1
|
Jan D, Kim KY. End-of-Life Care of Persons with Alzheimer's Disease and Other Dementias. Am J Hosp Palliat Care 2024:10499091241253838. [PMID: 38714329 DOI: 10.1177/10499091241253838] [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: 05/09/2024] Open
Abstract
End-of-life (EOL) care has been a common option for patients with terminal medical conditions such as cancers. However, the utilization of EOL care in Alzheimer disease and other dementing conditions have become available relatively recently. As the end-stage dementia approaches, the clinicians and caregivers become faced with numerous clinical challenges-delirium, neuropbehavioral symptoms, the patient's inability to communicate pain and associated discomfort, food refusal, and so on. In addition to providing quality clinical care to the EOL patients, clinicians should pay special attention to their families, assuring that their loved ones will receive supportive measures to improve quality of life (QOL).
Collapse
Affiliation(s)
- Darlon Jan
- Psychiatry Residency Program, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Center for Healthy Aging, Carilion Clinic, Roanoke, VA, USA
| | - Kye Y Kim
- Psychiatry Residency Program, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Center for Healthy Aging, Carilion Clinic, Roanoke, VA, USA
| |
Collapse
|
2
|
Arango-Gutiérrez A, Moreno S, Rondón M, Arroyo LI, Ardila L, Leal Arenas FA, Calvache JA, de Vries E. Factors associated with suffering from dying in patients with cancer: a cross-sectional analytical study among bereaved caregivers. BMC Palliat Care 2023; 22:48. [PMID: 37085859 PMCID: PMC10120203 DOI: 10.1186/s12904-023-01148-x] [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: 06/09/2022] [Accepted: 03/16/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND In Colombia, cancer incidence is increasing, as is the demand for end-of-life care. Understanding how patients who die from cancer experience this phase will allow the identification of factors associated with greater suffering and actions to improve end-of-life care. We aimed to explore associations between the level of suffering of patients who died from cancer and were cared for in three Colombian hospitals with patient, tumor, treatment, and care characteristics and provided information. METHODS Data on the last week of life and level of suffering were collected through proxies: Bereaved caregivers of patients who died from cancer in three participating Colombian hospitals. Bereaved caregivers participated in a phone interview and answered a series of questions regarding the last week of the patient's life. An ordinal logistic regression model explored the relationship between the level of suffering reported by bereaved caregivers with the patient's demographic and clinical characteristics, the bereaved caregivers, and the care received. Multivariate analyses were adjusted for place of death, treatments to prolong of life, prolongation of life during the dying process, suffering due to prolongation of life, type of cancer, age, if patient had partner, rural/urban residence of patient, importance of religion for the caregiver, caregivers´ relationship with the patient, and co-living with the patient. RESULTS A total of 174 interviews were included. Median age of the deceased patients was 64 years (IQR 52-72 years), and 93 patients were women (53.4%). Most caregivers had rated the level of suffering of their relative as "moderately to extremely" (n = 139, 80%). In multivariate analyses, factors associated with a higher level of suffering were: unclear information about the treatment and the process before death Odds Ratio (OR) 2.26 (90% CI 1.21-4.19), outpatient palliative care versus home care OR 3.05 (90% CI 1.05-8.88), procedures inconsistent with the patient's wishes OR 2.92 (90% CI 1.28-6.70), and a younger age (18-44 years) at death versus the oldest age group (75-93 years) OR 3.80 (90% CI 1.33-10.84, p = 0.04). CONCLUSION End-of-life care for cancer patients should be aligned as much as possible with patients´ wishes, needs, and capacities. A better dialogue between doctors, family members, and patients is necessary to achieve this.
Collapse
Affiliation(s)
- Angélica Arango-Gutiérrez
- MSc programme Clinical Epidemiology, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Socorro Moreno
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Martín Rondón
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lucía I Arroyo
- Departamento de Fonoaudiología, Universidad de Cauca, Popayán, Colombia
- MSc programme Public Health, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | | | - Fabián Alexander Leal Arenas
- National Cancer Institute of Colombia, Bogotá, Colombia
- Javeriano Oncology Center, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - José A Calvache
- Department of Anaesthesiology, Universidad del Cauca, Popayán, Colombia.
- Department of Anaesthesiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia.
| |
Collapse
|
3
|
Zumstein N, Yamada K, Eicher S, Theill N, Geschwindner H, Wolf H, Riese F. The German version of the Mini Suffering State Examination (MSSE) for people with advanced dementia living in nursing homes. BMC Geriatr 2022; 22:595. [PMID: 35850694 PMCID: PMC9290288 DOI: 10.1186/s12877-022-03268-0] [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: 11/15/2021] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background The Mini Suffering State Examination (MSSE) has been explicitly recommended to assess suffering in dementia patients. This study aimed to develop a German version of the MSSE and assess its psychometric properties involving people with advanced dementia (PAD) in a nursing home setting. Methods The MSSE was translated into German, and 95 primary nurses administered it cross-sectionally to 124 PAD in Zurich, Switzerland. The psychometric properties of the German MSSE version were calculated for this population. Results The mean age of the PAD was 83.3 years (SD = 9.1, range = 55–102 years), and 98 of them (79.0%) were women. The Kuder-Richardson Formula 20 coefficient for the entire scale (0.58), the eight items relating to objective health conditions (0.39), and the professional and family estimation of the patient’s suffering (0.64) indicated low internal consistency. A confirmatory factor analysis indicated an unsatisfactory fit to a one-factor structure, with a comparative fit index and root mean square error of approximation of 0.71 and 0.08, respectively, and a Tucker–Lewis index of 0.64. The MSSE total score was significantly but moderately correlated with the total scores of the Symptom Management–End-of-Life with Dementia (SM-EOLD) scale (Pearson’s correlation coefficient (r) = -0.44; p < 0.05), the physical suffering scores (r = 0.41; p < 0.05), and the psychological suffering scores (r = 0.55; p < 0.05). Conclusions The German version of the MSSE questionnaire did not perform well in the nursing home setting involving PAD. The instrument had low internal consistency, doubtful validity, and could not discriminate between suffering and other distressing symptoms. We do not recommend its use in this population.
Collapse
Affiliation(s)
- Naomi Zumstein
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Andreasstrasse 15, 8050, Zurich, Switzerland. .,Department of Anthropology, McGill University, 855 Sherbrooke Street West, Montreal, QC, H3A 2T7, Canada.
| | - Keiko Yamada
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada.,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Stefanie Eicher
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Andreasstrasse 15, 8050, Zurich, Switzerland.,Center for Gerontology, University of Zurich, Pestalozzistrasse 24, 8032, Zurich, Switzerland
| | - Nathan Theill
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Andreasstrasse 15, 8050, Zurich, Switzerland.,Division of Geriatric Psychiatry, University Hospital of Psychiatry, Lenggstr. 31, 8032, Zurich, Switzerland
| | - Heike Geschwindner
- City of Zurich Nursing Homes, Eggbühlstrasse 23, 8050, Zurich, Switzerland
| | - Henrike Wolf
- Psychiatrische Dienste Graubünden, Ambulatory Psychiatric Services, Piazza Paracelsus 2, 7500, St. Moritz, Switzerland
| | - Florian Riese
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Andreasstrasse 15, 8050, Zurich, Switzerland.,Division of Geriatric Psychiatry, University Hospital of Psychiatry, Lenggstr. 31, 8032, Zurich, Switzerland
| |
Collapse
|