Discussions during shared decision-making in older adults with advanced renal disease: a scoping review

ObjectivesThis review summarises the information available for clinicians counselling older patients with kidney failure about treatment options, focusing on prognosis, quality of life, the lived experiences of treatment and the information needs of older adults.DesignWe followed the Joanna Briggs Institute Methodology for Scoping Reviews. The final report conforms to the PRISMA-ScR guidelines.Data sourcesPubMed, PsycINFO, CINAHL, Embase, Scopus, Web of Science, TRIP and online repositories (for dissertations, guidelines and recommendations from national renal associations).Eligibility criteria for inclusionArticles in English studying older adults with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2); published between January 2000 and August 2018. Articles not addressing older patients separately or those comparing between dialysis modalities were excluded.Data extraction and synthesisTwo independent reviewers screened articles for inclusion and grouped them by topic as per the objectives above. Quantitative data were presented as tables and charts; qualitative themes were identified and described.Results248 articles were included after screening 15 445 initial results. We summarised prognostic scores and compared dialysis and non-dialytic care. We highlighted potentially modifiable factors affecting quality of life. From reports of the lived experiences, we documented the effects of symptoms, of ageing, the feelings of disempowerment and the need for adaptation. Exploration of information needs suggested that patients want to participate in decision-making and need information, in simple terms, about survival and non-survival outcomes.ConclusionWhen discussing treatment options, validated prognostic scores are useful. Older patients with multiple comorbidities do not do well with dialysis. The modifiable factors contributing to the low quality of life in this cohort deserve attention. Older patients suffer a high symptom burden and functional deterioration; they have to cope with significant life changes and feelings of disempowerment. They desire greater involvement and more information about illness, symptoms and what to expect with treatment.

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LGBTQ+ Aging Research in Canada: A 30-Year Scoping Review of the Literature

Geriatrics ◽

10.3390/geriatrics6020060 ◽

2021 ◽

Vol 6 (2) ◽

pp. 60

Author(s):

Kimberley Wilson ◽

Arne Stinchcombe ◽

Sophie M. Regalado

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Scoping Review ◽

Lived Experiences ◽

Systematic Search ◽

Review Of The Literature ◽

Aging Research ◽

Aging Populations ◽

Diverse Groups

Canada has a unique socio-political history concerning the inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people. With aging populations, understanding diverse groups of older adults is paramount. We completed a systematic search and scoping review of research in Canada to quantify and articulate the scale and scope of research on LGBTQ+ aging. Our search identified over 4000 results and, after screening for relevance, our review focused on 70 articles. Five major themes in the literature on LGBTQ+ aging in Canada were identified: (1) risk, (2) HIV, (3) stigma, and discrimination as barriers to care, (4) navigating care and identity, (5) documenting the history and changing policy landscapes. Most of the articles were not focused on the aging, yet the findings are relevant when considering the lived experiences of current older adults within LGBTQ+ communities. Advancing the evidence on LGBTQ+ aging involves improving the quality of life and aging experiences for LGBTQ+ older adults through research.

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Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome

Leukemia ◽

10.1038/sj.leu.2403289 ◽

2004 ◽

Vol 18 (4) ◽

pp. 809-816 ◽

Cited By ~ 132

Author(s):

M A Sekeres ◽

R M Stone ◽

D Zahrieh ◽

D Neuberg ◽

V Morrison ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Decision Making ◽

Acute Myeloid Leukemia ◽

Myelodysplastic Syndrome ◽

Myeloid Leukemia ◽

Acute Myeloid

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A Review on Deprescribing in Elderly

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v11i4.4871 ◽

2021 ◽

Vol 11 (4) ◽

pp. 136-137

Author(s):

Christy Babu ◽

Lincy George ◽

K. Krishnakumar

Keyword(s):

Quality Of Life ◽

Older Adults ◽

High Risk ◽

Older Patients ◽

Adverse Drug Events ◽

Patient Centered ◽

Inappropriate Medications ◽

Related Harm ◽

Improve Health

Deprescribing can be defined as the process of stopping a medication or reducing its dose to reduce adverse effects and improve health outcomes. Elderly people with co morbidities usually have a risk of adverse drug events and these events can only be treated by medicines. Despite the benefits offered by these medicines, older patients are at a high risk of harm caused by these medications. The use of multiple medications for treating the comorbidities may also leads to severe health problems. Deprescribing help to reduce the risk related to inappropriate medicines. Deprescribing is usually a patient centered process which helps to withdraw drugs which are harmful to be prescribed to older patients. Several explicit and implicit tools have been developed internationally to identify these inappropriate medications. Deprescribing of inappropriate medicines would help to reduces drug-related harm and improves the quality of life of older adults. Keywords: Deprescribing, polypharmacy, older adults

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Does providing autonomy for older adults through shared decision making improve quality of life?

Evidence-Based Practice ◽

10.1097/ebp.0000000000001566 ◽

2022 ◽

Vol Publish Ahead of Print ◽

Author(s):

Janelle Whitt ◽

John Duke ◽

Livia Maruoka Nishi ◽

Molly Martin

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Decision Making ◽

Shared Decision Making ◽

Shared Decision ◽

Improve Quality

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Death at the Beginning

10.1093/oxfordhb/9780199974412.013.2 ◽

2015 ◽

Author(s):

Renee D. Boss

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Prenatal Diagnosis ◽

Congenital Anomalies ◽

Pregnancy Termination ◽

Treatment Options ◽

Fetal Surgery ◽

Technological Advances ◽

Life Threatening

Medical and technological advances permit the survival of many infants born prematurely or with congenital anomalies. Prenatal diagnosis of a life-threatening fetal condition can give families the time to prepare for a sick infant and to consider treatment options ranging from pregnancy termination to fetal surgery. Despite the successes in perinatal and neonatal care, there remain a group of infants whose neonatal complications result in chronic illness, serious disability, and a foreshortened life span. It remains unclear how clinicians can best guide families who wish to make decisions based on their infant’s predicted quality of life. Multiple legal and policy restrictions attempt to limit the scope of parent–clinician decision making for these infants.

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Anaemia

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0147 ◽

2017 ◽

pp. 1133-1138

Author(s):

Ammon M. Fager ◽

Harvey Jay Cohen

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Older Patients ◽

Functional Decline ◽

Functional Deficits ◽

Mild Anaemia ◽

Clinical Trial Evidence ◽

The Impact ◽

Trial Evidence

Anaemia is an important problem in the older population. As it is usually mild and insidious in onset, the symptoms of anemia are often overlooked by older adults who attribute their symptoms to an inevitable consequence of ageing while clinicians may ignore mild anaemia in favour of focusing on more prominent comorbidities. However, anaemia in older adults is associated with significant mortality and decreased quality of life due to functional decline. As our understanding of anaemia in elderly people on a biological and clinical level increases, our ability to impact the functional deficits associated with it will improve. However, quality clinical trial evidence on the impact of anaemia and its treatment on crucial outcomes in older patients is currently lacking. The completion of such trials will be critical to assure the safety and efficacy of future interventions designed to improve the treatment and quality of life for older adults.

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Cardiopulmonary resuscitation: outcomes and decision-making processes for older adults

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0110 ◽

2017 ◽

pp. 857-862

Author(s):

Esther M. M. van de Glind ◽

Barbara C. van Munster ◽

Marije E. Hamaker

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Cardiopulmonary Resuscitation ◽

Older Patients ◽

Cardiopulmonary Arrest ◽

Good Condition ◽

Limiting Factor ◽

Decision Making Processes ◽

Meta Analyses

Cardiopulmonary resuscitation (CPR) was developed in the 1950s as a treatment for cardiopulmonary arrest. Outcome of CPR remains poor, particularly in older people, as demonstrated by two recent meta-analyses. The first addressed out-of-hospital resuscitation in patients aged 70 years and over, and found pooled overall rates of survival to discharge of 4.1%. For in-hospital resuscitation, the overall pooled rate of survival to discharge was 18.7% for patients aged 70–79 years, 15.4% for patients aged 80–89 years and 11.6% for those aged 90 or over. It is not clear if age alone is a limiting factor, or rather a marker of comorbidity. Overall, information about the quality of life after surviving CPR is lacking. Older patients should be adequately informed about their chances of survival in good condition in order to make a decision about the desirability of CPR.

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Modifiable Factors of Health-Related Quality of Life Among LGBTQ Older Adults Living With Cognitive Impairment

Innovation in Aging ◽

10.1093/geroni/igab046.427 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 112-112

Author(s):

Hyun-Jun Kim ◽

Karen Fredriksen Goldsen

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Cognitive Impairment ◽

Leisure Activities ◽

Later Life ◽

Health Related Quality ◽

Modifiable Factors ◽

Related Quality ◽

Health Related

Abstract Cognitive impairment can lead to significant decline in health-related quality of life (HRQOL) in later life especially among those who are socially marginalized. While Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are documented to be at heightened risks of cognitive impairment, they may face unique challenges due to discrimination, social isolation, and other LGBTQ-related risks. This study examined factors associated with psychological and physical HRQOL among LGBTQ adults aged 50 and older analyzing a sub-set of longitudinal data (N = 646) from National Health, Aging, and Sexuality/Gender Study: Aging with Pride. Lifetime LGBTQ discrimination and victimization and insufficient food intake were negatively, and physical and leisure activities were positively associated with both HRQOL dimensions. Community engagement, social support, and social activities were positively associated with psychological HRQOL. Culturally responsive interventions addressing these modifiable factors are needed to improve HRQOL of this socially marginalized but resilient population.

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Attitudes and Perceptions Toward Healthcare Technology Adoption Among Older Adults in Singapore: A Qualitative Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.588590 ◽

2021 ◽

Vol 9 ◽

Author(s):

Sarah T. H. Low ◽

P. Govind Sakhardande ◽

Yi Feng Lai ◽

Andrew D. S. Long ◽

Satveer Kaur-Gill

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Lived Experiences ◽

The Elderly ◽

Healthcare Industry ◽

Digital Revolution ◽

Health Technologies ◽

Attitudes And Perceptions ◽

The Voice

Smart Nation is a key initiative of Singapore to move toward digitalization of its industries including healthcare. The complex negotiations of aging amid Smart Nation are addressed in this paper, where we study the challenges faced to adapt the elderly for the digital revolution while ensuring dignified aging. While the healthcare industry accelerates its study and use of health technologies to improve diagnostics, treatment, and the quality of life of those in the aging category, the elderly socially construct these technological insertions that challenge the dominant understandings of what these technologies can do for their health outcomes. The study reveals re-constructions of these technological insertions through the voice of the elderly in their negotiations with health technologies in their everyday lives. Here, narratives reveal key themes that proliferate technology negotiation as barriers to everyday lived experiences.

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The Priorities of People with Mesothelioma: A Qualitative Study of Trial Participation and Treatment Decisions

10.21203/rs.3.rs-721316/v1 ◽

2021 ◽

Author(s):

Anna Bibby ◽

Anna J Morley ◽

Emma Keenan ◽

Nick A Maskell ◽

Rachael Gooberman-Hill

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Treatment Options ◽

Randomised Trial ◽

Research Participation ◽

Trial Participation ◽

Structured Interviews ◽

Care Needs ◽

Physical Strength

Abstract BackgroundTreatment options for mesothelioma are increasing, as are the number of clinical trials available to patients. However, little is known about patients’ and relatives’ priorities when making decisions about treatment and trial participation. MethodsFace to face, semi-structured interviews were undertaken with mesothelioma patients who were participating in the TILT trial (a randomised trial of intra-pleural immunotherapy) and their relatives. Interviews were audio-recorded, transcribed and analysed thematically. ResultsTwelve people were interviewed, comprising five mesothelioma patients and seven relatives. Four themes were identified relating to the experience of mesothelioma: physicality, quality of life, uncertainty and risk, and anxiety and the future. A further theme related to attitudes to research participation.Participants valued physical strength and were careful not to jeopardise this with potential side effects of medication. Quality of life was important and was often prioritised over survival. Participants found ambiguity challenging and sought certainty, potentially in response to the uncertainty surrounding their future. The desire for certainty impacted on risk perception; an important factor in decision-making. Relatives often advocated on behalf of patients and were more reluctant about research participation due to concern about potential risks.ConclusionThe study confirmed previous qualitative findings around physicality, uncertainty and relatives as advocates, building on these themes to highlight their influence on decision-making. Important findings for practice include the challenges associated with risk communication and the differing care needs of relatives.

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