scholarly journals ERS Presidential Summit 2018: multimorbidities and the ageing population

2019 ◽  
Vol 5 (3) ◽  
pp. 00126-2019
Author(s):  
Mina Gaga ◽  
Pippa Powell ◽  
Marta Almagro ◽  
Ioanna Tsiligianni ◽  
Stelios Loukides ◽  
...  
Keyword(s):  
End Of Life Care ◽  
Respiratory Diseases ◽  
New Technologies ◽  
Ageing Population ◽  
Advanced Care Planning ◽  
Life Care ◽  
Clinical Environment ◽  
Chronic Respiratory Diseases ◽  
New Ideas ◽  
Oriented Approach

As the average age of the population increases, so will the prevalence of chronic respiratory diseases and associated multimorbidity. This will result in a more complex clinical environment. Part of the solution will be to allow patients to be co-creators in the design of their care. It will also require clinicians to shift in their current approaches to care, step out of the disease- or pathology-oriented approach and embrace new ideas. In an effort to prepare the respiratory community for the challenge, we reflect on concepts to empower patients via multidisciplinary systems, new technologies and transition from end-of-life care to advanced care planning.

Palliative and end-of-life care

2020 ◽  
pp. 395-408
Author(s):  
Elizabeth Sampson ◽  
Karen Harrison Dening
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Terminal Illness ◽  
Mental Health Problems ◽  
Tube Feeding ◽  
Spiritual Needs ◽  
Ageing Population ◽  
Life Care ◽  
Anticipatory Grief ◽  
Poor Access

Our ageing population and changes in cause of death mean that increasing number of people will die in old age. In many countries, older people have had poor access to good-quality end-of-life care. Many will develop multiple comorbidities associated with age—dementia, mental health problems, and general frailty. Palliative care is an approach that aims to relieve suffering and take account of a person’s physical, psychosocial, and spiritual needs as they near the end of life. Advanced dementia is now being perceived as a ‘terminal illness’. Interventions such as antibiotics and enteral tube feeding remain in use despite little evidence that they improve quality of life or other outcomes. A person-centred approach from a multi-disciplinary team is vital in providing good-quality end-of-life care in a range of settings. The acknowledgement of anticipatory grief and provision of bereavement support are vital for some family carers.

Implementing a Pilot Program of Advanced Directives in Nursing Homes

2007 ◽  
Vol 100 (1) ◽  
pp. 195-198 ◽  
Author(s):  
William L. Chovan
Keyword(s):  
Advance Directives ◽  
Advance Directive ◽  
End Of Life Care ◽  
Sense Of Self ◽  
Pilot Program ◽  
Life Care ◽  
Emotional Needs ◽  
Advanced Directives ◽  
Social And Emotional ◽  
Oriented Approach

This project focused on employing a comprehensive advance directive, called Five Wishes, that is suited to a process-oriented approach emphasizing a discussion of personal, social, and emotional needs in end-of-life care. With findings of a limited number of advance directives completed, the traditional explanation of the ‘onset of progressive deterioration’ among the residents is offered. Residents with low sense of self-efficacy is suggested as another explanation and one worthy of further research.

Advance Care Planning in End of Life Care

2018 ◽  
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Research Policy ◽  
Ageing Population ◽  
Care Planning ◽  
Life Care ◽  
Wide Range ◽  
Advance Care ◽  
The Subject

Advance Care Planning (ACP) is an essential part of quality end of life care in the UK and in most developed countries, enabling more people to live well and die well as they would choose. In the context of the ageing population, with increasing possibilities for medical interventions, ACP is an crucial consideration, with important implications for the individual person and their family and for our wider population. This book takes a comprehensive look at the subject, helps readers explore a wide range of issues and practicalities in providing ACP; frames the purpose, process, and outcomes; provides updates on national and international research, policy, and practice and includes contributions from experts from around the world. Death will affect us all; it is the one certainty in life. Yet the subject of death remains something of a taboo, we rarely discuss what our preferences would be at end of life, what we would want, where we would want to be cared for, not even with loved ones.

scholarly journals Exploring an integrated palliative care model for older people: an integrative review

2019 ◽  
Vol 27 (2) ◽  
pp. 111-122 ◽  
Author(s):  
Marina Raco ◽  
Teresa Burdett ◽  
Vanessa Heaslip
Keyword(s):  
Palliative Care ◽  
Global Health ◽  
Older People ◽  
End Of Life ◽  
Integrated Care ◽  
End Of Life Care ◽  
Integrative Review ◽  
Ageing Population ◽  
Life Care ◽  
Content Type

Purpose Due to an international ageing population, global health organisations have recognised the challenges arising from fragmented interaction between health and social sectors in the end of life care. The purpose of this paper is to explore the existing literature on integrative palliative care services for older people. Design/methodology/approach An integrative review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Papers included in the review focused upon integrated care within palliative care systems (January 2007–2017). A certain number of papers were excluded when the review focused on individuals younger than 65, not written in English and not being focused on integrated palliative care. Findings Nine studies fitted the inclusion criteria and three themes were identified: person-centred care, co-ordination of care, and education and training. The review identifies that integrated palliative care requires co-ordinated techniques that focus upon the quality of life, individual needs and awareness of vulnerability rather than fixation on inevitable mortality. Research limitations/implications The emerging presence of the need for integrated palliative care requires further research in order to develop coherent models of integrated palliative care which can be incorporated into practice. Originality/value This review identified themes relevant to the emerging issues in the global health sector of end of life care. The literature suggests that the optimised use of an integrated care approach to a palliative model of care is required and in need of further investigation.

Improving code status documentation as a marker of advanced care planning at an outpatient academic cancer center: A pilot project.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 38-38 ◽  
Author(s):  
Anjana Ranganathan ◽  
James J. Sauerbaum ◽  
Katie Green ◽  
Heather Sheaffer ◽  
Mary Coniglio ◽  
...  
Keyword(s):  
Pilot Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Pilot Project ◽  
Cancer Center ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care ◽  
Code Status ◽  
Group A

38 Background: Advanced care planning can significantly impact the quality of end of life care. Readily accessible documentation of goals of care for patients (pts) known to have a high morbidity and mortality provides a concrete means for practitioners to discuss and guide advanced care planning. We previously reported a surprisingly small proportion of established pts in our oncology clinic with a documented code status (CS), and undertook a pilot project aimed at improving this rate. Methods: Query of the outpatient electronic medical record (EMR) at the Abramson Cancer Center for established pts revealed an average of 2% with a documented CS. Our pilot study focused on 8 providers in thoracic and gastrointestinal oncology. We established provider agreement on the importance of CS documentation, and analyzed the mechanisms in place for documentation. We educated providers on the method of documentation, raised visibility and importance of advanced directives, implemented a system of normalizing conversations for all new pts, reported weekly to providers on upcoming established pts without documentation and provided monthly report cards, indicating provider rates within the pilot group. Results: Prior to intervention, a median of 499-established pts per month were seen by our pilot group. A median of 50 pts (10%) had a documented CS with documentation rates by provider ranging from 0 – 91%. 5 of 8 providers had no established pts with a documented CS. After intervention, a median of 494-established pts per month were seen by the same group. A median of 197 pts (40%) (p < 0.05) had a documented CS with provider rates ranging from 26 – 94%. All providers had documented a CS on at least some of their established pts; improvements ranged from an increase of 0 to 26%, to an increase of 1 to 43%. Conclusions: Previously, at our institution, only a small minority of established patients with an oncologic diagnosis had documentation of CS in the readily available EMR. Our pilot study resulted in a statistically significant increase in the documentation rates for all providers over a 2-month period. We have yet to analyze the clinical significance of this, with attention to quality and cost of end of life care.

Population-based end-of-life care

2019 ◽  
pp. 739-762
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Quality Care ◽  
Population Based ◽  
Ageing Population ◽  
Life Care ◽  
Care Services ◽  
The Face ◽  
The Uk ◽  
Developed Nations

This chapter describes the changing face of end-of-life care in the face of demographic changes and the need for a population-based approach in providing end-of-life care in a meaningful manner. Building on the major advances in palliative or end of life care across the world over recent decades, there now seems to be radical groundswell of change in this area, as we face the major challenge of meeting the needs the ageing population. This challenge, most noted in the developed nations, now places specific and seemingly overwhelming unprecedented demands on all our health and social care services. Some would argue that a new approach is needed, building on lessons learnt, to care for the rising numbers of people nearing the last stage of life within our population—in other words, a population approach to end-of-life care. Using examples from the Gold Standards Framework in the UK, the chapter explores the importance of enabling generalists to deliver high quality care across a population, citing a variety of examples and programmes promoting person-centred care at the end of life.

Prescribing in end-of-life care

2019 ◽  
Vol 1 (6) ◽  
pp. 284-288
Author(s):  
Amanda Armstrong
Keyword(s):  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care ◽  
Limiting Condition

End-of-life care aims to support a person in the last stages of a life-limiting condition to live as well as possible until they die. Prescribing at the end-of-life presents many challenges. Advanced care planning can be carried out so that health professionals are aware and supportive of the patient's and their family's wishes. This article discusses the care and management of patients as they receive care at the end of their life as well as any anticipatory medication that may be needed.

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