What is “Optimal Nourishment” for Older Adults at the End of Life? A Conversation

Abstract Although there has been growing evidence that Advance care planning (ACP) benefits people with cognitive impairment nearing death, our understanding about this issue is still limited. This study examines whether cognitive impairment is associated with ACP engagement and end-of-life care preferences among older adults in the U.S. Using data from the 2012 National Health and Trends Study (n=1798, aged 65 to 101), we identified four levels of ACP engagement: None (28%), Informal ACP conversation only (12%), Formal ACP only (14%), and Both informal and formal ACP (46%). Older adults with None showed the highest prevalence of having cognitive impairment (17%), followed by those with Formal ACP only (15%) and the other two (6%, 6%). The results of Multinomial Logistic Regression showed that, compared to those without, respondents with cognitive impairment had 143% increased relative risk of having None (RR = 2.43, CI: 1.58-3.73) and 81% increased relative risk of completing Formal ACP only (RR = 1.81, CI: 1.11-2.95) relative to completing Both informal and formal ACP. In addition, respondents with None were more likely to prefer to receive all treatments available nearing death than those with any ACP engagement. Achieving high quality care at the end of life can be more challenging for older adults with cognitive impairment and their family caregivers due to the limited capacity. Although encouraged, informal ACP conversation with loved ones does not necessarily occur before the formal ACP, especially, for those with cognitive impairment. Therefore, they may merit more attention such as early ACP engagement.

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Self-compassion as predictor of daily physical symptoms and chronic illness across older adulthood

Journal of Health Psychology ◽

10.1177/13591053211002326 ◽

2021 ◽

pp. 135910532110023

Author(s):

Heather Herriot ◽

Carsten Wrosch

Keyword(s):

Older Adults ◽

Longitudinal Study ◽

Chronic Illness ◽

End Of Life ◽

Old Age ◽

Physical Symptoms ◽

Older Adulthood ◽

Self Compassion ◽

Early Old Age

This study examined whether self-compassion could benefit daily physical symptoms and chronic illness in early and advanced old age. The hypotheses were evaluated in a 4-year longitudinal study of 264 older adults. Results showed that self-compassion predicted lower levels of daily physical symptoms across the study period in advanced, but not early, old age ( T-ratio = −1.93, p = 0.05). In addition, self-compassion was associated with fewer increases in chronic illness in advanced, but not early, old age ( T-ratio = − 2.45, p < 0.02). The results of this study suggest that self-compassion may be particularly adaptive towards the end of life.

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End-of-Life Planning in a Family Context: Does Relationship Quality Affect Whether (and With Whom) Older Adults Plan?

The Journals of Gerontology Series B ◽

10.1093/geronb/gbt034 ◽

2013 ◽

Vol 68 (4) ◽

pp. 586-592 ◽

Cited By ~ 35

Author(s):

D. Carr ◽

S. M. Moorman ◽

K. Boerner

Keyword(s):

Older Adults ◽

Relationship Quality ◽

End Of Life ◽

Family Context ◽

Life Planning ◽

End Of Life Planning

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Last Place of Care and End-of-Life Quality of Life in the United States: Evidence From a National Representative Data Set

Innovation in Aging ◽

10.1093/geroni/igaa057.056 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 17-17

Author(s):

Yifan Lou ◽

Nan Jiang ◽

Katherine Ornstein

Keyword(s):

Quality Of Life ◽

Older Adults ◽

End Of Life ◽

End Of Life Care ◽

The United States ◽

Life Care ◽

Person Centered Care ◽

Centered Care ◽

The Relationship

Abstract Background: Quality of life (QoL) during last stage of life has raised expanded interests as an important aspect of person-centered care. Last place of care (LPC), refer to the last place decedents received their formal end-of-life care (EOLC), has been identified as a key indicator of older adults’ end-of-life QoL, but the relationship was understudied. This study explores the association between LPC and end-of-life QoL among American older adults. Methods: Data used seven waves of Last Month of Life data with a total sample of 3068 Medicare decedents in NHATS. Outcome is end-of-life QoL assessed by eleven measures on four domains: pain and symptoms management (SP), quality of healthcare encounter (HE), person-centered care (PC), and overall quality of care (QC). LPC was categorized into home, hospital, nursing home, and residential hospice. Multivariate logistic regression analyses were used to examine the relationship with covariates. Results: LPC varied by most demographic characteristics, except immigration status and education. Older adults whose LPC is hospital, compared to those who had home-care, were less likely to have great experiences on HE, PC, and QC. People dying at nursing homes are more likely to receive care meeting their dyspnea and spiritual needs. Residential hospice is negatively related to respected care, clear coordination, and keeping family informed, but are more likely to provide PS and spiritual care. Discussion: Home-based end-of-life care has certain advantages but still has room to improve on SP and religious concerns. Hospitals should keep reforming their service delivery structure to improve patients’ QoL.

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Biomedicalization of end-of-life conversations with medically frail older adults - Malleable and senescent bodies

Social Science & Medicine ◽

10.1016/j.socscimed.2020.113428 ◽

2020 ◽

pp. 113428

Author(s):

Celina Carter ◽

Shan Mohammed ◽

Ross Upshur ◽

Pia Kontos

Keyword(s):

Older Adults ◽

End Of Life ◽

Frail Older Adults

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Family caregiving and place of death: Insights from cross-national analysis of the Harmonized End of Life Data

The Journals of Gerontology Series B ◽

10.1093/geronb/gbaa225 ◽

2020 ◽

Author(s):

Jennifer Ailshire ◽

Margarita Osuna ◽

Jenny Wilkens ◽

Jinkook Lee

Keyword(s):

United States ◽

Older Adults ◽

Nursing Home ◽

End Of Life ◽

Family Caregiving ◽

The United States ◽

Place Of Death ◽

Life Data ◽

Cross National ◽

At Home

Abstract Objectives Family is largely overlooked in research on factors associated with place of death among older adults. We determine if family caregiving at the end of life is associated with place of death in the United States and Europe. Methods We use the Harmonized End of Life data sets developed by the Gateway to Global Aging Data for the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS). We conducted multinomial logistic regression on 7,113 decedents from 18 European countries and 3,031 decedents from the United States to determine if family caregiving, defined based on assistance with activities of daily living, was associated with death at home versus at a hospital or nursing home. Results Family caregiving was associated with reduced odds of dying in a hospital and nursing home, relative to dying at home in both the United States and Europe. Care from a spouse/partner or child/grandchild was both more common and more strongly associated with place of death than care from other relatives. Associations between family caregiving and place of death were generally consistent across European welfare regimes. Discussion This cross-national examination of family caregiving indicates that family-based support is universally important in determining where older adults die. In both the United States and in Europe, most care provided during a long-term illness or disability is provided by family caregivers, and it is clear families exert tremendous influence on place of death.

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How Do Patients with Life-Limiting Illness and Caregivers Want End-Of-Life Prognostic Information Delivered? A Pilot Study

Healthcare ◽

10.3390/healthcare9070784 ◽

2021 ◽

Vol 9 (7) ◽

pp. 784

Author(s):

Ebony T. Lewis ◽

Kathrine A. Hammill ◽

Maree Ticehurst ◽

Robin M. Turner ◽

Sally Greenaway ◽

...

Keyword(s):

Older Adults ◽

Pilot Study ◽

Health Services ◽

End Of Life ◽

Older Patients ◽

Prognostic Information ◽

Clinical Scenarios ◽

Delivery Format ◽

Patient Groups ◽

To Receive

We aimed to identify the level of prognostic disclosure, type of prognostic information and delivery format of prognostic communication that older adults diagnosed with a life-limiting illness or caregivers prefer to receive. We developed and pilot tested an open-ended survey to 15 older patients and caregivers who had experience in health services for life-limiting illness either for a relative, friend or themselves. Five hypothetical clinical scenarios of prognostic options were presented to ascertain preferences. The preferred format to receive prognostic information was verbal delivery by the clinician with a written summary. Photos and videos were less favoured, and a table with numbers/percentages was least preferred. Distress levels to the prognostic scenarios were low, with the exception of a photo. We conclude that older patients/caregivers want end-of-life prognostic information delivered the traditional way, verbally by clinicians. Options to deliver prognostic information may vary across patient groups but empower clinicians in introducing end-of-life discussions with patients/caregivers. Our study illustrates the feasibility of involving terminal patients and caregivers in research that contributes to eliciting prognostic preferences. Further research is needed to understand whether the prognostic preferences of hospitalized patients with life-limiting illness differ.

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