End-of-Life Care for Older Adults in ICUs

2002 ◽  
Vol 20 (1) ◽  
pp. 181-229 ◽  
Author(s):  
JUDITH G. BAGGS
Keyword(s):  
Older Adults ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Support ◽  
Symptom Relief ◽  
Life Support Care ◽  
Life Care ◽  
Care Providers ◽  
Care Needs

This review was undertaken to present and critique the most recent (1990-2000) empirical evidence about end-of-life care for older adult patients in ICUs, their families, and care providers. The studies (including descriptive, correlational, longitudinal, and intervention) were found using a combination of these terms: (a) intensive care (units) or critical care (units), and (b) critical illness, critically ill patients, terminally ill, terminal care, life support care, or palliative care. The computerized databases searched were CINAHL and MEDLINE. Only published studies of persons 44 years of age or older, written in English, and conducted in the U.S. or Canada were included. Research was not limited to studies conducted by or written by nurses. Excluded were articles focused on physiology, for example, studies of treatment for specific conditions, and articles focused on predictors of ICU outcomes.Findings and Implications for ResearchThere is little research specifically focused on end-of-life care of older adults in ICUs. Most research has been retrospective, and most has involved either providers or patients and families but not both.Research is needed in many areas. The mechanism by which age affects choice of care needs further exploration. The experience of patients, families, and providers and how those experiences change with interventions needs investigation. The influence of the ICU culture, variation in decisions made and reasons for that variation, the decision-making process, and variations in care, all require further attention. Four domains were identified for research needed to improve care for older adults at the end of life in intensive care: symptom relief, communication improvement, psychological support, and relationship improvement. No one has assessed whether the ICU is a good place for transition to palliation to occur, or whether it would be better to transfer patients to another type of unit.

Documentation on Withdrawal of Life Support in Adult Patients in the Intensive Care Unit

2004 ◽  
Vol 13 (4) ◽  
pp. 328-334 ◽  
Author(s):  
Karin T. Kirchhoff ◽  
Prashanth Reddy Anumandla ◽  
Kristine Therese Foth ◽  
Shea Nicole Lues ◽  
Stephanie Ho Gilbertson-White
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Retrospective Studies ◽  
Life Support ◽  
Adult Patients ◽  
Life Care ◽  
Care Providers

• Background Patients’ charts have been a source of data for retrospective studies of the quality of end-of-life care. In the intensive care unit, most patients die after withdrawal of life support. Chart reviews of this process could be used not only to assess the quality of documentation but also to provide information for quality improvement and research.• Objective To assess the documentation of end-of-life care of patients and their families by care providers in the intensive care unit.• Method Charts of 50 adult patients who died in the intensive care unit at a large midwestern hospital after initiation of withdrawal of life support (primarily mechanical ventilation) were reviewed. A form developed for the study was used for data collection.• Results The initiation of the decision making for withdrawal was documented in all 50 charts. Sixteen charts (32%) had no information on advance directives. Eight charts (16%) had no documentation on resuscitation status. About two thirds of the charts documented nurses’ participation during the withdrawal process; only one tenth documented physicians’ participation. A total of 13 charts (26%) had no information on the time of initiation of the withdrawal process, and 11 (22%) had no documentation of medications administered for withdrawal. Thirty-seven charts (74%) had information on whether the patient was or was not extubated during withdrawal.• Conclusion Comprehensive documentation of end-of-life care is lacking.

scholarly journals Family Behaviors as Unchanging Obstacles in End-of-Life Care: 16-Year Comparative Data

2020 ◽  
Vol 29 (4) ◽  
pp. e81-e91
Author(s):  
Renea L. Beckstrand ◽  
Jasmine B. Jenkins ◽  
Karlen E. Luthy ◽  
Janelle L. B. Macintosh
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Critical Care Nurses ◽  
Life Care ◽  
Care Providers ◽  
Over Time

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. Results Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient’s end-of-life wishes, and not understanding the meaning of the term lifesaving measures). Two were related to nurse issues. Seven obstacles decreased in magnitude, including poor design of units, overly restrictive visiting hours, and physicians avoiding conversations with families. Four helpful behavior magnitude scores increased significantly over time, including physician agreement on patient care and family access to the patient. Three helpful behavior items decreased in magnitude, including intensive care unit design. Conclusions The same end-of-life care obstacles that were reported in 1999 are still present. Obstacles related to family behaviors increased significantly, whereas obstacles related to intensive care unit environment or physician behaviors decreased significantly. These results indicate a need for better end-of-life education for families and health care providers.

Managing End-of-Life Care

2012 ◽  
Author(s):  
John W. Albarran ◽  
Marika Hills
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Care Delivery ◽  
Symptom Relief ◽  
Death And Dying ◽  
Past Century ◽  
Life Care ◽  
Care Needs ◽  
Definition Of ◽  
The Uk

This chapter addresses the fundamental nursing role of managing end-of-life care. Death is as fundamental a part of life as living, and while caring for a dying patient and their family is demanding, complex, and emotionally exhausting, it can also be a gratifying and privileged experience for nurses. Specifically, nurses have a centre-stage role in leading and informing care delivery at the end of life. Care will typically embrace assessing the needs of the patient and family, providing symptom relief and comfort care, and providing cultural and spiritual support. Additionally, caring functions should also extend following death to caring for the deceased in a dignified manner and supporting the newly bereaved, demonstrating genuine concern, compassion, and effective communication skills (Hills and Albarran, 2010a; Maben et al., 2010). To examine the key themes and challenges of practice, it is important to understand the political, professional and societal influences, and contextual nature of death and dying in the UK. At present, there is neither a clear nor universally accepted definition of end-of-life care, but it is generally understood to be the care of a person who is identified as having failing health and who is in a progressive state of decline (Shipman et al., 2008). Establishing the last phase of a patient’s life can be a difficult and complex process, and this might occur:…● after the diagnosis of a life-limiting condition; ● during the transition or deterioration of a chronic disease illness; ● when there is an increasing frailty combined with greater dependence on care provision, particularly in the older adult; ● following a sudden infective episode, cardiac event, or a life-threatening accident….The last phase of end-of-life care is referred to as the dying phase. Consideration of the end-of-life care needs of people with chronic terminal conditions should begin at diagnosis, and must embrace after-death care and family support. Over the past century, progress and advancement in disease management, together with improvements in living standards, have resulted in changes to the national death profile, with currently two-thirds of the 0.5 million annual deaths in the UK occurring in people over 75 years of age.

scholarly journals A national survey of ambulance paramedics on the identification of patients with end of life care needs

2021 ◽  
Vol 5 (4) ◽  
pp. 60-61
Author(s):  
Peter Eaton-Williams ◽  
Jack Barrett ◽  
Craig Mortimer ◽  
Julia Williams
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Primary Care Providers ◽  
Free Text ◽  
Life Care ◽  
Care Providers ◽  
Care Needs ◽  
Online Questionnaire ◽  
Communication Difficulties ◽  
Assessment Training

<sec id="s1"> Aims: Developing the proactive identification of patients with end of life care (EoLC) needs within ambulance paramedic clinical practice may improve access to care for patients not benefitting from EoLC services at present. To inform development of this role, this study aims to assess whether ambulance paramedics currently identify EoLC patients, are aware of identification guidance and believe this role is appropriate for their practice. </sec> <sec id="s2"> Methods: Between 4 November 2019 and 5 January 2020, registered paramedics from nine English NHS ambulance service trusts were invited to complete an online questionnaire. The questionnaire initially explored current practice and awareness, employing multiple-choice questions. The Gold Standards Framework Proactive Identification Guidance (GSF PIG) was then presented as an example of EoLC assessment guidance and further questions, permitting free-text responses, explored attitudes towards performing this role. </sec> <sec id="s3"> Results: 1643 questionnaires were analysed. Most participants (79.9%; n = 1313) perceived that they attended a patient who was formally unrecognised as within the last year of life on at least a monthly basis. Despite 72.0% (n = 1183) of paramedics indicating that they had previously made an EoLC referral to a General Practitioner (GP), only 30.5% (n = 501) were familiar with the GSF PIG and of those only 25.9% (n = 130) had received training in its use. Participants overwhelmingly believed that they can (94.4%; n = 1551) and should (97.0%; n = 1594) perform this role, yet current barriers were identified as the inaccessibility of a patient’s medical records, inadequate EoLC education and communication difficulties. Consequently, facilitators to performing this role were identified as the provision of further training in EoLC assessment guidance and establishing accessible, responsive EoLC referral pathways. </sec> <sec id="s4"> Conclusion: Ambulance paramedics frequently encounter patients that they perceive are not receiving appropriate EoLC provision, and participants in this study overwhelmingly supported a role in highlighting this to primary care providers. Though many paramedics are already making referrals for these patients, the majority are performed without knowledge of validated EoLC assessment guidance. Provision of EoLC assessment training might therefore be expected to improve the timeliness and sensitivity of referrals, potentially addressing current inequalities in access to EoLC. The communication difficulties currently encountered when making a referral might be addressed by the provision of dedicated EoLC referral pathways. Future qualitative and quantitative evaluation of local initiatives providing both assessment training and referral pathways would be hugely beneficial for revealing the benefits and barriers associated with the development of this role in practice. </sec>

scholarly journals End of Life Care in Scotland: Trends in the Population in Need of Palliative Care

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Anna Schneider ◽  
Iain Atherton
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Living Arrangements ◽  
End Of Life Care ◽  
Service Use ◽  
Census Data ◽  
Estimation Method ◽  
Life Care ◽  
Care Providers ◽  
Care Needs

BackgroundEstimation of population-wide palliative care needs is crucial for end-of-life care planning, and literature around it has grown in the last years. However, no estimates have yet been published for Scotland. ObjectivesThis paper provides estimates of how many people require palliative care in Scotland and describes changes in the composition of this subpopulation. What are their living arrangements? How have their medical conditions, health service use, and health trajectories changed? Methods (including data)The analysis is based on linked hospital records, death records, and Scottish Census data from 2001/02 and 2011/12. The palliative care estimation method by Murtagh et al. is utilised, as well as the illness trajectories distinguished by Murray et al. Comparative cross-sectional descriptive statistics are provided. FindingsWhile a recent paper suggests that palliative care need in England/Wales has increased from 72.5% in 2006 to 74.9% in 2014, the share of people with a palliative care need among all deaths in Scotland has decreased from 80.6% to 78.3% in the period of this study. The share of people aged 85+ rose from 26.6% to 31.4%, and we observe a doubling of cases with prolonged dwindling at the end of their life. Despite their high need for care, 4 in 5 people lived in a private household in their last year of life, and 1 in 3 people lived alone. ConclusionsOur findings suggest a change in the volume of care need and in the types of care required. They have strong implications for care providers.

Characteristics, Mortality Rates, and Treatments Received in Last Few Days of Life for Patients Dying in Intensive Care Units: A Multicenter Study

2020 ◽  
Vol 37 (10) ◽  
pp. 761-766 ◽  
Author(s):  
Issa Mohammad Almansour ◽  
Muayyad Mustafa Ahmad ◽  
Mohammad Minwer Alnaeem
Keyword(s):  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Invasive Mechanical Ventilation ◽  
Mortality Rates ◽  
Treatment Modalities ◽  
Life Care ◽  
Care Needs ◽  
Multicenter Cohort Study ◽  
Medical Icus

Background: Information is presently lacking about the end-of-life care in intensive care unit (ICU). We explored the characteristics, mortality rates, and treatments received in the last few days of life for patients who died in ICU. Methods: This was a retrospective multicenter cohort study. We included patients who died from different medical illnesses between January 2014 and January 2017 in 8 medical ICUs across 3 major health-care systems in Jordan. Of 11 029 patients who were admitted for the study in ICUs, data from 3885 health records were retrieved and analyzed. Pediatric patients aged younger than 18 years and patients admitted to an ICU for less than 4 hours were excluded. Results: The mean ICU mortality rate was 34.6% (29%-38%), with a slight decline from 2014 through 2016. Most of the patients who died were male (56.6%), transferred from the emergency department (46.8%), and had multiple comorbidities (74%). Cardiopulmonary resuscitation, invasive mechanical ventilation, pharmacological hemodynamic support, and artificial hydration were pursued until death for most patients (91.5%, 80.1%, 78.8%, and 94.1%, respectively). Conclusions: Aggressive treatment modalities were usually pursued for critically ill patients at the end of their lives. There is a need to explore further the current end-of-life care needs and practices in ICUs in Jordan and to tailor end-of-life care and management suitably to meet the needs of Islamic and Arabic cultures.

scholarly journals Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e049711
Author(s):  
Yunji Lee ◽  
Minjeong Jo ◽  
Taehwa Kim ◽  
Kyoungsun Yun
Keyword(s):  
Older Adults ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Health Insurance ◽  
South Korea ◽  
End Of Life ◽  
High Intensity ◽  
End Of Life Care ◽  
Life Care ◽  
Cross Sectional

ObjectivesTo provide useful information for clinicians and policy makers to prepare guidelines for adequate use of medical resources during end-of-life period by analysing the intensive care use and related costs at the end of life in South Korea.DesignCross-sectional, retrospective, observational study.SettingTertiary hospitals in South Korea.ParticipantsWe analysed claim data and patient information from the Health Insurance Review and Assessment Service national dataset. This dataset included 19 119 older adults aged 65 years or above who received high-intensity care at least once and died in the intensive care unit in South Korea between 2016 and 2019. High-intensity care was defined as one of the following treatments or procedures: cardiopulmonary resuscitation, mechanical ventilation, extra-corporeal membrane oxygenation, haemodialysis, transfusion, chemotherapy and vasopressors.Primary and secondary outcome measuresUsage and cost of high-intensity care.ResultsThe most commonly used high-intensity care was transfusion (68.9%), mechanical ventilation (50.6%) and haemodialysis (35.7%) during the study period. The annual cost of high-intensity care at the end of life increased steadily from 2016 to 2019. There existed differences by age, gender, length of hospital stays and primary cause of death in use of high-intensity care and associated costs.ConclusionFindings indicate that invasive and device-dependent high-intensity care is frequently provided at the end of life among older adults, which could potentially place an economic burden on patients and their families. In Korea’s ageing society, increased rates of chronic illness are expected to significantly burden those who lack the financial resources to provide end-of-life care. Therefore, guidelines for the use of high-intensity care are required to ensure affordable end-of-life care.

A scoping review of research to assess the frequency, types, and reasons for end-of-life care setting transitions

2018 ◽  
Vol 48 (4) ◽  
pp. 376-381
Author(s):  
Donna M. Wilson ◽  
Stephen Birch
Keyword(s):  
Open Access ◽  
End Of Life ◽  
Scoping Review ◽  
End Of Life Care ◽  
Care Setting ◽  
Hospital Admissions ◽  
Research Articles ◽  
Life Care ◽  
Care Providers ◽  
Care Needs

Aims: Most people approaching the end of life develop care needs, which typically change over time. Moves between care settings may be required as health deteriorates. However, in some cases, care setting transitions may have little to do with end-of-life care needs and instead reflect the needs, demands, availability, or funding provisions of the country or funding body and organizations providing care. This paper is a scoping review of the international peer-reviewed research literature to gain evidence on the frequency and types of end-of-life care setting transitions, and the reasons for these moves. Methods: All relevant print and open access research articles published in 2000+ were sought using the Directory of Open Access Journals and EBSCO Discovery Host. Results: A total of 39 research articles were identified and reviewed. However, minimal useful evidence was revealed. Most articles focused solely on hospital admissions near death, and some focused on nursing home admissions, with other moves infrequently studied. Conclusions: This review demonstrates the need to quantify and justify end-of-life care setting transitions as it appears dying people are frequently moved, often as death nears. This research is needed to distinguish transitions related to end-of-life care needs and those arising from pressures on or from care providers and others unrelated to the person’s care needs.

An Admiral Nursing and hospice partnership in end-of-life care: Innovative practice

Dementia ◽  
2018 ◽  
Vol 19 (7) ◽  
pp. 2484-2493
Author(s):  
Karen Harrison Dening ◽  
Jaqueline Crowther ◽  
Sadaf Adnan
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Stage ◽  
Life Care ◽  
Care Providers ◽  
Care Needs ◽  
People With Dementia ◽  
Health And Social Care ◽  
Palliative Care Needs

Addressing palliative care needs of people with dementia appropriately, identifying the end-of-life stage, meeting the needs of family carers as well as supporting the preferences and wishes of the person with the diagnosis can all present challenges to generalist health and social care providers. In partnership with Dementia UK and Kirkwood Hospice in West Yorkshire embarked upon a two-year pilot to introduce the first end-of-life care Admiral Nurse to their Specialist Community Palliative Care Team to identify and support people with dementia who required palliative and end-of-life care. This paper describes and discusses this innovative partnership and outcomes from year one evaluation and sets out future plans.

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