scholarly journals PREVALENCE AND CORRELATES OF SYMPTOMS OF ANXIETY AND DEPRESSION AT THE VERY END OF LIFE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S669-S669
Author(s):  
Elissa K Kozlov ◽  
Veerawat Phongtankuel ◽  
Cary Reid
Keyword(s):  
End Of Life ◽  
Symptom Management ◽  
Hospice Care ◽  
Psychological Symptoms ◽  
Psychological Symptom ◽  
Symptom Assessment ◽  
Anxiety And Depression ◽  
Future Research ◽  
Cross Sectional ◽  
Edmonton Symptom Assessment Scale

Abstract Rates of psychological symptoms for patients with serious illness is high, but there has been limited research investigating psychological symptoms at the very end of life. The aim of this study was to better understand the prevalence, intensity and correlates of psychological distress at the very end of life. This cross-sectional study utilized caregiver proxy interviews. Caregivers were contacted after their loved one recently died after being on home hospice and invited to participate in a brief interview with a trained research assistant. Patient, caregiver and hospice utilization data were also abstracted from electronic medical records. N = 351 caregivers were included in the study. According to caregivers, 46.4% of patients had moderate to severe anxiety, as assessed with a score of ≥4 on the Edmonton Symptom Assessment Scale (ESAS) and 43% had moderate to severe symptoms of depression in the last week of life. Symptoms of anxiety and depression were significantly associated with caregiver burden scores and inversely associated with the age of the patient. Psychological symptom management at the very end of life is essential to providing comprehensive hospice care. Our study revealed that nearly half of patients die with moderate to severe symptoms of anxiety and/or depression. Future research is needed to improve psychological symptom management at the very end of life in order to improve the quality of life for both patients and their families.

scholarly journals Sexuality and assessment of physical and psychological symptoms of older adults in outpatient care

2021 ◽  
Vol 74 (suppl 2) ◽  
Author(s):  
Natalia Coelho Marques da Silva ◽  
Luana Baldin Storti ◽  
Gabriella Santos Lima ◽  
Renata Karina Reis ◽  
Thaís França de Araújo ◽  
...  
Keyword(s):  
Older Adults ◽  
Sexual Activity ◽  
Psychological Symptoms ◽  
Symptom Assessment ◽  
Well Being ◽  
Sexual Experiences ◽  
Cross Sectional ◽  
Symptom Intensity ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

ABSTRACT Objective: to analyze the relationship between affective and sexual experiences and the intensity of physical and psychological symptoms of older adults. Methods: observational, cross-sectional and analytical study, guided by the STROBE tool, carried out in a geriatric outpatient clinic. Sociodemographic and health questionnaire, Affective and Sexual Experiences Scale for Elderly, Edmonton Symptom Assessment Scale were used. Descriptive statistical analysis and Spearman correlation were performed. Results: forty-five older adults participated, with a mean age of 73.8 years; most (91.1%) were married. The highest averages of symptom intensity were pain (4.9), anxiety (4.8), drowsiness (4.5), and a feeling of well-being (4.5). There was a negative correlation between sadness and the dimensions of sexual activity and affective relationships (rs=-0.365; p=0.014 and rs=-0.386; p=0.009) and between anxiety and sexual activity (rs=-0.308; p=0.040). Conclusion: as sadness increases, affective and sexual experiences are less. The greater the anxiety intensity, the lower the sexual experiences.

Insurance Status and Ethnicity Impact Health Disparities in Rates of Advance Directives in Trauma

2021 ◽  
pp. 000313482110111
Author(s):  
Krista L. Haines ◽  
Benjamin P. Nguyen ◽  
Ioana Antonescu ◽  
Jennifer Freeman ◽  
Christopher Cox ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
End Of Life ◽  
Hospice Care ◽  
Private Insurance ◽  
Future Research ◽  
Trauma Patients ◽  
Improvement Program ◽  
Advanced Directives ◽  
Logistic Regression Models ◽  
Discharge Disposition

Introduction Advanced directives (ADs) provide a framework from which families may understand patient’s wishes. However, end-of-life planning may not be prioritized by everyone. This analysis aimed to determine what populations have ADs and how they affected trauma outcomes. Methods Adult trauma patients recorded in the American College of Surgeons Trauma Quality Improvement Program (TQIP) from 2013-2015 were included. The primary outcome was presence of an AD. Secondary outcomes included mortality, length of stay (LOS), mechanical ventilation, ICU admission/LOS, withdrawal of life-sustaining measures, and discharge disposition. Multivariable logistic regression models were developed for outcomes. Results 44 705 patients were included in the analyses. Advanced directives were present in 1.79% of patients. The average age for patients with ADs was 77.8 ± 10.7. African American (odds ratio (OR) .53, confidence intervals [CI] .36-.79) and Asian (OR .22, CI .05-.91) patients were less likely to have ADs. Conversely, Medicaid (OR 1.70, CI 1.06-2.73) and Medicare (OR 1.65, CI 1.25-2.17) patients were more likely to have ADs as compared to those with private insurance. The presence of ADs was associated with increased hospital mortality (OR 2.84, CI 2.19-3.70), increased transition to comfort measures (OR 2.87, CI 2.08-3.95), and shorter LOS (CO −.74, CI −1.26-.22). Patients with ADs had an increased odds of hospice care (OR 4.24, CI 3.18-5.64). Conclusion Advanced directives at admission are uncommon, particularly among African Americans and Asians. The presence of ADs was associated with increased mortality, use of mechanical ventilation, admission to the ICU, withdrawal of life-sustaining measures, and hospice. Future research should target expansion of ADs among minority populations to alleviate disparities in end-of-life treatment.

scholarly journals Media consumption and mental health during COVID-19 lockdown: a UK cross-sectional study across England, Wales, Scotland and Northern Ireland

2021 ◽  
Author(s):  
Ruth D Neill ◽  
Carolyn Blair ◽  
Paul Best ◽  
Emily McGlinchey ◽  
Cherie Armour
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Media Exposure ◽  
Cross Sectional Study ◽  
Anxiety And Depression ◽  
Future Research ◽  
Media Consumption ◽  
Sectional Study ◽  
Cross Sectional ◽  
Longitudinal Data Collection

Abstract Aim As individuals adjust to new ‘norms’ and ways of living during the COVID-19 lockdown, there is a continuing need for up-to-date information and guidance. Evidence suggests that frequent media exposure is related to a higher prevalence of mental health problems, especially anxiety and depression. The aim of this study was to determine whether COVID-19 related media consumption is associated with changes in mental health outcomes. Methods This paper presents baseline data from the COVID-19 Psychological Wellbeing Study. The cross-sectional study data was collected using an online survey following the Generalised Anxiety Disorder scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), with some other basic information collected. Logistic regression analysis was used to examine the influence of socio-demographic and media specific factors on anxiety and depression. Results The study suggested that media usage is statistically significantly associated with anxiety and depression on the GAD-7 and PHQ-9 scales with excessive media exposure related to higher anxiety and depression scores. Conclusion This study indicated that higher media consumption was associated with higher levels of anxiety and depression. Worldwide it should be acknowledged that excessive media consumption, particularly social media relating to COVID-19, can have an effect on mental health. However, as this was a cross-sectional study we cannot infer any directionality as we cannot infer cause and effect; therefore, future research involving longitudinal data collection and analyses of variables over time is warranted.

Cannabis and End-of-Life Care: A Snapshot of Hospice Planning and Experiences Among Illinois Medical Cannabis Patients With A Terminal Diagnosis

2021 ◽  
pp. 104990912110186
Author(s):  
James Alton Croker ◽  
Julie Bobitt ◽  
Sara Sanders ◽  
Kanika Arora ◽  
Keith Mueller ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Fast Track ◽  
Hospice Care ◽  
Cannabis Use ◽  
Care Plan ◽  
Medical Cannabis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Eol Care

Introduction: Between 2013 and 2019, Illinois limited cannabis access to certified patients enrolled in the Illinois Medical Cannabis Program (IMCP). In 2016, the state instituted a fast-track pathway for terminal patients. The benefits of medicinal cannabis (MC) have clear implications for patients near end-of-life (EOL). However, little is known about how terminal patients engage medical cannabis relative to supportive care. Methods: Anonymous cross-sectional survey data were collected from 342 terminal patients who were already enrolled in ( n = 19) or planning to enroll ( n = 323) in hospice for EOL care. Logistic regression models compare patients in the sample on hospice planning vs. hospice enrollment, use of palliative care vs. hospice care, and use standard care vs non-hospice palliative care. Results: In our sample, cancer patients ( OR = 0.21 (0.11), p < .01), and those who used the fast-track application into the IMCP ( OR = 0.11 (0.06), p < .001) were less likely to be enrolled in hospice. Compared to patients in palliative care, hospice patients were less likely to report cancer as their qualifying condition ( OR = 0.16 (0.11), p < .01), or entered the IMCP via the fast-track ( OR = 0.23 (0.15), p < .05). Discussion: Given low hospice enrollment in a fairly large EOL sample, cannabis use may operate as an alternative to supportive forms of care like hospice and palliation. Clinicians should initiate conversations about cannabis use with their patients while also engaging EOL Care planning discussions as an essential part of the general care plan.

scholarly journals Perception of Threat and Psychological Impact of COVID-19 among Expatriates in Makkah Region, Saudi Arabia

2021 ◽  
Vol 18 (12) ◽  
pp. 6650
Author(s):  
Majed A. Algarni ◽  
Mohammad S. Alzahrani ◽  
Yasser Alatawi ◽  
Raghad A. Alasmari ◽  
Hashem O. Alsaab ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Psychological Symptoms ◽  
Psychological Impact ◽  
Self Report ◽  
Future Research ◽  
Perceived Threat ◽  
Cross Sectional ◽  
Psychological Burden ◽  
Arabic Speakers ◽  
Perception Of Threat

In the first few months of the pandemic, Makkah region reported the highest number of COVID-19 cases among all regions in Saudi Arabia. More than 80% of these reported cases were non-Saudi residents. In this study, we evaluated the perceived threat from and psychological impact of COVID-19 among non-Saudi residents of Makkah region. This was a cross-sectional analysis of data collected using a standardized self-report questionnaire. A total of 292 expatriates were included in the study, the majority of whom were non-Arabic speakers. The prevalence of self-reported depression was nearly 40%, anxiety was 32%, and stress was 43%. The findings indicated variability in the prevalence of psychological symptoms among expatriates from different ethnic backgrounds. Additionally, work environment and perceived threat were strong predictors of psychological disorders. This suggested that the perceived threat from and psychological burden of COVID-19 among non-Saudis in Makkah region is substantial. Future research should investigate the reasons behind these variations in the psychological impact of the pandemic among different ethnic groups.

Symptom Management in Palliative Medicine

2012 ◽  
Author(s):  
Kathy J Selvaggi ◽  
Janet L Abrahm
Keyword(s):  
Symptom Management ◽  
Symptom Control ◽  
Hot Flashes ◽  
Symptom Assessment ◽  
Symptomatic Treatment ◽  
Assessment Scale ◽  
Transdermal Fentanyl ◽  
Memorial Symptom Assessment Scale ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

Palliative care is an interdisciplinary specialty focused on providing comfort, communication, and support for patients, families, and professional caregivers throughout the course of a life-limiting illness. This chapter discusses assessment and treatment of symptoms and disorders that commonly contribute to patient distress during these illnesses: pain, disorders of the respiratory and gastrointestinal systems, skin disorders, hot flashes, fatigue, pruritis, insomnia, and delirium. This chapter reviews care of the imminently dying patient, discusses methods for assessing patients' symptoms, and provides two examples of valid and reliable symptom measurement systems: the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Achieving symptom control requires the physician to assess patient suffering in all dimensions: physical, psychological, social, and spiritual. The extent of the assessment may be modified, however, based on patients’ prognosis as well as their goals and the burden and benefit of the diagnostic intervention. A 10-step protocol for terminal wean is presented. Signs that patients are entering their final days and symptom management in the last hours of a patient's life are discussed. Tables list the modified Edmonton Symptom Assessment Scale; the Memorial Symptom Assessment Scale; the DOLOPLUS-2 scale (behavioral pain assessment in the elderly); relative potencies of commonly used opioids; conversions between the transdermal fentanyl patch and morphine; symptomatic treatment for dyspnea, cough, and hiccups; pharmacologic treatment of nausea and vomiting; a progressive bowel regimen for patients receiving opioid therapy; treatments for constipation; etiology-based treatment for oral problems; risk factors for pressure ulcers; and applicable medications for physical and psychological sources of distress near the end of life. This review contains 12 tables and 120 references

scholarly journals Psychological symptoms are associated with screen and exercise time: a cross-sectional study of Chinese adolescents

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Feng Zhang ◽  
Xiaojian Yin ◽  
Cunjian Bi ◽  
Liu Ji ◽  
Huipan Wu ◽  
...  
Keyword(s):  
Mental Health ◽  
Screen Time ◽  
Psychological Symptoms ◽  
Psychological Symptom ◽  
Public Health Problem ◽  
Chinese Adolescents ◽  
Time Data ◽  
Cross Sectional ◽  
Detection Rates ◽  
Exercise Time

Abstract Background Mental disorders among adolescents have become a worldwide public health problem. This study aimed to estimate the best combination of exercise time and screen time to promote the mental health of Chinese adolescents. Methods Participants included 7200 Chinese adolescents aged 13–18 years from six regions of China. Screen and exercise time data were collected via a self-rated questionnaire. Psychological symptoms (e.g., often feeling depressed, school-weary) were evaluated with the “Multidimensional Sub-health Questionnaire of Adolescents”. Chi-squared tests and logistic regression analysis were conducted to investigate the differences in and correlations among screen time, exercise time, and psychological symptoms. Results The overall detection rate of psychological symptoms among Chinese adolescents was 21.4% (22.1% for boys and 20.6% for girls). Psychological symptom detection rates were lowest among adolescents with 1–2 h/d of screen time (19.5%) and those with 30–60 min/d of exercise time (17.3%). Screen time > 2 h/d (OR = 1.38, P < 0.001) and exercise time < 30 min/d (OR = 1.62, P < 0.001) were positively correlated with psychological symptoms. Conclusion Screen and exercise time are associated with psychological symptoms in Chinese adolescents. A combination of 1–2 h/d of screen time and 30–60 min/d of exercise time is provided as a reference for better mental health.

Use of Medical Devices in Hospice for Symptom Management

2016 ◽  
Vol 33 (10) ◽  
pp. 929-934 ◽  
Author(s):  
Nidhi Shah ◽  
Peter Homel ◽  
Jennifer Breznay
Keyword(s):  
End Of Life ◽  
Medical Device ◽  
Medical Devices ◽  
Symptom Management ◽  
Hospice Care ◽  
The United States ◽  
Patient Controlled Analgesia ◽  
Sampling Weights ◽  
Hospice Patients ◽  
Device Use

Background: Home health services in the United States(US) have been on a rise. Hospice patients cope with diverse physical and pain symptoms; medical devices are used for symptom management to improve their quality-of-care at end-of-life. Objective: Using the National Home and Hospice Care Survey (NHHCS), the study summarizes medical device use for symptom management and tracks various demographic variables for home hospice patients. Methods: A cross-sectional analysis of data using the 2007 NHHCS was conducted. There were 4733 hospice discharges which corresponded to 2,505,011 individuals in US with sampling weights. The data was analyzed using chi square tests and confounding factors adjusted with logistic regression. Results: Eighty-nine percent of hospice discharges were evaluated for pain at first assessment. The regression model for pain at first assessment was significantly associated with use of patient controlled analgesia (OR = 1.82, 95% CI = 1.28, 2.59) and urinary catheters (OR = 1.16, 95% CI = 1.02, 1.33). Patient with dyspnea were associated with significant use of oxygen (OR = 3.00, 95% CI = 2.64, 3.40) and metered dose inhaler (OR = 2.43, 95% CI = 1.92, 3.07). There was negligible use of total parenteral nutrition (TPN) noted in the study. Conclusion: In conclusion, the study highlights medical device use in home hospice care for end-of-life symptom management. It noted the significant use of IV infusion pumps and patient controlled analgesia. Conversely, there is little use of TPN or CPAP in patients with anorexia or dyspnea. While missing data on critical symptom evaluations regrettably raises questions about the validity of the study, the NHHCS serves as an important reservoir of data on the growing population of home hospice patients.

scholarly journals THE LAST MONTH OF LIFE: AN EXPLORATORY REVIEW OF THE NATIONAL HEALTH AND AGING TRENDS STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S274-S274
Author(s):  
Abigail Latimer ◽  
Lauren Montemuro-Rode ◽  
Brianna Garrison ◽  
Allison Gibson
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
National Health ◽  
Hospice Care ◽  
Influential Factors ◽  
Future Research ◽  
Time Of Death ◽  
Medicare Beneficiaries ◽  
Cross Sectional Survey ◽  
At Home

Abstract Approximately 80% of Americans prefer to die at home. Hospice and palliative care services are associated with improved pain and symptom management, increasing capacity to meet preferences for end-of-life care at home. However, according to the NHPCO (2018) only 48% of Medicare beneficiaries were enrolled in hospice at the time of death. This poster presents trends in the last month of life for adult Medicare beneficiaries age 65 or older examining the influential factors contributing to the quality of end-of-life experiences. A cross-sectional survey design was utilized with the National Health and Aging Trends Study (NHATS). Descriptive and inferential statistics were generated to describe a sample of persons (n= 241) who died in 2017. The sample demographics are predominately white (77.6%) females (61.4%) over 90 years old (42.4%). 29.5% of individuals died at home, 29.5% at the hospital, and 27% at a nursing home. Only 32.2% had hospice care in the last month, with many experiencing pain (71.1%), shortness of breath (54.7%), and anxiety/sadness (56.9%). There were 33.6% of participants who lived alone at death and 70% did not receive hospice care. The majority of these individuals were widowed (70.4%) and 33.3% died in the hospital. The other 28.4% died at their home or someone else’s and 25.9% died in a nursing home. Many older adults face multiple barriers to experiencing a quality end-of-life experience. Future research should examine the challenges facing those living alone at time of death.

scholarly journals Physician Palliative Education Associated With High Use of Hospice Care Service

2021 ◽  
pp. 104990912110141
Author(s):  
Mei-Hsing Chuang ◽  
Fang-Niarn Lee ◽  
Yih-Tsong Shiau ◽  
Hsiu-Yi Shen ◽  
Chih-Ching Lee ◽  
...  
Keyword(s):  
Renal Failure ◽  
Health Insurance ◽  
End Of Life ◽  
National Health Insurance ◽  
National Health ◽  
Hospice Care ◽  
Care Service ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Care Services

Background: Taiwan’s National Health Insurance provides coverage for palliative and hospice care. The following 10 types of diseases have been added to the National Health Insurance reimbursement regulation: end-stage cancer, motor neuron disease, organic psychosis, brain degeneration, heart failure, chronic airway obstruction diseases, other lung diseases, chronic liver disease and cirrhosis, acute renal failure, and chronic renal failure. Objective: This study aimed to determine the association between physicians’ palliative education and use of hospice care in hospitalized patients at the end of life. Design and Setting: A cross-sectional study in a Taipei community hospital. Participants: Patients who died between 2014 and 2019 were identified. The deceased had at least 1 of the 10 diseases covered by health insurance were included. Hospice care services included hospice ward care and hospice shared care. This study included 2,661 individuals. In total, 972 (36.5%) patients used hospice care services. Results: After adjusting for age, gender, and comorbidities, physicians’ palliative education was found to significantly associated with the use of hospice care (OR: 14.38, 95% CI: 10.90-18.98). Conclusions: Physicians’ palliative education was found to be an independent factor associated with higher use of hospice care. The findings suggest increasing palliative and hospice education among physicians so that they can ensure that their patients have high-quality end-of-life medical care in an aging society.

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