scholarly journals Lights and shadows on the last week of life of nursing home residents with advanced dementia: retrospective study

2019 ◽  
Author(s):  
Franco Toscani ◽  
Silvia Finetti ◽  
Fabrizio Giunco ◽  
Ines Basso ◽  
Debora Rosa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Retrospective Study ◽  
End Of Life ◽  
Nursing Home Residents ◽  
Advanced Dementia ◽  
Convenience Sample ◽  
Lombardy Region ◽  
Inappropriate Drugs ◽  
Clinical Records ◽  
Geriatric Settings

Abstract Background Barriers to palliative care still exist in geriatric settings, thus persons with advanced dementia may not receive adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The study aimed at evaluating the palliative appropriateness of clinical interventions and care at end of life in a cohort of NH residents with advanced dementia in a large Italian region (Lombardy Region). Methods Retrospective study in a convenience sample of 29 NHs. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the last week of life. Results Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs was prescribed. The acknowledgement of worsening condition in clinical records was recorded for 57% of residents, a median of 4 days before death. Conclusions A full implementation of palliative care is not yet achieved possibly due to the insufficient acknowledgement of the inappropriateness of some drugs and interventions, and health professionals’ fears and prejudices regarding critical end-of-life decisions. Further studies should focus on how to improve care for NH residents.

scholarly journals The last week of life of nursing home residents with advanced dementia: a retrospective study

2019 ◽  
Author(s):  
Franco Toscani ◽  
Silvia Finetti ◽  
Fabrizio Giunco ◽  
Ines Basso ◽  
Debora Rosa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Retrospective Study ◽  
Nursing Home Residents ◽  
Advanced Dementia ◽  
Term Care ◽  
Convenience Sample ◽  
Lombardy Region ◽  
Inappropriate Drugs ◽  
Clinical Records

Abstract Background: Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. Methods: This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the seven days before death. Results: Most residents (97.1%) died in the NH. In the seven days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of four days before death. Conclusions: Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals’ lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.

scholarly journals The last week of life of nursing home residents with advanced dementia: a retrospective study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Franco Toscani ◽  
Silvia Finetti ◽  
Fabrizio Giunco ◽  
Ines Basso ◽  
Debora Rosa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Retrospective Study ◽  
Nursing Home Residents ◽  
Advanced Dementia ◽  
Term Care ◽  
Convenience Sample ◽  
Lombardy Region ◽  
Inappropriate Drugs ◽  
Clinical Records

Abstract Background Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. Methods This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death. Results Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death. Conclusions Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals’ lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.

scholarly journals The last week of life of nursing home residents with advanced dementia: a retrospective study

2019 ◽  
Author(s):  
Franco Toscani ◽  
Silvia Finetti ◽  
Fabrizio Giunco ◽  
Ines Basso ◽  
Debora Rosa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Retrospective Study ◽  
End Of Life ◽  
Nursing Home Residents ◽  
Advanced Dementia ◽  
Term Care ◽  
Convenience Sample ◽  
Inappropriate Drugs ◽  
Clinical Records

Abstract Background: Barriers to palliative care still exist in long term care settings for older people, thus persons with advanced dementia may not receive adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. This study aimed to evaluate the clinical interventions and care at end of life in a cohort of Nursing Home (NH) residents with advanced dementia in a large Italian region (Lombardy Region). Methods: Retrospective study in a convenience sample of 29 NHs. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the last week of life. Results: Most residents (97.1%) died in the NH. In the seven days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. The acknowledgement of worsening condition in clinical records was recorded for 57% of residents, a median of four days before death. Conclusions: Full implementation of palliative care was not achieved possibly due to the insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals’ lack of implementation of end-of-life palliative care decisions. Future studies should focus on how to improve care for NH residents.

Guilt as an Influencer in End-of-Life Care Decisions for Nursing Home Residents With Advanced Dementia

2022 ◽  
Vol 48 (1) ◽  
pp. 22-27
Author(s):  
Ashley Roach ◽  
Anita H. Rogers ◽  
Meghan Hendricksen ◽  
Ellen P. McCarthy ◽  
Susan L. Mitchell ◽  
...  
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Life Care ◽  
Advanced Dementia

scholarly journals Sex-Specific Differences in End-of-Life Burdensome Interventions and Antibiotic Therapy in Nursing Home Residents With Advanced Dementia

2019 ◽  
Vol 2 (8) ◽  
pp. e199557 ◽  
Author(s):  
Nathan M. Stall ◽  
Hadas D. Fischer ◽  
Kinwah Fung ◽  
Vasily Giannakeas ◽  
Susan E. Bronskill ◽  
...  
Keyword(s):  
Nursing Home ◽  
Antibiotic Therapy ◽  
End Of Life ◽  
Nursing Home Residents ◽  
Advanced Dementia

scholarly journals Nursing home staff’s perspective on end-of-life care of German nursing home residents: a cross-sectional survey

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Anke Strautmann ◽  
Katharina Allers ◽  
Alexander Maximilian Fassmer ◽  
Falk Hoffmann
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
Nursing Staff ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Hospital Death ◽  
Life Care ◽  
Cross Sectional

Abstract Background Nursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany. Methods A cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested. Results 486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement. Conclusions Together with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.

scholarly journals ‘There’s a Catch-22’ – The complexities of pain management for people with advanced dementia nearing the end of life: A qualitative exploration of physicians’ perspectives

2016 ◽  
Vol 31 (8) ◽  
pp. 734-742 ◽  
Author(s):  
Bannin De Witt Jansen ◽  
Kevin Brazil ◽  
Peter Passmore ◽  
Hilary Buchanan ◽  
Doreen Maxwell ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
End Of Life ◽  
Knowledge Exchange ◽  
Structured Interview ◽  
Training Needs ◽  
Advanced Dementia ◽  
Treatment Approaches ◽  
The Impact ◽  
And Training

Background: Pain management is a cornerstone of palliative care. The clinical issues encountered by physicians when managing pain in patients dying with advanced dementia, and how these may impact on prescribing and treatment, are unknown. Aim: To explore physicians’ experiences of pain management for patients nearing the end of life, the impact of these on prescribing and treatment approaches, and the methods employed to overcome these challenges. Design: Qualitative, semi-structured interview study exploring barriers to and facilitators of pain management, prescribing and treatment decisions, and training needs. Thematic analysis was used to elicit key themes. Setting/participants: A total of 23 physicians, responsible for treating patients with advanced dementia approaching the end of life, were recruited from primary care ( n = 9), psychiatry ( n = 7) and hospice care ( n = 7). Results: Six themes emerged: diagnosing pain, complex prescribing and treatment approaches, side effects and adverse events, route of administration, importance of sharing knowledge and training needs. Knowledge exchange was often practised through liaison with physicians from other specialities. Cross-speciality mentoring and the creation of knowledge networks were believed to improve pain management in this patient population. Conclusion: Pain management in end-stage dementia is complex, requiring cross-population of knowledge between palliative care specialists and non-specialists, in addition to collateral information provided by other health professionals and patients’ families. Regular, cost- and time-effective mentoring and ongoing professional development are perceived to be essential in empowering physicians to meet clinical challenges in this area.

scholarly journals Do Palliative Care Teams in Nursing Homes Improve the Quality of End-of-Life Care for Nursing Home Residents?

2019 ◽  
Author(s):  
Helena Temkin-Greener Helena Temkin-Greener ◽  
Dana Mukamel ◽  
Susan Ladwig ◽  
Thomas , Caprio ◽  
Sally Norton ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Nursing Homes ◽  
End Of Life ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Life Care ◽  
Palliative Care Teams

MO207END-OF-LIFE CARE IN NEPHROLOGY INPATIENTS - ARE WE GETTING IT RIGHT?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Catarina Mateus ◽  
Ana Rita Martins ◽  
Eunice Cacheira ◽  
Maria Augusta Gaspar
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Nasogastric Tube ◽  
Symptom Control ◽  
Comfort Care ◽  
Care Plans ◽  
Symptom Evaluation ◽  
The Family ◽  
Clinical Records ◽  
Eol Care

Abstract Background and Aims Average life expectancy have been continuously increasing within the general population and, equally so, within Nephrology patients. End-of-life (EOL) care is part of non-oncologic palliative care provided by Nephrology. The aim of our study is to evaluate the quality of EOL care provided in Nephrology, and to determine potential areas of improvement. Method Retrospective single-centre analysis of all nephrology and kidney transplant inpatients dying between January 2019 and June 2020. Clinical records were reviewed for evidence of recognition of end of life, resuscitation plans, acute interventions in the 48 hours previous to death, comfort care plans and symptoms evaluation. Results A total of 83 patients were included. 19.6% of patients had chronic kidney disease, 60.2% were in haemodialysis, 14.5% were kidney transplanted patients and 3.6% had acute kidney injury. 89.2% of the admissions were for acute events, 5% for symptom control and 4.8% for diagnosis. In 72.3% of admissions, EOL was recognised. Most patients were unable to discuss EOL plans (67.5%), and the family was informed of the prognosis in only 61.4% of the cases. At the time of dead: only 62.7% of patients had a clear resuscitation plan, 44.6% were on antibiotics and 26.5% died with nasogastric tube. Within 48h of death: invasive interventions were still being given in 42.2%, blood samples were taken in 69.9%; imaging was performed in 36.1% and 48.2% had a haemodialysis session. Comfort measure were provided to 53% and only 60.2% had evidence of symptom evaluation. 44.6% stopped invasive measures in the last 48h. Recognition of EOL was associated with having a clear resuscitation plan (p<0.001), comfort measures (p<0.001), evidence of symptom evaluation (p=0.004), stopping invasive measures (p<0.001), having less imaging (p=0.270) and discussing prognosis with the family (p<0.001). Despite recognition of EOL, there was no difference in dying with nasogastric tube (p=0.404) or dying on antibiotics (p=0.134). In a multivariable analysis (binary logistic regression), EOL recognition was associated with a clear resuscitation plan (Exp(B) 0.088, (CI 95%: 0.018-0.419) p=0.002), with discussion of prognosis with family ( Exp(B) 0.061 (CI 95%: 0.011-0.337) p=0.001), and with reduced body mass index (Exp(B) 0.870, (CI 95%: 0.763-0.991), p=0.037,); in a model adjusted to the age. Conclusion In our cohort, patient for whom EOL was recognized had better EOL care. In conclusion, there are still areas in which EOL care can be improved. Palliative care should be an investment area for training within the Nephrology core curriculum and awareness for EOL care is needed.

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