Terms used by physicians when deciding to withhold treatment for older patients not having received palliative care in an acute geriatric care unit

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

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Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2020.09.025 ◽

2020 ◽

Author(s):

Michael P. Cary ◽

Farica Zhuang ◽

Rachel Lea Draelos ◽

Wei Pan ◽

Sathya Amarasekara ◽

...

Keyword(s):

Machine Learning ◽

Palliative Care ◽

Hip Fracture ◽

Older Patients ◽

Learning Algorithms ◽

Machine Learning Algorithms

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Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

Australian Health Review ◽

10.1071/ah14242 ◽

2016 ◽

Vol 40 (2) ◽

pp. 149 ◽

Cited By ~ 11

Author(s):

Clair Sullivan ◽

Andrew Staib ◽

Rob Eley ◽

Bronwyn Griffin ◽

Rohan Cattell ◽

...

Keyword(s):

Palliative Care ◽

Mortality Rate ◽

Older Patients ◽

Emergency Admission ◽

Emergency Admissions ◽

Admission Rates ◽

Triage Category ◽

After Hours ◽

Mode Of Transport ◽

National Emergency

Objective The aim of the present study was to identify patient and non-patient factors associated with reduced mortality among patients admitted from the emergency department (ED) to in-patient wards in a major tertiary hospital that had previously reported a near halving in mortality in association with a doubling in National Emergency Access Target (NEAT) compliance over a 2-year period from 2012 to 2014. Methods We retrospectively analysed routinely collected data from the Emergency Department Information System (EDIS) and hospital discharge abstracts on all emergency admissions during calendar years 2011 (pre-NEAT interventions) and 2013 (post-NEAT interventions). Patients admitted to short-stay wards and then discharged home, as well as patients dying in the ED, were excluded. Patients included in the study were categorised according to age, time and day of arrival to the ED, mode of transport to the ED, emergency triage category, type of clinical presentation and major diagnostic codes. Results The in-patient mortality rate for emergency admissions decreased from 1.9% (320/17 022) in 2011 to 1.2% (202/17 162) in 2013 (P < 0.001). There was no change from 2011 to 2013 in the percentage of deaths in the ED (0.19% vs 0.17%) or those coded as in-patient palliative care (17.9% vs 22.2%). Although deaths were not associated with age by itself, the mortality rate of older patients admitted to medical wards decreased significantly from 3.5% to 1.7% (P = 0.011). A higher mortality rate was seen among patients presenting to ED triage between midnight and 12 noon than at other times in 2011 (2.5% vs 1.5%; P < 0.001), but this difference disappeared by 2013 (1.3% vs 1.1%; P = 0.150). A similar pattern was seen among patients presenting on weekends versus weekdays: 2.2% versus 1.7% (P = 0.038) in 2011 and 1.3% versus 1.1% (P = 0.150) in 2013. Fewer deaths were noted among patients with acute cardiovascular or respiratory disease in 2013 than in 2011 (1.7% vs 3.6% and 1.5% vs 3.4%, respectively; P < 0.001 for both comparisons). Mode of transport to the ED or triage category was not associated with changes in mortality. These analyses took account of any possible confounding resulting from differences over time in emergency admission rates. Conclusions Improved NEAT compliance as a result of clinical redesign is associated with improved in-patient mortality among particular subgroups of emergency admissions, namely older patients with complex medical conditions, those presenting after hours and on weekends and those presenting with time-sensitive acute cardiorespiratory conditions. What is known about the topic? Clinical redesign aimed at improving compliance with NEAT and reducing time spent within the ED of acutely admitted patients has been associated with reduced mortality. To date, no study has attempted to identify subgroups of patients who potentially derive the greatest benefit from improved NEAT compliance in terms of reduced risk of in-patient death. It also remains unclear as to what extent non-patient factors (e.g. admission practices and differences in coding of palliative care patients) affect or confound this reduced risk. What does this paper add? The present study is the first to reveal that enhanced NEAT compliance is associated with lower mortality among particular subgroups of emergency patients admitted to in-patient wards. These include older patients with complex medical conditions, those presenting after hours or on weekends or those with time-sensitive acute cardiorespiratory conditions. These results took account of any possible confounding resulting from differences over time in emergency admission rates, deaths in the ED, numbers of short-stay ward admissions and coding of palliative care deaths. What are the implications for practitioners? Efforts aimed at improving NEAT compliance and efficiencies at the ED–in-patient interface appear to be worthwhile in reducing in-patient mortality among particular subgroups of emergency admissions at high risk. More research is urgently needed in identifying patient- and system-level factors that predispose to higher mortality rates in such populations, but are potentially amenable to focused interventions aimed at optimising transitions of care at the ED–in-patient interface and increasing NEAT compliance for patients admitted to in-patient wards from the ED.

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Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Qualitative Study (Preprint)

10.2196/preprints.34952 ◽

2022 ◽

Author(s):

Wenwen Chen ◽

Ashley Flanagan ◽

Pria MD Nippak ◽

Michael Nicin ◽

Samir K Sinha

Keyword(s):

Older Patients ◽

Online Survey ◽

Structured Interview ◽

Geriatric Care ◽

Knowledge Network ◽

Relative Advantage ◽

Design Quality ◽

Greater Toronto Area ◽

Knowledge And Beliefs ◽

Access To Knowledge

BACKGROUND Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be employed to meet the needs of geriatric care professionals in providing care to frail older patients and their caregivers, and families. OBJECTIVE This study aimed to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and families, and how to maximize the benefits of this method of providing care. METHODS We conducted a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine and participate in a semi-structured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). RESULTS We obtained quantitative and qualitative data from 30 practicing geriatric care professionals (22 geriatricians, 5 geriatric psychiatrists, and 3 geriatric specialist nurses) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (Complexity, Design quality and packaging, Patient needs and resources, Readiness for implementation, and Culture) and 13 CFIR contextual facilitators (Relative Advantage, Adaptability, Tension for Change, Available Resources, Access to Knowledge, Network and Communications, Compatibility, Knowledge and Beliefs, Self-Efficacy, Champions, External Agents, Executing, and Reflecting and Evaluating). The CFIR concept of External Policy and Incentives was found to be a neutral construct. CONCLUSIONS This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person, but is less useful in providing specific aspects of geriatric care to frail older patients and their caregivers, and families.

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Generic Care Pathway for Acute Geriatric Care and Rehabilitation as a Tool for Care Management, Discharge Planning and Continuous Clinical Audit

Journal of integrated Care Pathways ◽

10.1177/147322970300700205 ◽

2003 ◽

Vol 7 (2) ◽

pp. 75-79

Author(s):

S Suman ◽

T J Lockington

Keyword(s):

Care Management ◽

Discharge Planning ◽

Clinical Audit ◽

Care Pathway ◽

Geriatric Care ◽

Acute Geriatric Care

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Nutritional variables predict chances of returning home and activities of daily living in post-acute geriatric care

Clinical Interventions in Aging ◽

10.2147/cia.s154129 ◽

2018 ◽

Vol Volume 13 ◽

pp. 151-157 ◽

Cited By ~ 13

Author(s):

Keisuke Maeda ◽

Takayuki Koga ◽

Junji Akagi

Keyword(s):

Activities Of Daily Living ◽

Daily Living ◽

Geriatric Care ◽

Returning Home ◽

Acute Geriatric Care

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Cancer-Related Pain in Older Adults Receiving Palliative Care: Patient and Family Caregiver Perspectives on the Experience of Pain

Pain Research and Management ◽

10.1155/2013/439594 ◽

2013 ◽

Vol 18 (6) ◽

pp. 293-300 ◽

Cited By ~ 14

Author(s):

Christine J McPherson ◽

Thomas Hadjistavropoulos ◽

Michelle M Lobchuk ◽

Kelly N Kilgour

Keyword(s):

Older Adults ◽

Palliative Care ◽

Pain Management ◽

Cancer Pain ◽

Family Caregivers ◽

Advanced Cancer ◽

Older Patients ◽

Main Category ◽

Home Setting ◽

Living With Cancer

BACKGROUND: Despite an emphasis on pain management in palliative care, pain continues to be a common problem for individuals with advanced cancer. Many of those affected are older due to the disproportionate incidence of cancer in this age group. There remains little understanding of how older patients and their family caregivers perceive patients’ cancer-related pain, despite its significance for pain management in the home setting.OBJECTIVES: To explore and describe the cancer pain perceptions and experiences of older adults with advanced cancer and their family caregivers.METHODS: A qualitative descriptive approach was used to describe and interpret data collected from semistructured interviews with 18 patients (≥65 years of age) with advanced cancer receiving palliative care at home and their family caregivers.RESULTS: The main category ‘Experiencing cancer pain’ incorporated three themes. The theme ‘Feeling cancer pain’ included the sensory aspects of the pain, its origin and meanings attributed to the pain. A second theme, ‘Reacting to cancer pain’, included patients’ and family caregivers’ behavioural, cognitive (ie, attitudes, beliefs and control) and emotional responses to the pain. A third theme, ‘Living with cancer pain’ incorporated individual and social-relational changes that resulted from living with cancer pain.CONCLUSIONS: The findings provide an awareness of cancer pain experienced by older patients and their family caregivers within the wider context of ongoing relationships, increased patient morbidity and other losses common in the aged.

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