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Smith S, Brick A, Johnston B, Ryan K, McQuillan R, O’Hara S, May P, Droog E, Daveson B, Morrison RS, Higginson IJ, Normand C. Place of Death for Adults Receiving Specialist Palliative Care in Their Last 3 Months of Life: Factors Associated With Preferred Place, Actual Place, and Place of Death Congruence. J Palliat Care 2024; 39:184-193. [PMID: 38404130 PMCID: PMC11097611 DOI: 10.1177/08258597241231042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Objectives: Congruence between the preferred and actual place of death is recognised as an important quality indicator in end-of-life care. However, there may be complexities about preferences that are ignored in summary congruence measures. This article examined factors associated with preferred place of death, actual place of death, and congruence for a sample of patients who had received specialist palliative care in the last three months of life in Ireland. Methods: This article analysed merged data from two previously published mortality follow-back surveys: Economic Evaluation of Palliative Care in Ireland (EEPCI); Irish component of International Access, Rights and Empowerment (IARE I). Logistic regression models examined factors associated with (a) preferences for home death versus institutional setting, (b) home death versus hospital death, and (c) congruent versus non-congruent death. Setting: Four regions with differing levels of specialist palliative care development in Ireland. Participants: Mean age 77, 50% female/male, 19% living alone, 64% main diagnosis cancer. Data collected 2011-2015, regression model sample sizes: n = 342-351. Results: Congruence between preferred and actual place of death in the raw merged dataset was 51%. Patients living alone were significantly less likely to prefer home versus institution death (OR 0.389, 95%CI 0.157-0.961), less likely to die at home (OR 0.383, 95%CI 0.274-0.536), but had no significant association with congruence. Conclusions: The findings highlight the value in examining place of death preferences as well as congruence, because preferences may be influenced by what is feasible rather than what patients would like. The analyses also underline the importance of well-resourced community-based supports, including homecare, facilitating hospital discharge, and management of complex (eg, non-cancer) conditions, to facilitate patients to die in their preferred place.
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Affiliation(s)
- Samantha Smith
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aoife Brick
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
| | - Bridget Johnston
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Ryan
- School of Medicine, University College Dublin, Dublin, Ireland
- St Francis Hospice, Dublin, Ireland
| | - Regina McQuillan
- St Francis Hospice, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Sinead O’Hara
- Healthcare Pricing Office, Health Service Executive, Dublin, Ireland
| | - Peter May
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Elsa Droog
- National Office of Quality & Patient Safety, Health Service Executive, Cork, Ireland
| | - Barbara Daveson
- Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, New South Wales, Australia
| | - R. Sean Morrison
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, USA and James J Peters VA Medical Center, Bronx, USA
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Charles Normand
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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Pinto S, Lopes S, de Sousa AB, Delalibera M, Gomes B. Patient and Family Preferences About Place of End-of-Life Care and Death: An Umbrella Review. J Pain Symptom Manage 2024; 67:e439-e452. [PMID: 38237790 DOI: 10.1016/j.jpainsymman.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 02/05/2024]
Abstract
CONTEXT The place where people are cared towards the end of their life and die is a complex phenomenon, requiring a deeper understanding. Honoring preferences is critical for the delivery of high-quality care. OBJECTIVES In this umbrella review we examine and synthesize the evidence regarding preferences about place of end-of-life care and death of patients with life-threatening illnesses and their families. METHODS Following the Joanna Briggs Institute methodology, we conducted a comprehensive search for systematic reviews in PsycINFO, MEDLINE, EMBASE, CINAHL, Epistemonikos, and PROSPERO without language restrictions. RESULTS The search identified 15 reviews (10 high-quality, three with meta-analysis), covering 229 nonoverlapping primary studies. Home is the most preferred place of end-of-life care for both patients (11%-89%) and family members (23%-84%). It is also the most preferred place of death (patient estimates from two meta-analyses: 51%-55%). Hospitals and hospice/palliative care facilities are preferred by substantial minorities. Reasons and factors affecting preferences include illness-related, individual, and environmental. Differences between preferred places of care and death are underexplored and the evidence remains inconclusive about changes over time. Congruence between preferred and actual place of death ranges 21%-100%, is higher in studies since 2004 and a meta-analysis shows noncancer patients are at higher risk of incongruence than cancer patients (OR 1.23, 95% CI: 1.01-1.49, I2 = 62%). CONCLUSION These findings are a crucial starting point to address gaps and enhance strategies to align care with patient and family preferences. To accurately identify patient and family preferences is an important opportunity to change their lives positively.
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Affiliation(s)
- Sara Pinto
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal; Nursing School of Porto (S.P.), Rua Dr. António Bernardino de Almeida, Porto, Portugal; Cintesis@RISE, NursID (S.P.), Rua Dr. Plácido da Costa, Porto, Portugal
| | - Sílvia Lopes
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal; NOVA National School of Public Health, Public Health Research Center (S.L.), Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center (S.L.), Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Andrea Bruno de Sousa
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Mayra Delalibera
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Barbara Gomes
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal; Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation (B.G.), King's College London, London, United Kingdom, Bessemer Road, SE5 9PJ, London, United Kingdom.
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Ginggeaw S, LeBlanc R. The determinants of actual place of death among noncancer patients with end-stage chronic health conditions: a scoping review. Palliat Care Soc Pract 2024; 18:26323524241236964. [PMID: 38510469 PMCID: PMC10953110 DOI: 10.1177/26323524241236964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
A home is a preferred place of death by most people. Nurses play a key role in supporting end-of-life home care, yet less is known about the factors that determine home as a place of death. This scoping review describes the percentage of actual places of death and determines social factors related to home as the place of death among noncancer patients with end-stage chronic health conditions. Inclusion criteria included (1) noncancer chronic illness conditions, (2) outcomes of place of death, and (3) factors that determine home as a place of death. Sources of evidence included PubMed, CINAHL, and Web of Science databases, which were searched in May 2022, and additional searches from May 2022 to November 2023.The JBI scoping review guide (2020) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension were used. Twenty-eight studies were included in this analysis. The range of percentages is varied within the same place of death among the sample. Two major constructs that determine a home as a place of death were identified: preceding factors and social capital. The results suggest that the place of death among noncancer patients with end-stage chronic health conditions should be continued to be understood. Two constructs determined home as a place of death and are considered as a fundamental to increasing equal accessibility in the initiation of palliative care services to promote home death and meet end-of-life care goals.
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Affiliation(s)
- Sangduan Ginggeaw
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, 651 North Pleasant Street, Amherst, MA 01003, USA
| | - Raeann LeBlanc
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
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Larsdotter C, Nyblom S, Gyllensten H, Furst CJ, Ozanne A, Hedman R, Nilsson S, Öhlén J. Trends in the place of death in Sweden from 2013 to 2019 - disclosing prerequisites for palliative care. Palliat Care Soc Pract 2024; 18:26323524241238232. [PMID: 38497045 PMCID: PMC10943753 DOI: 10.1177/26323524241238232] [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: 10/13/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Background The drive for home care has increasingly impacted the organization and allocation of resources within the Swedish healthcare system. Objectives With an interest in uncovering prerequisites for palliative care, this study aimed to investigate longitudinal trends in place of death within the adult Swedish population from 2013 to 2019 and examine potential associations between place of death and individual, geographic, and socioeconomic factors; hospital capacity; and healthcare utilization. Methods This population-level comprehensive register study included all deceased individuals ⩾18 years old with a registered place of death (n = 599,137). Data were retrieved from public and patient data registers and the national register for palliative care. Trends and associations between place of death and co-variables were investigated by logistic regression- and interaction analyses. Results From 2013 to 2019, the total number of home deaths increased by 1.9%, whereas the number of hospital deaths decreased by 2.6%. In the overall population of individuals living in their own homes, from 2013 to 2019, the likelihood of dying in hospital versus dying at home decreased (odds ratio: 0.98, 95% confidence interval: 0.97-0.99). Within the population with potential palliative needs living in their own home (78.4%), the likelihood of dying in hospitals equally decreased, except in Stockholm and the north region. For individuals residing in a nursing home, however, the likelihood of dying in hospital versus remaining in the nursing home until death only significantly decreased in the southern region. Conclusion The results show a trend towards a decrease in hospital deaths but with cross-regional variations. Still, in 2019, only about one-fifth of all individuals died in their own homes. Public health-oriented interventions aimed at strengthening palliative care resources in nursing homes and home care are suggested.
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Affiliation(s)
- Cecilia Larsdotter
- Department of Nursing Science, Sophiahemmet University, Box 5605, Stockholm SE-114 86, Sweden
| | - Stina Nyblom
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, and Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl-Johan Furst
- Faculty of Medicine, Department of Clinical Sciences Lund, The Institute for Palliative Care, Respiratory Medicine, Allergology, and Palliative Medicine, Lund University, Lund, Sweden
| | - Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ragnhild Hedman
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Stefan Nilsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, and Centre for Person-centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
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Raunkiaer M, Mikkelsen TB, Shabnam J, Christiansen SR, Jarlbaek L. Community-based palliative care in two primary care settings - nursing homes and home care: a national survey. Scand J Public Health 2024:14034948241232461. [PMID: 38443360 DOI: 10.1177/14034948241232461] [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: 03/07/2024]
Abstract
AIMS Based on selected themes from a national survey, the study aims to describe and analyse similarities and differences in community-based palliative care provided to people living at home in two different care settings - the nursing home setting and the home care setting. METHODS Responses from four palliative care themes covered by a national survey sent to 717 managers in municipality-based care units were used. The themes were: (a) target groups in palliative care; (b) wishes for end-of-life care; (c) tools/guidelines in palliative care; and (d) palliative care provided to relatives. RESULTS The response rates were 53% in the nursing home setting and 69% in the home care setting (69%). Both settings had target groups for palliative care, in which significantly more units in the home care settings cared for people with other cultural backgrounds or children. Wishes for end-of-life care were addressed by more than 90% of the units in both settings. There were significantly more nursing home units that addressed questions regarding resuscitation, decision making when you are incapable of making decisions for yourself, and the level of medication. In both settings, around half of the units did not use or did not know if they used tools/guidelines to identify palliative care needs. Half of home care and 65% of nursing home settings did not/were unaware of providing palliative care to relatives. CONCLUSIONS Both settings serve target populations for palliative care with few differences. Identifying palliative care needs seemed to be a low priority in both settings. A difference was found between the settings regarding end-of-life care questions and palliative care promotion to relatives.
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Affiliation(s)
- Mette Raunkiaer
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tina B Mikkelsen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jahan Shabnam
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sofie R Christiansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Abstract
BACKGROUND Little is known about where young adults with chronic illness die in the United States and factors associated with place of death. OBJECTIVES This study aimed to examine place of death and factors associated with place of death for young adults with chronic illness using the most recent national data. METHODS Our sample ( N = 405,535) from the National Center for Health Statistics Division of Vital Statistics death certificate data (2003-2018) included young adults (age 18-39 years) who died from chronic conditions common in childhood or young adulthood. Conditions were grouped by underlying pathophysiology (oncological, cardiovascular, neuromuscular, metabolic, hematological/immunological, renal, chromosomal/congenital, gastrointestinal, and respiratory). Place of death was dichotomized into acute care (inpatient, outpatient/emergency room, and dead on arrival) or nonacute care (home, hospice, nursing home/long-term care, other, and unknown). Examined factors were gender, year of death, age, race (White, Black, Asian/Pacific Islander, American Indian/Alaskan Native), cause of death, and city of residence population (100,000 or greater and under 100,000). Descriptive statistics and logistic regression were used to examine factors related to place of death. RESULTS Over half of young adults died in acute care settings. Young adults who were Asian/Pacific Islander or Black or who died from a respiratory or renal cause of death were most likely to die in an acute care setting. Rates of acute care death decreased over the studied years. DISCUSSION Many young adults died in an acute care setting. Race and cause of death were the most influential factors associated with place of death. Young adults with an oncological cause of death were less likely to die in an acute care setting than patients with other underlying causes. This may indicate that specific care needs or preferences at the end of life may differ in certain disease populations and may affect place of death. Previous research has shown similar results in other developmental populations; however, given the complex psychosocial concerns that often arise during young adulthood, further research is needed to describe how the young adult status may specifically affect place of death.
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Cheon J, Kim DH, Cho CM. Factors associated with home death in South Korea: Using the exit data from the Korean Longitudinal Study of Aging, 2008-2018. PLoS One 2023; 18:e0288165. [PMID: 37450472 PMCID: PMC10348527 DOI: 10.1371/journal.pone.0288165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Even though home deaths have been reported to improve quality of life, satisfy patients and families, and reduce healthcare expenditures, not enough is known about the factors that influence home deaths in Korea. OBJECTIVES This study aimed to examine the factors associated with home deaths among middle-aged and older adults in South Korea. METHODS This secondary data analysis used core interview and exit interview data of the Korean Longitudinal Study of Aging conducted between 2008 and 2018. The deceased included adults over the age of 45 years. The exit data were obtained from interviews with family members or other acquaintances known to the deceased every two years since 2008. Complex-sample logistic regression was conducted using 1,565 middle-aged and older deceased adults. RESULTS Among 1,565 decedents, the average age at the time of death was 80.67±10.69 in the home death group, and 78.72±9.83 in the non-home death group. The proportion of home-related deaths was 26.4%. Age over 81 years was associated with increased odds of home death, whereas having two or more living children, living in town/small city, paid medical expenses by children/grandchildren and their spouses, expected death, death from disease, and having three or more chronic diseases were associated with decreased odds of home death. An increase in activities of daily living during three months before death was associated with a decrease in home death. CONCLUSION The findings could help healthcare professionals develop tailored interventions to help people die at their preferred place of death based on family characteristics and healthcare accessibility. Age, residential area, number of children and children's financial support, and illness-related factors influenced home death by creating differences in access to healthcare resources and support. Policymakers should decrease healthcare disparities and improve health resource allocation and home-based care.
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Affiliation(s)
- Jooyoung Cheon
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
| | - Dong Hee Kim
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
| | - Chung Min Cho
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
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McFerran E, Cairnduff V, Elder R, Gavin A, Lawler M. Cost consequences of unscheduled emergency admissions in cancer patients in the last year of life. Support Care Cancer 2023; 31:201. [PMID: 36869930 PMCID: PMC9985568 DOI: 10.1007/s00520-023-07633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES Cancer is a leading cause of death. This paper examines the utilisation of unscheduled emergency end-of-life healthcare and estimates expenditure in this domain. We explore care patterns and quantify the likely benefits from service reconfigurations which may influence rates of hospital admission and deaths. METHODS Using prevalence-based retrospective data from the Northern Ireland General Registrar's Office linked by cancer diagnosis to Patient Administration episode data for unscheduled emergency care (1st January 2014 to 31st December 2015), we estimate unscheduled-emergency-care costs in the last year of life. We model potential resources released by reductions in length-of-stay for cancer patients. Linear regression examined patient characteristics affecting length of stay. RESULTS A total of 3134 cancer patients used 60,746 days of unscheduled emergency care (average 19.5 days). Of these, 48.9% had ≥1 admission during their last 28 days of life. Total estimated cost was £28,684,261, averaging £9200 per person. Lung cancer patients had the highest proportion of admissions (23.2%, mean length of stay = 17.9 days, mean cost=£7224). The highest service use and total cost was in those diagnosed at stage IV (38.4%), who required 22,099 days of care, costing £9,629,014. Palliative care support, identified in 25.5% of patients, contributed £1,322,328. A 3-day reduction in the mean length of stay with a 10% reduction in admissions, could reduce costs by £7.37 million. Regression analyses explained 41% of length-of-stay variability. CONCLUSIONS The cost burden from unscheduled care use in the last year of life of cancer patients is significant. Opportunities to prioritise service reconfiguration for high-costing users emphasized lung and colorectal cancers as offering the greatest potential to influence outcomes.
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Affiliation(s)
- Ethna McFerran
- C/o Patrick G Johnson Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK.
| | | | - Ray Elder
- South Eastern Health and Social Care Trust, Ulster Hospital, Upper Newtownards Road, Dundonald, BT16 1RH, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Mulhouse Building, Queen's University, Mulhouse Rd, Belfast, BT12 6DP, UK
| | - Mark Lawler
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK
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Ceylan S, Guner Oytun M, Okyar Bas A, Kahyaoglu Z, Ayaz CM, Balci C, Dogu BB, Cankurtaran M, Halil MG. Changes in Place of Death of Older Adults during the COVID-19 Pandemic: A Retrospective Study from an Aging Country. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231154361. [PMID: 36715548 PMCID: PMC9892879 DOI: 10.1177/00302228231154361] [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] [Indexed: 01/31/2023]
Abstract
In the COVID-19 pandemic, due to the difficulties in patients' applications to health centres, changes have occurred in the places of death of older adults. It is aimed to investigate the change in the places of death of older adults in Turkey, which is one of the countries most affected by the pandemic. Patients admitted to the geriatric outpatient clinic of a university hospital from 01.01.2013 to 29.02.2020 were included. Place and date of death were recorded as hospital or out-of-hospital death. According to results, while the median age of those who died during the pandemic was higher than before (p < 0.001) and during the pandemic, the hospital mortality ratio was higher than before. During the pandemic period, the hospital mortality ratio of older adults has increased in Turkey. This situation, which has occurred despite the increasing healthcare burden, can show the importance of the measures taken and robust health infrastructure.
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Affiliation(s)
- Serdar Ceylan
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Merve Guner Oytun
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Arzu Okyar Bas
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Zeynep Kahyaoglu
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Caglayan Merve Ayaz
- Department of Infectious Disease
and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Cafer Balci
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Burcu Balam Dogu
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Mustafa Cankurtaran
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
| | - Meltem Gulhan Halil
- Division of Geriatrics, Department
of Internal Medicine, Faculty of Medicine, Hacettepe
University, Ankara, Turkey
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Steel A, Owen L. Advance care planning-factors influencing stability of preferences. Age Ageing 2022; 51:6881502. [PMID: 36477786 DOI: 10.1093/ageing/afac294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anna Steel
- Department of Geriatrics, Barnet Hospital, Wellhouse Lane, Barnet, EN5 3DJ, UK
| | - Lucy Owen
- Department of Geriatrics, Barnet Hospital, Wellhouse Lane, Barnet, EN5 3DJ, UK
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