Living, loving and letting go‐navigating the relational within palliative care of older people in long‐term care facilities: An action research study

Abstract Background Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology. Aim To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above. Methods A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy. Results The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines. Conclusion Meaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.

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Mapping Research Conducted on Long-Term Care Facilities for Older People in Brazil: A Scoping Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041522 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1522

Author(s):

Patrick Alexander Wachholz ◽

Deborah Cristina De Oliveira ◽

Kathryn Hinsliff-Smith ◽

Reena Devi ◽

Paulo José Fortes Villas Boas ◽

...

Keyword(s):

Mixed Methods ◽

Older People ◽

Study Design ◽

Scoping Review ◽

Long Term Care ◽

Assessment Tools ◽

Small Scale ◽

Term Care ◽

Care Facilities

This scoping review aimed to explore the characteristics, strengths, and gaps in research conducted in Brazilian long-term care facilities (LTCFs) for older adults. Electronic searches investigating the residents (≥60 years old), their families, and the LTCF workforce in Brazil were conducted in Medline, EMBASE, LILACS, and Google Scholar, within the timescale of 1999 to 2018, limited to English, Portuguese, or Spanish. The reference lists were hand searched for additional papers. The Mixed Methods Appraisal Tool (MMAT) was used for critical appraisal of evidence. Data were reported descriptively considering the study design, using content analysis: 327 studies were included (n = 159 quantitative non-randomized, n = 82 quantitative descriptive, n = 67 qualitative, n = 11 mixed methods, n = 6 randomized controlled trials, and n = 2 translation of assessment tools). Regardless of the study design, most were conducted in a single LTCF (45.8%), in urban locations (84.3%), and in non-profit settings (38.7%). The randomized trials and descriptive studies presented the lowest methodological quality based on the MMAT. This is the first review to provide an overview of research on LTCFs for older people in Brazil. It illustrates an excess of small-scale, predominantly qualitative papers, many of which are reported in ways that do not allow the quality of the work to be assured.

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Combating Coronavirus Disease-2019 Outbreak in Long-Term Care Facilities for Frail Older Adults: Preventive Measures and Palliative Care Go Hand-in-Hand

Journal of Palliative Care ◽

10.1177/08258597211039364 ◽

2021 ◽

pp. 082585972110393

Author(s):

Hon Wai Benjamin Cheng

Keyword(s):

Palliative Care ◽

Long Term Care ◽

Care Delivery ◽

Nursing Home Residents ◽

Respiratory Illness ◽

Term Care ◽

The People ◽

Care Facilities ◽

Novel Coronavirus

While the whole population is at risk from infection with the coronavirus, older people—often frail and subject to multimorbidity—are at the highest risk for the severe and fatal disease. Despite strict infection control and social distancing measures, frail adults in long-term care facilities may be at particular risk of transmission of respiratory illness. Treatment decisions are often complex attributed to the heterogeneity of this population with regards to different geriatric domains such as functional status, comorbidity, and poly-pharmacy. While measures must be taken to prevent the novel coronavirus from spreading through these facilities, it is also essential that residents with coronavirus disease 2019 (COVID-19) have access to the symptom management and support they want and deserve. What most nursing home residents want during the course of their illness is to be able to stay in their facilities, to be surrounded by the people they love most, and to feel relief from their physical and emotional pain. By addressing the limited access to hospice and palliative care delivery in nursing homes, we can prevent unnecessary suffering and pain from COVID-19 as well as lay the groundwork for improving care for all residents moving forward.

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Advancing Palliative Care in Long Term Care Facilities (LTCFs) in Europe Within the PACE Project: An Innovative Educational and Development Intervention

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2018.10.196 ◽

2018 ◽

Vol 56 (6) ◽

pp. e70-e71

Author(s):

Sheila Payne ◽

Katherine Froggatt ◽

Jo Hockley ◽

Danni Collingridge Moore ◽

Lieve van den Block

Keyword(s):

Palliative Care ◽

Long Term Care ◽

Term Care ◽

Development Intervention ◽

Care Facilities

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Palliative care provision in long-term care facilities differs across Europe: Results of a cross-sectional study in six European countries (PACE)

Palliative Medicine ◽

10.1177/0269216319861229 ◽

2019 ◽

Vol 33 (9) ◽

pp. 1176-1188 ◽

Cited By ~ 4

Author(s):

Maud ten Koppel ◽

Bregje D Onwuteaka-Philipsen ◽

Lieve Van den Block ◽

Luc Deliens ◽

Giovanni Gambassi ◽

...

Keyword(s):

Palliative Care ◽

Advance Care Planning ◽

Long Term Care ◽

Care Planning ◽

Care Provision ◽

Cross Sectional ◽

Term Care ◽

Care Facilities ◽

Advance Care

Background: While the need for palliative care in long-term care facilities is growing, it is unknown whether palliative care in this setting is sufficiently developed. Aim: To describe and compare in six European countries palliative care provision in long-term care facilities and to assess associations between patient, facility and advance care planning factors and receipt and timing of palliative care. Design: Cross-sectional after-death survey regarding care provided to long-term care residents in Belgium, England, Finland, Italy, the Netherlands and Poland. Generalized estimating equations were used for analyses. Setting/participants: Nurses or care assistants who are most involved in care for the resident. Results: We included 1298 residents in 300 facilities, of whom a majority received palliative care in most countries (England: 72.6%–Belgium: 77.9%), except in Poland (14.0%) and Italy (32.1%). Palliative care typically started within 2 weeks before death and was often provided by the treating physician (England: 75%–the Netherlands: 98.8%). A palliative care specialist was frequently involved in Belgium and Poland (57.1% and 86.7%). Residents with cancer, dementia or a contact person in their record more often received palliative care, and it started earlier for residents with whom the nurse had spoken about treatments or the preferred course of care at the end of life. Conclusion: The late initiation of palliative care (especially when advance care planning is lacking) and palliative care for residents without cancer, dementia or closely involved relatives deserve attention in all countries. Diversity in palliative care organization might be related to different levels of its development.

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