19. Number and essential characteristics of COVID-19-associated deaths in Munich during the so-called first wave could be mapped. The interest of physicians in autopsies was rather low despite the appearance of a new infectious disease.
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Affiliation(s)
- S. Gleich
- Gessundheitsreferat, LH München, Bayerstr. 28a, 80335 München, Deutschland
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - M. Graw
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - S. Viehöver
- Gessundheitsreferat, LH München, Bayerstr. 28a, 80335 München, Deutschland
| | - S. Schmidt
- Gessundheitsreferat, LH München, Bayerstr. 28a, 80335 München, Deutschland
| | - D. Wohlrab
- Gessundheitsreferat, LH München, Bayerstr. 28a, 80335 München, Deutschland
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Nolasco A, Fernández-Alcántara M, Pereyra-Zamora P, Cabañero-Martínez MJ, Copete JM, Oliva-Arocas A, Cabrero-García J. Socioeconomic inequalities in the place of death in urban small areas of three Mediterranean cities. Int J Equity Health 2020; 19:214. [PMID: 33272290 PMCID: PMC7713024 DOI: 10.1186/s12939-020-01324-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dying at home is the most frequent preference of patients with advanced chronic conditions, their caregivers, and the general population. However, most deaths continue to occur in hospitals. The objective of this study was to analyse the socioeconomic inequalities in the place of death in urban areas of Mediterranean cities during the period 2010-2015, and to assess if such inequalities are related to palliative or non-palliative conditions. METHODS This is a cross-sectional study of the population aged 15 years or over. The response variable was the place of death (home, hospital, residential care). The explanatory variables were: sex, age, marital status, country of birth, basic cause of death coded according to the International Classification of Diseases, 10th revision, and the deprivation level for each census tract based on a deprivation index calculated using 5 socioeconomic indicators. Multinomial logistic regression models were adjusted in order to analyse the association between the place of death and the explanatory variables. RESULTS We analysed a total of 60,748 deaths, 58.5% occurred in hospitals, 32.4% at home, and 9.1% in residential care. Death in hospital was 80% more frequent than at home while death in a nursing home was more than 70% lower than at home. All the variables considered were significantly associated with the place of death, except country of birth, which was not significantly associated with death in residential care. In hospital, the deprivation level of the census tract presented a significant association (p < 0.05) so that the probability of death in hospital vs. home increased as the deprivation level increased. The deprivation level was also significantly associated with death in residential care, but there was no clear trend, showing a more complex association pattern. No significant interaction for deprivation level with cause of death (palliative, not palliative) was detected. CONCLUSIONS The probability of dying in hospital, as compared to dying at home, increases as the socioeconomic deprivation of the urban area of residence rises, both for palliative and non-palliative causes. Further qualitative research is required to explore the needs and preferences of low-income families who have a terminally-ill family member and, in particular, their attitudes towards home-based and hospital-based death.
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Affiliation(s)
- Andreu Nolasco
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain
| | | | - Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain.
| | - María José Cabañero-Martínez
- Department of Nursing, University of Alicante, Alicante, Spain.,Institute for Health and Biomedical Research of Alicante (ISABIAL- FISABIO Foundation), Alicante, Spain
| | - José M Copete
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain
| | - Adriana Oliva-Arocas
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain
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Sterbefälle Münchner Altenheimbewohner und betagter Allgemeinbevölkerung – ein Vergleich ausgestellter Todesbescheinigungen. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00441-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Boland P, Geddes Z, Hill J. Families may benefit from spiritual care in acute settings when loved ones are coming to the end of their lives. Evid Based Nurs 2020; 24:142. [PMID: 32855173 DOI: 10.1136/ebnurs-2020-103279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Paul Boland
- Research Support Team, University of Central Lancashire, Preston, Lancashire, UK
| | - Zoe Geddes
- Neuro-oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - James Hill
- Health Technology Assessment Group, University of Central Lancashire, Preston, Lancashire, UK
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Ó Coimín D, Prizeman G, Korn B, Donnelly S, Hynes G. Dying in acute hospitals: voices of bereaved relatives. BMC Palliat Care 2019; 18:91. [PMID: 31672137 PMCID: PMC6824032 DOI: 10.1186/s12904-019-0464-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 09/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background Internationally there is an increasing concern about the quality of end-of-life care (EoLC) provided in acute hospitals. More people are cared for at end of life and die in acute hospitals than in any other healthcare setting. This paper reports the views of bereaved relatives on the experience of care they and the person that died received during their last admission in two university adult acute tertiary hospitals. Methods Relatives of patients who died were invited to participate in a post-bereavement postal survey. An adapted version of VOICES (Views of Informal Carers - Evaluation of Services) questionnaire was used. VOICES MaJam has 36 closed questions and four open-ended questions. Data were gathered in three waves and analysed using SPSS and NVivo. 356 respondents completed the survey (46% response rate). Results The majority of respondents (87%: n = 303) rated the quality of care as outstanding, excellent or good during the last admission to hospital. The quality of care by nurses, doctors and other staff was highly rated. Overall, care needs were well met; however, findings identified areas of care which could be improved, including communication and the provision of emotional and spiritual support. In addition, relatives strongly endorsed the provision of EoLC in single occupancy rooms, the availability of family rooms on acute hospital wards and the provision of bereavement support. Conclusions This research provides a powerful snapshot in time into what works well and what could be improved in EoLC in acute hospitals. Findings are reported under several themes, including the overall quality of care, meeting care needs, communication, the hospital environment and support for relatives. Results indicate that improvements can be made that build on existing good practice that will enhance the experience of care for dying persons and their relatives. The study adds insights in relation to relative’s priorities for EoLC in acute hospitals and can advance care providers’, policy makers’ and educationalists’ priorities for service improvement.
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Affiliation(s)
- Diarmuid Ó Coimín
- End-of-Life Care, Mater Misericordiae University Hospital, Quality and Patient Safety Directorate, Eccles Street, Dublin 7, Ireland.
| | - Geraldine Prizeman
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Bettina Korn
- End-of-Life Care, Hospice Friendly Hospital Programme, 1st Floor CEO Building, St. James's Hospital, James Street, Dublin 8, Ireland
| | - Sarah Donnelly
- Social Work, School of Social Policy, Social Work and Social Justice, University College, Dublin, Ireland
| | - Geralyn Hynes
- Palliative Care, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Turner V, Flemming K. Socioeconomic factors affecting access to preferred place of death: A qualitative evidence synthesis. Palliat Med 2019; 33:607-617. [PMID: 30848703 DOI: 10.1177/0269216319835146] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Existing quantitative evidence suggests that at a population level, socioeconomic factors affect access to preferred place of death. However, the influence of individual and contextual socioeconomic factors on preferred place of death are less well understood. AIM To systematically synthesise the existing qualitative evidence for socioeconomic factors affecting access to preferred place of death in the United Kingdom. DESIGN A thematic synthesis of qualitative research. DATA SOURCES Cochrane Library, MEDLINE, Embase, CINAHL, ASSIA, Scopus and PsycINFO databases were searched from inception to May 2018. RESULTS A total of 13 articles, reporting on 12 studies, were included in the synthesis. Two overarching themes were identified: 'Human factors' representing support networks, interactions between people and decision-making and 'Environmental factors', which included issues around locations and resources. Few studies directly referenced socioeconomic deprivation. The main factor affecting access to preferred place of death was social support; people with fewer informal carers were less likely to die in their preferred location. Other key findings included fluidity around the concept of home and variability in preferred place of death itself, particularly in response to crises. CONCLUSION There is limited UK-based qualitative research on socioeconomic factors affecting preferred place of death. Further qualitative research is needed to explore the barriers and facilitators of access to preferred place of death in socioeconomically deprived UK communities. In practice, there needs to be more widespread discussion and documentation of preferred place of death while also recognising these preferences may change as death nears or in times of crisis.
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Affiliation(s)
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
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