Frailty, Complexity, and Priorities in the Use of Advanced Palliative Care Resources in Nursing Homes

Background and objectives: This study aimed to determine the frailty, prognosis, complexity, and palliative care complexity of nursing home residents with palliative care needs and define the characteristics of the cases eligible for receiving advanced palliative care according to the resources available at each nursing home. Materials and Methods: In this multi-centre, descriptive, and cross-sectional study, trained nurses from eight nursing homes in southern Spain selected 149 residents with palliative care needs. The following instruments were used: the Frail-VIG index, the case complexity index (CCI), the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal), the palliative prognosis index, the Barthel index (dependency), Pfeiffer’s test (cognitive impairment), and the Charlson comorbidity index. A consensus was reached on the complexity criteria of the Diagnostic Instrument of Complexity in Palliative Care that could be addressed in the nursing home (no priority) and those that required a one-off (priority 2) or full (priority 1) intervention of advanced palliative care resources. Non-parametric tests were used to compare non-priority patients and patients with some kind of priority. Results: A high percentage of residents presented frailty (80.6%), clinical complexity (80.5%), and palliative care complexity (65.8%). A lower percentage of residents had a poor prognosis (10.1%) and an extremely poor prognosis (2%). Twelve priority 1 and 14 priority 2 elements were identified as not matching the palliative care complexity elements that had been previously identified. Of the studied cases, 20.1% had priority 1 status and 38.3% had priority 2 status. Residents with some kind of priority had greater levels of dependency (p < 0.001), cognitive impairment (p < 0.001), and poorer prognoses (p < 0.001). Priority 1 patients exhibited higher rates of refractory delirium (p = 0.003), skin ulcers (p = 0.041), and dyspnoea (p = 0.020). Conclusions: The results indicate that there are high levels of frailty, clinical complexity, and palliative care complexity in nursing homes. The resources available at each nursing home must be considered to determine when advanced palliative care resources are required.

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Nurse-physician Communication around Identifying Palliative Care Needs in Nursing Home Residents

10.1101/2021.08.26.21262659 ◽

2021 ◽

Author(s):

Jenny T. van der Steen ◽

Esmée Jongen ◽

Natashe Lemos Dekker ◽

Lotje Bagchus ◽

H. Roeline W. Pasman ◽

...

Keyword(s):

Palliative Care ◽

Nursing Home ◽

Nursing Homes ◽

The Netherlands ◽

Nurse Practitioners ◽

Nursing Staff ◽

Nursing Home Residents ◽

Care Needs ◽

Qualitative Interview Study ◽

Palliative Care Needs

Objective: To assess experiences of medical practitioners who are on the staff of nursing homes with communication with nursing staff about identifying emerging and changing (palliative) care needs of residents of nursing homes in the Netherlands. Design: Qualitative interview study. Setting and Participants: Fifteen physicians and two nurse practitioners employed by eight care organizations in the western urbanized region of the Netherlands. Methods: We conducted individual semi-structured interviews in 2018 informed by a topic list that was based on a qualitative dataset about facilitators to palliative care in dementia reported by elderly care physicians. The interviews were recorded, transcribed verbatim and analysed with Atlas.ti. We used both deductive and inductive coding adding refined codes related to communication. Results: All interviewees expressed appreciation for nursing staff on whom they relied to communicate palliative care needs, yet they reported a variety of communication challenges around important changes in the condition of the residents which were covered by two themes. (1) Teamwork was facilitated or impeded by team size and structure, quality of relationships and clarity in hierarchical relationships. (2) Continuity of information was affected by (in)effective routes of consultation and (lack of) detail in communicating observations. Conclusions and Implications: Also in the case of on-staff physicians, functioning of the multidisciplinary team and accurate sharing of observed changes in the condition of nursing home residents are crucial for physicians to be able to address palliative care needs. The expressions of the physicians of how they would favor nursing staff to communicate can inspire interprofessional training, such as reporting objective observations and phrasing a clear request for help while avoiding overly demanding appeals.

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A New Approach to the Identification of Palliative Care Needs and Advanced Chronic Patients among Nursing Home Residents

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063171 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3171

Author(s):

Ana A. Esteban-Burgos ◽

María José Lozano-Terrón ◽

Daniel Puente-Fernandez ◽

César Hueso-Montoro ◽

Rafael Montoya-Juárez ◽

...

Keyword(s):

Palliative Care ◽

Nursing Homes ◽

Statistical Significance ◽

Nursing Home Residents ◽

Cross Sectional Study ◽

Care Needs ◽

Chronic Patients ◽

Cross Sectional ◽

Surprise Question ◽

Palliative Care Needs

Background: Proper planning of Palliative Care in nursing homes requires advanced knowledge of the care needs that residents show. The aim of the study was to evaluate Palliative Needs and other conditions such as fragility, complexity, and prognosis and also to suggest new indicators for the establishment of the resident’s advanced chronic condition. Methods: Cross-sectional study conducted in 149 nursing homes Complex Chronic residents evaluated by trained professionals. Palliative Care Needs, assessed by the NECPAL ICO-CCOMS© tool, and fragility, case and palliative complexity and prognosis were evaluate through a comprehensive assessment. Descriptive analyses and association measures were performed setting the statistical significance at 0.05. Results: More than 50% of the residents had positive Surprise Question and other Palliative Needs and were classified as Advanced Chronic Patients. Distress and/or Severe Adaptative Disorder was the most frequent need shown by the residents and significant differences in levels of frailty and other characteristics, were found between the Positive and the Negative Surprise Question Groups. Statistically significant correlations were also found between aspects of both groups. Conclusions: Nursing homes residents show Palliative Needs regardless of the response to the Surprise Question of the NECPAL tool. Other characteristics such as presence of an intermediate level of frailty are suggested as a new perspective to identify advanced chronic patients among nursing homes residents.

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Nursing Home Providers' Perception of Palliative Care Needs of Residents with Advanced Dementia

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2010.12.059 ◽

2011 ◽

Vol 12 (3) ◽

pp. B17-B18

Author(s):

Amy M. Corcoran ◽

Karen Hirschman ◽

Sarah Lena Panzer ◽

David Casarett

Keyword(s):

Palliative Care ◽

Nursing Home ◽

Advanced Dementia ◽

Care Needs ◽

Palliative Care Needs

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Palliative care in the nursing home

10.1093/med/9780199656097.003.0014 ◽

2015 ◽

Author(s):

Jane L. Phillips ◽

Annmarie Hosie ◽

Patricia M. Davidson

Keyword(s):

Palliative Care ◽

Nursing Homes ◽

Older People ◽

Care Needs ◽

Allied Health Professionals ◽

Family Structures ◽

Technological Advances ◽

Challenges And Opportunities ◽

Care Outcomes ◽

Palliative Care Needs

Internationally, ageing, technological advances, evolving patterns of disease and disability, and changes in family structures have resulted in nursing homes becoming the final residence for many frailer older people. Much of the on-site assistance with activities of daily living in nursing homes is predominately provided by an unregulated or minimally trained carer workforce with registered nurse supervision, while professional nursing and medical care is provided either by on-site or visiting doctors, nurses, and allied health professionals from external services. This chapter details the palliative care needs of older people living in nursing homes and the challenges and opportunities to deliver better end-of-life care to this population, and proposes utilizing the Chronic Care Model as a framework for delivering the elements of a palliative approach to improve care outcomes for residents and their families.

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Palliative care needs of chronically ill nursing home residents in Germany: focusing on living, not dying

International Journal of Palliative Nursing ◽

10.12968/ijpn.2011.17.1.27 ◽

2011 ◽

Vol 17 (1) ◽

pp. 27-34 ◽

Cited By ~ 18

Author(s):

Barbara Strohbuecker ◽

Yvonne Eisenmann ◽

Maren Galushko ◽

Thomas Montag ◽

Raymond Voltz

Keyword(s):

Palliative Care ◽

Nursing Home ◽

Nursing Home Residents ◽

Chronically Ill ◽

Care Needs ◽

Palliative Care Needs

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Nurse-Physician Communication Around Identifying Palliative Care Needs in Nursing Home Residents

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2021.09.034 ◽

2021 ◽

Author(s):

Jenny T. van der Steen ◽

Esmée A. Jongen ◽

Natashe Lemos Dekker ◽

Lotje Bagchus ◽

H. Roeline W. Pasman ◽

...

Keyword(s):

Palliative Care ◽

Nursing Home ◽

Nursing Home Residents ◽

Physician Communication ◽

Care Needs ◽

Palliative Care Needs

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

Palliative & Supportive Care ◽

10.1017/s1478951520000395 ◽

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.

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