scholarly journals Identifying Palliative Care Needs Among Older Adults in Nonclinical Settings

2018 ◽  
Vol 35 (12) ◽  
pp. 1477-1482 ◽  
Author(s):  
Elissa Kozlov ◽  
Anna Cai ◽  
Jo Anne Sirey ◽  
Angela Ghesquiere ◽  
M. Carrington Reid
Keyword(s):  
Older Adults ◽  
New York ◽  
Palliative Care ◽  
Living Arrangement ◽  
Community Settings ◽  
Supportive Services ◽  
Care Needs ◽  
Community Based ◽  
Acute Hospitalization ◽  
Palliative Care Needs

Though palliative care is appropriate for patients with serious illness at any stage of the illness and treatment process, the vast majority of palliative care is currently delivered in inpatient medical settings in the past month of life during an acute hospitalization. Palliative care can have maximal benefit to patients when it is integrated earlier in the illness trajectory. One possible way to increase earlier palliative care use is to screen for unmet palliative care needs in community settings. The goal of this study was to assess the rates of unmet palliative care needs in older adults who attend New York City–based senior centers. The results of this study revealed that 28.8% of participants screened positive for unmet palliative care needs. Lower education and living alone were predictors of positive palliative care screens, but age, gender, marital status, and race were not. This study determined that the rate of unmet palliative care needs in community-based older adults who attend senior center events was high and that living arrangement and education level are both correlates of unmet palliative care needs. Screening for unmet palliative care needs in community settings is a promising approach for moving palliative care upstream to patients who could benefit from the additional supportive services prior to an acute hospitalization.

scholarly journals Associations between unmet palliative care needs and cognitive impairment in a sample of diverse, community-based older adults

2020 ◽  
pp. 1-5
Author(s):  
Elissa Kozlov ◽  
Matthew J. Wynn ◽  
M. Carrington Reid ◽  
Charles R. Henderson ◽  
XinQi Dong ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Status ◽  
Care Needs ◽  
Community Based ◽  
Diverse Community ◽  
The Relationship ◽  
Palliative Care Needs

Abstract Objective Given a large number of community-based older adults with mild cognitive impairment, it is essential to better understand the relationship between unmet palliative care (PC) needs and mild cognitive impairment in community-based samples. Method Participants consisted of adults ages 60+ receiving services at senior centers located in New York City. The Montreal Cognitive Assessment (MoCA) and the Unmet Palliative Care Needs screening tool were used to assess participants’ cognitive status and PC needs. Results Our results revealed a quadratic relationship between unmet PC needs and mild cognitive impairment, controlling for gender, living status, and age. Participants with either low or high MoCA scores reported lower PC needs than participants with average MoCA scores, mean difference of the contrast (low and high vs. middle) = 2.15, P = 0.08. Significance of results This study is a first step toward elucidating the relationship between cognitive impairment and PC needs in a diverse community sample of older adults. More research is needed to better understand the unique PC needs of older adults with cognitive impairment living in the community.

Leveraging Emergency Department Information Systems to Address Palliative Care Needs of ED Patients During the COVID Pandemic

2021 ◽  
pp. 104990912110428
Author(s):  
Audrey J. Tan ◽  
Jordan Swartz ◽  
Christine Wilkins ◽  
Corita Grudzen
Keyword(s):  
New York ◽  
Palliative Care ◽  
Information Systems ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Patient Volume ◽  
Care Needs ◽  
High Acuity ◽  
Hospital Resources ◽  
Palliative Care Needs

The arrival of the COVID-19 pandemic to hospitals in New York City stressed our emergency departments (ED) with high patient volume, stresses on hospital resources and the arrival of numerous high acuity, critically ill patients. Amid this time, we sought to leverage the ED Information Systems (EDIS), to assist in connecting critically ill patients, their families, and providers in the ED with palliative care resources. We discuss 4 innovative, thoughtful solutions to assist ED providers in identifying and addressing the acute and unique palliative care needs of COVID patients.

Mortality among referrals to a community-based intermediate care team

2017 ◽  
Vol 9 (3) ◽  
pp. 263-266
Author(s):  
Bharath Lakkappa ◽  
Sanjay Shah ◽  
Stephen Rogers ◽  
Leanne Helen Holman
Keyword(s):  
Palliative Care ◽  
Care Team ◽  
Intermediate Care ◽  
Care Needs ◽  
Community Based ◽  
Care Services ◽  
Palliative Care Teams ◽  
Care Models ◽  
End Stage ◽  
Palliative Care Needs

ObjectivesIntermediate care services have been introduced to help mitigate unnecessary hospital demand and premature placement in long-term residential care. Many patients are elderly and/or with complex comorbidities, but little consideration has been given to the palliative care needs of patients referred to intermediate care services. The objective of this study is to determine the proportion of patients referred to a community-based intermediate care team who died during care and up to 24 months after discharge and so to help inform the development of supportive and palliative care in this setting.MethodsA retrospective cohort study of all 4770 adult patients referred to Northamptonshire Intermediate Care Team (ICT) between 11 April 2010 and 10 April 2011.ResultsOf 4770 patients referred, 60% were 75 years or older and 32% were 85 years of age or older. 4.0% of patients died during their ICT stay and 11% within 30 days of discharge. At the end of 12 months, 25% of the patients had died, increasing to 32% before the end of the second year. About 34% of all deaths occurred during the ICT stay or within 30 days of discharge, and a further 46% by the end of the first year. Male gender and higher age were associated with greater likelihood of death.ConclusionsIt is important for ICT clinicians to consider immediate and longer-term palliative care needs among patients referred to ICTs. Care models involving ICTs and palliative care teams working together could enable more people with end-stage non-cancer illnesses to die at home.

Palliative Care and Rapid Emergency Screening Tool and the Palliative Performance Scale to Predict Survival of Older Adults Admitted to the Hospital From the Emergency Department

2020 ◽  
pp. 104990912096071
Author(s):  
Jonas R. Te Paske ◽  
Sarah DeWitt ◽  
Robin Hicks ◽  
Shana Semmens ◽  
Leigh Vaughan
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Palliative Care ◽  
South Carolina ◽  
Performance Status ◽  
Care Needs ◽  
Vital Status ◽  
Prognostic Utility ◽  
Palliative Care Needs ◽  
Performance Scale

Background: The Palliative Care and Rapid Emergency Screening (P-CaRES) tool has been validated to identify patients in the emergency department (ED) with unmet palliative care needs, but no prognostic data have been published. The Palliative Performance Scale (PPS) has been validated to predict survival based on performance status and separately has been shown to predict survival among adults admitted to the hospital from the ED. Objective: To concurrently validate the 6-month prognostic utility of P-CaRES with a replication of prior studies that demonstrated the prognostic utility of the PPS among adults admitted to the hospital from the ED. Design: Prospective cohort study. Setting/Subjects: Adults >55 years admitted to the hospital from the ED at an urban academic hospital in South Carolina. Measurement: Baseline PPS score and P-CaRES status were evaluated within 51 hours of admission. Vital status at 6 months was evaluated by phone or chart review. Results: 131 of 145 participants completed the study. Six-month survival was 79.2% of those with a PPS of 60-100 (22/106 died) and 48% of those with a PPS of 10-50 (13/25 died) (p = 0.0004). Six-month survival was 85.2% for P-CaRES negative (13/88 died) and 48.8% for P-CaRES positive (22/43 died) (p < 0.0001). The inferred hazard ratio (HR) for PPS 10-50, as compared to PPS 60-100 was 3.003 (95%CI (1.475, 6.112) p = 0.0024) and the HR for P-CaRES positive, as compared to P-CaRES negative was 4.186 (95%CI (2.052, 8.536) p < 0.0001). Conclusion: The P-CaRES tool and PPS can predict 6-month survival of older adults admitted from the ED.

scholarly journals PHP38 PREVALENCE OF PALLIATIVE CARE NEEDS IN A COMMUNITY-BASED PUBLIC HOSPITAL

2007 ◽  
Vol 10 (6) ◽  
pp. A372
Author(s):  
S Rankin ◽  
TM Conner ◽  
S Schuch ◽  
SA Strassels
Keyword(s):  
Palliative Care ◽  
Public Hospital ◽  
Care Needs ◽  
Community Based ◽  
Palliative Care Needs

scholarly journals Palliative Care Needs of Seriously Ill, Older Adults Presenting to the Emergency Department

2010 ◽  
Vol 17 (11) ◽  
pp. 1253-1257 ◽  
Author(s):  
Corita R. Grudzen ◽  
Lynne D. Richardson ◽  
Matthew Morrison ◽  
Elizabeth Cho ◽  
R. Sean Morrison
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Palliative Care ◽  
Care Needs ◽  
Palliative Care Needs ◽  
Seriously Ill

scholarly journals High Burden of Palliative Care Needs of Older Adults During Emergency Major Abdominal Surgery

2018 ◽  
Vol 66 (11) ◽  
pp. 2072-2078 ◽  
Author(s):  
Zara Cooper ◽  
Elizabeth J. Lilley ◽  
Evan Bollens-Lund ◽  
Susan L. Mitchell ◽  
Christine S. Ritchie ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Abdominal Surgery ◽  
Major Abdominal Surgery ◽  
Care Needs ◽  
High Burden ◽  
Palliative Care Needs

scholarly journals Assessing the palliative care needs and service use of diverse older adults in an urban medically-underserved community

2019 ◽  
Vol 8 (5) ◽  
pp. 769-774
Author(s):  
Daniel S. Gardner ◽  
Nina S. Parikh ◽  
Carolina H. Villanueva ◽  
Angela Ghesquiere ◽  
Cara Kenien ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Service Use ◽  
Medically Underserved ◽  
Care Needs ◽  
Underserved Community ◽  
Palliative Care Needs

Pilot randomized trial of a transdisciplinary geriatric intervention for older adults with cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11549-11549
Author(s):  
Paul Kay ◽  
Areej El-Jawahri ◽  
Charn-Xin Fuh ◽  
Brandon Temel ◽  
Sophia Landay ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Usual Care ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Assessment System ◽  
Care Needs ◽  
Care Intervention ◽  
Geriatric Intervention ◽  
Palliative Care Needs

11549 Background: Oncologists often struggle with managing the unique care needs of older adults with cancer. We sought to determine the feasibility of delivering a transdisciplinary geriatric intervention designed to address the geriatric (physical function & comorbidity) and palliative care (symptoms & prognostic understanding) needs of older adults with cancer. Methods: We randomly assigned patients age ≥65 with newly diagnosed incurable gastrointestinal (GI) or lung cancer to receive a transdisciplinary geriatric intervention or usual care. Intervention patients received two visits with a geriatrician who was trained to address patients’ palliative care needs in addition to conducting a geriatric assessment. We defined the intervention as feasible if > 70% of patients enrolled in the study and > 75% completed study visits and surveys. At baseline and week 12, we assessed patients’ quality of life (QOL, Functional Assessment of Cancer Therapy General), symptoms (Edmonton Symptom Assessment System), and communication confidence (Perceived Efficacy in Patient Physician Interactions). As this was a pilot study, we calculated mean change scores in outcomes and estimated intervention effect sizes (ES). Results: From 2/2017-6/2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age = 72.3 [range 65.2-91.8]; 45.2% female; cancer types: 56.5% GI, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 76.2% attended both. Overall, 77.8% completed all study surveys. Compared to usual care, intervention patients had less decrement in QOL scores (-0.77 vs -3.84, ES = .21), greater reduction in the number of moderate/severe symptoms (-0.69 vs +1.04, ES = .58), and more improvement in communication confidence (+1.06 vs -0.80, ES = .38). Conclusions: In this trial of older adults with advanced cancer, more than half enrolled in the study and over 75% of those who enrolled completed all study visits and surveys. Our effect size estimates suggest that a transdisciplinary intervention targeting patients’ geriatric and palliative care needs may be a promising approach to improve patients’ QOL, symptom burden, and communication confidence. Clinical trial information: NCT02868112.

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