scholarly journals Change in medical and health care decision-making patterns at the End-of-Life: A cohort of the very old people

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 776-776
Author(s):  
Xinran Liu ◽  
Steven Albert
Keyword(s):  
Decision Making ◽  
Urgent Care ◽  
Old People ◽  
Very Old ◽  
Random Effects Models ◽  
Multiple Imputations ◽  
Healthcare Decision Making ◽  
Interview Methods ◽  
Medical And Healthcare

Abstract How does medical and healthcare decision-making among the very old people change in their last year before death? We explored patterns of decision-making in the Health ABC cohort study in 2011-14 (years 15-17), which involved 12 waves of quarterly phone interviews. When the participant was unable to do the interview, a proxy completed it instead. We identified a sample of 291 decedents (aged 90.0±2.9 at death, 35.7% Black, 52.6% female) with at least 1-year follow-up before death. Percentages of decedents who have made medical or healthcare decisions in the last four quarters before death were 32.0%, 31.2%, 32.6%, 41.9%, respectively. Decedents made more healthcare decisions in the last quarter before death (P<0.01), compared to the baseline. Across all quarters, decision-making is most in need for medications (17.6%), hospital admission (13.2%), and ER/urgent care visit (13.2%). We matched a 1:1 sample of survivors at the time of death by race, sex, and age (within ±3 years). In random effects models with multiple imputations of missing data, we found that decedents were more likely to make healthcare decisions than survivors across all four quarters before death or censor (Odds ratio=1.99, 95%CI: 1.49-2.65, P<0.01). The significance still held after adjusting for age, female, race, education, and interview methods. Overall, compared to matched survivors, the frequency of making medical and healthcare decisions among the very old decedents has already been high in the last year before death. This frequency rose sharply in the last quarter before death.

UNALTERED IMAGE OF HEALTH MAINTENANCE: AN OBSERVATION OF NON-PARTICIPANTS IN A SWEDISH COHORT STUDY OF 85 TO 86 YEAR OLDS

2015 ◽  
pp. 1-7
Author(s):  
H.-J. DONG ◽  
E. WRESSLE ◽  
J. MARCUSSON
Keyword(s):  
Home Visit ◽  
Hospital Admissions ◽  
Clinic Visit ◽  
Old People ◽  
Related Factors ◽  
Health Maintenance ◽  
Very Old ◽  
Significant Difference ◽  
Sheltered Accommodation

Background: Selection bias is often inevitable in epidemiologic studies. It is not surprising that study conclusions based on participants’ health status are frequently questioned. Objective: This study aimed to assess whether the non-participants affected the characteristics of a general population of the very old people. Design, Setting and Participants: Prospective, cross-sectional (N=650, aged 85 years old) analysis and 1-year follow-up (n=273), in Linköping, Sweden. Measurements: We analysed data on health-related factors from a postal questionnaire, a home visit and a clinic visit at baseline and at the 1-year follow-up. We calculated the effect size to evaluate the degree of differences between the groups. Results: A greater proportion of non-participants resided in sheltered accommodation or nursing homes (participants vs non-response vs refusal, 11% vs 22% vs 40, P<0.001, φ=0.24). During the home visit or clinic visit, a higher proportion of dropouts reported mid-severe problems in EQ-5D domains (mobility and self-care) and limitations in personal activities of daily living, but the differences between participants and dropouts were very small (φ<0.2). No significant difference was found between the groups with regard to emergency room visits or hospital admissions, despite the fact that more participants than dropouts (φ=0.23) had multimorbidities (≥2 chronic diseases). Living in sheltered accommodation or a nursing home (odds ratio (OR), 2.8; 95% confidence interval (CI), 1.5-5), female gender (OR, 1.8; 95% CI, 1.1-3.1) and receiving more home visits in primary care (OR, 1.03; 95% CI, 1-1.06) contributed positively to drop out in the data collection stages over the study period. Conclusion: Non-participants were not considered to be a group with worse health. Mobility problems may influence very old people when considering further participation, which threatens attrition.

The wave of very old people in the intensive care unit–A challenge in decision-making

2020 ◽  
Vol 60 ◽  
pp. 290-293 ◽  
Author(s):  
Peter Vernon van Heerden ◽  
Sigal Sviri ◽  
Michael Beil ◽  
Wojciech Szczeklik ◽  
Dylan de Lange ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Old People ◽  
Very Old

scholarly journals Low or Declining Gait Speed is Associated With Risk of Developing Dementia Over 5 Years Among People Aged 85 Years and Over

2020 ◽  
pp. 1-8
Author(s):  
Jerry Öhlin ◽  
Yngve Gustafson ◽  
Håkan Littbrand ◽  
Birgitta Olofsson ◽  
Annika Toots
Keyword(s):  
Nursing Home ◽  
Cognitive Decline ◽  
Gait Speed ◽  
Daily Living ◽  
Population Aging ◽  
Old People ◽  
Very Old ◽  
Dementia Screening ◽  
Screening Procedures

Improving dementia screening procedures beyond simple assessment of current cognitive performance is timely given the ongoing phenomenon of population aging. A slow or declining gait speed (GS) is a potential early indicator of cognitive decline scarcely investigated in very old people. Here, we investigated the 5-year associations of baseline GS, change in GS, and cognitive function with subsequent dementia development in people aged 85 years and older (n = 296) without dementia at baseline. Declining and a slow baseline GS were associated with higher odds of dementia development after adjusting for confounders (e.g., age, sex, and dependency in activities of daily living) and missing GS values at follow-up. The GS decline was associated with cognitive decline in participants who developed dementia. The results support the potential of GS tests to predict future cognitive decline among community- and nursing home-dwelling very old people.

Effects and utility of an online forward triage tool during the SARS-CoV-2 pandemic: patient perspectives (Preprint)

2020 ◽  
Author(s):  
Janet Michel
Keyword(s):  
Decision Making ◽  
Health System ◽  
Information Source ◽  
Patient Perspectives ◽  
User Friendliness ◽  
Fear And Anxiety ◽  
Mail Address ◽  
Second Wave ◽  
E Mail

BACKGROUND Background: Online forward triage tools (OFTT) or symptom checkers are being widely used during this COVID-19 pandemic. The effects and utility of such tools however, have not been widely assessed. OBJECTIVE Objective: To assess the effects (quantitatively) and the utility (qualitatively) of a COVID-19 OFTT in a pandemic context, exploring patient perspectives as well as eliciting recommendations for tool improvement. METHODS Methods: We employed a mixed-method sequential explanatory study design. Quantitative data of all users of the OFTT between March 2nd, 2020 and May 12th, 2020 were collected. A follow-up survey of people who consented to participation was conducted. Secondly, qualitative data was collected through key informant interviews (n=19) to explain the quantitative findings, as well as explore tool utility, user experience and elicit recommendations. RESULTS Results: An estimate of the effects, (quantitatively) and the utility (qualitatively) of a COVID-19 OFTT in a pandemic context, and recommendations for tool improvement. In the study period, 6,272 users consulted our OFTT; 560 participants consented to a follow-up survey and provided a valid e-mail address. 176 (31.4%) participants returned a complete follow-up questionnaire. 85.2% followed the recommendations given. 41.5% reported that their fear was allayed after using tool and 41.1% would have contacted the GP or visited a hospital had the tool not existed. Qualitatively, seven overarching themes emerged namely i) accessibility of tool, ii) user-friendliness of tool, iii) utility of tool as an information source, iv) utility of tool in allaying fear and anxiety, v) utility of tool in decision making (test or not to test), vi) utility of tool in reducing the potential for onward transmissions (preventing cross infection) and vii) utility of tool in reducing health system burden. CONCLUSIONS Conclusion: Our findings demonstrated that a COVID-19 OFTT does not only reduce the health system burden, but can also serve as an information source, reduce anxiety and fear, reduce cross infections and facilitate decision making (to test or not to test). Further studies are needed to assess the transferability of these COVID-19 OFTT findings to other contexts as the second wave sweeps across Europe.

scholarly journals Nursing Home Staff’s Perceptions of Healthcare Decision Making for Unbefriended Residents

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 384-384
Author(s):  
Hyejin Kim ◽  
Molly Perkins ◽  
Thaddeus Pope ◽  
Patricia Comer ◽  
Mi-Kyung Song
Keyword(s):  
Decision Making ◽  
Geographic Area ◽  
Care Physician ◽  
Healthcare Decision ◽  
Do Not Resuscitate ◽  
Best Interest ◽  
Care Plans ◽  
Course Of Action ◽  
Healthcare Decision Making ◽  
Facility Level

Abstract ‘Unbefriended’ adults are those who lack decision-making capacity and have no surrogates or advance care plans. Little data exist on nursing homes (NHs)’ healthcare decision-making practices for unbefriended residents. This study aimed to describe NH staff’s perceptions of healthcare decision making on behalf of unbefriended residents. Sixty-six staff including administrators, physicians, nurses, and social workers from three NHs in one geographic area of Georgia, USA participated in a 31-item survey. Their responses were analyzed using descriptive statistics and conventional content analysis. Of 66 participants, eleven had been involved in healthcare decision-making for unbefriended residents. The most common decision was do-not-resuscitate orders. Decisions primarily were made by relying on the resident’s primary care physician and/or discussing within a facility interdisciplinary team. Key considerations in the decision-making process included “evidence that the resident would not have wanted further treatment” and the perception that “further treatment would not be in the resident’s best interest”. Compared with decision making for residents with surrogates, participants perceived decision making for unbefriended residents to be equally-more difficult. Key barriers to making decisions included uncertainty regarding what the resident would have wanted in the given situation and concerns regarding the ethically and legally right course of action. Facilitators (reported by 52 participants) included some information/knowledge about the resident, an understanding regarding decision-making-related law/policy, and facility-level support. The findings highlight the complexity and difficulty of healthcare decision making for unbefriended residents and suggest more discussions among all key stakeholders to develop practical strategies to support decision-making practices in NHs.

Antibiotic Prescribing in Adults Presenting with Pharyngitis Pre- and Post-Implementation of a Rapid Group A Streptococcus Test

2021 ◽  
pp. 001857872110323
Author(s):  
Preeyaporn Sarangarm ◽  
Timothy A. Huerena ◽  
Tatsuya Norii ◽  
Carla J. Walraven
Keyword(s):  
Group A Streptococcus ◽  
Intervention Group ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Care Clinic ◽  
Rapid Antigen Detection Test ◽  
Appropriate Prescribing ◽  
Icd 10 ◽  
Group A

Background: Group A Streptococcus (GAS) pharyngitis is the most common bacterial cause of acute pharyngitis and is often over treated with unnecessary antibiotics. The purpose was to evaluate if implementation of a rapid antigen detection test (RADT) for GAS would reduce the number of inappropriately prescribed antibiotics for adult patients presenting with symptoms of pharyngitis. Methods: This was a retrospective cohort study of adult urgent care clinic patients pre- and post-implementation of a GAS RADT. We included patients who had a diagnosis of GAS identified via ICD-10 codes and either a throat culture, GAS RADT, or antibiotic prescribed for GAS. Antibiotic prescribing was assessed as appropriate or inappropriate based on testing and IDSA guideline recommendations. Thirty-day follow-up visits related to pharyngitis or the prescribed antibiotics was also evaluated. Results: A total of 1734 patients were included; 912 and 822 in the pre- and post-implementation groups, respectively. Following implementation of the GAS RADT, there was an increase in the number of antibiotics prescribed for GAS (43.4% vs 59.1%, P < .001) as well as an increase in appropriate prescribing (67.6% vs 77.5%, P < .001). More 30-day pharyngitis-related follow-up visits were seen in the pre-intervention group (12.5% vs 9.3%, P = .03). Conclusion: Implementation of a RADT for GAS pharyngitis was associated with an increase in both the overall number of antibiotic prescriptions for GAS and the proportion of appropriately prescribed antibiotics. There was also a reduction in follow up visits related to GAS pharyngitis, however educational efforts to further increase appropriate prescribing is needed.

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