scholarly journals Characteristics of Older Adults Accessing Medical Assistance in Dying (MAiD): a Descriptive Study

2021 ◽  
Vol 24 (4) ◽  
pp. 312-318
Author(s):  
Debbie Selby ◽  
Brandon Chan ◽  
Amy Nolen
Keyword(s):  
Older Adults ◽  
Living Arrangements ◽  
Tertiary Care ◽  
Functional Decline ◽  
Significant Proportion ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Loss Of Autonomy ◽  
Subsequent Loss ◽  
Socially Isolated

Background  Medical Assistance in Dying (MAiD) is an end-of-life option for Canadians accounting for 2% of all deaths in Canada in 2019. Adults over 80 years old represent a significant proportion of these deaths, yet little is known about how they compare with their younger counterparts.  Methods  This study retrospectively reviewed our tertiary care institution’s MAiD database to compare MAiD recipients <65, 65–80, and >80 years of age. Extracted data included basic demographics, illness characteristics, functional status, social living arrangements/contacts, and outcomes of MAiD assessments.  Results  Of 267 patients assessed for MAiD, 38.2% were over 80. Compared to the younger groups, those over 80 were more likely to be female, to live alone, and to be widowed; however, they did not self-identify as ‘socially isolated’. The majority fit into the illness categories of malignancy, cardiopulmonary or neurologic diseases, but those over 80 were more likely to have other more chronic/subacute conditions leading to the MAiD request.  Conclusions  Older adults accessing MAiD are distinct in that they tend to be increasingly frail and without a predominant underlying diagnosis as compared with younger adults, but rather have an accumulation of losses resulting in global functional decline and subsequent loss of autonomy and independence. 

scholarly journals Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review

2021 ◽  
pp. 104990912110304
Author(s):  
Amy Nolen ◽  
Rawaa Olwi ◽  
Selby Debbie
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Care Hospital ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Before And After

Background: Patients approaching end of life may experience intractable symptoms managed with palliative sedation. The legalization of Medical Assistance in Dying (MAiD) in Canada in 2016 offers a new option for relief of intolerable suffering, and there is limited evidence examining how the use of palliative sedation has evolved with the introduction of MAiD. Objectives: To compare rates of palliative sedation at a tertiary care hospital before and after the legalization of MAiD. Methods: This study is a retrospective chart analysis of all deaths of patients followed by the palliative care consult team in acute care, or admitted to the palliative care unit. We compared the use of palliative sedation during 1-year periods before and after the legalization of MAiD, and screened charts for MAiD requests during the second time period. Results: 4.7% (n = 25) of patients who died in the palliative care unit pre-legalization of MAiD received palliative sedation compared to 14.6% (n = 82) post-MAiD, with no change in acute care. Post-MAiD, 4.1% of deaths were medically-assisted deaths in the palliative care unit (n = 23) and acute care (n = 14). For patients who requested MAiD but instead received palliative sedation, the primary reason was loss of decisional capacity to consent for MAiD. Conclusion: We believe that the mainstream presence of MAiD has resulted in an increased recognition of MAiD and palliative sedation as distinct entities, and rates of palliative sedation increased post-MAiD due to greater awareness about patient choice and increased comfort with end-of-life options.

scholarly journals 40-Year Projections of Disability and Social Isolation of Older Adults for Long-Range Policy Planning in Singapore

2020 ◽  
Vol 17 (14) ◽  
pp. 4950 ◽  
Author(s):  
Reuben Ng ◽  
Si Qi Lim ◽  
Su Ying Saw ◽  
Kelvin Bryan Tan
Keyword(s):  
Older Adults ◽  
Social Isolation ◽  
Long Range ◽  
Living Arrangements ◽  
Living Alone ◽  
Population Projections ◽  
Policy Planning ◽  
Housing Type ◽  
Term Care ◽  
Socially Isolated

Against a rapidly aging population, projections are done to size up the demand for long-term care (LTC) services for long-range policy planning. These projections are typically focused on functional factors such as disability. Recent studies indicate the importance of social factors, for example, socially isolated seniors living alone are more likely to be institutionalized, resulting in higher demand for LTC services. This is one the first known studies to complete a 40-year projection of LTC demand based on disability and social isolation. The primary micro dataset was the Retirement and Health Survey, Singapore’s first nationally representative longitudinal study of noninstitutionalized older adults aged 45 to 85 with over 15,000 respondents. Disability prevalence across the mild to severe spectrum is projected to increase five-fold over the next 40 years, and the number of socially isolated elders living alone is projected to grow four-fold. Regression models of living arrangements revealed interesting ethnic differences: Malay elders are 2.6 times less likely to live alone than their Chinese counterparts, controlling for marital status, age, and housing type. These projections provide a glimpse of the growing demand for LTC services for a rapidly aging Singapore and underscore the need to shore up community-based resources to enable seniors to age-in-place.

Medical Assistance in Dying (MAiD): A Descriptive Study From a Canadian Tertiary Care Hospital

2019 ◽  
Vol 37 (1) ◽  
pp. 58-64 ◽  
Author(s):  
Debbie Selby ◽  
Sally Bean ◽  
Elie Isenberg-Grzeda ◽  
Blair Henry D. Bioethics ◽  
Amy Nolen
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
High Rate ◽  
Care Hospital ◽  
Limited Information ◽  
Medical Assistance ◽  
Assisted Death ◽  
Medical Assistance In Dying ◽  
The Government ◽  
Government Of Canada

Background: In June 2016, the Government of Canada passed Bill C-14 decriminalizing medically assisted death. Increasing numbers of Canadians are accessing medical assistance in dying (MAiD) each year, but there is limited information about this population. Objective: To describe the characteristic outcomes of MAiD requests in a cohort of patients at an academic tertiary care center in Toronto, Ontario, Canada. Methods: A retrospective chart review of patients making a formal request for a MAiD eligibility assessment from July 16 to September 18. Data extracted included demographics, diagnosis, psychosocial characteristics, information relating to the MAiD request, and clinical outcome. Results: We received 107 formal requests for MAiD assessment. Ninety-seven patients were found eligible, of whom 80 received MAiD. Cancer was the primary diagnosis for 78% and median age was 74 years. The majority of patients (64%) cited “functional decline or inability to participate in meaningful activities” as the main factor motivating their request for MAiD. Half of patients who received MAiD (46%) described their request as consistent with a long-standing, philosophical view predating their illness. The 10-day reflection period was reduced for 39% of provisions due to impending loss of capacity. Our cohort was very similar demographically to those described both nationally and internationally. Conclusion: Patients seeking MAiD at our institution were similar to those described in other jurisdictions where assisted dying is legal and represent a group for whom autonomy and independence is critical. We noted a very high rate of risk of loss of capacity, suggesting a need for both earlier assessments and regular monitoring.

scholarly journals The Epidemiology of Social Isolation: National Health and Aging Trends Study

2018 ◽  
Vol 75 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Thomas K M Cudjoe ◽  
David L Roth ◽  
Sarah L Szanton ◽  
Jennifer L Wolff ◽  
Cynthia M Boyd ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Isolation ◽  
National Health ◽  
Low Income ◽  
Living Arrangement ◽  
Significant Proportion ◽  
Community Dwelling ◽  
Religious Attendance ◽  
Socially Isolated ◽  
Community Dwelling Older Adults

Abstract Objectives Social isolation among older adults is an important but under-recognized risk for poor health outcomes. Methods are needed to identify subgroups of older adults at risk for social isolation. Methods We constructed a typology of social isolation using data from the National Health and Aging Trends Study (NHATS) and estimated the prevalence and correlates of social isolation among community-dwelling older adults. The typology was formed from four domains: living arrangement, core discussion network size, religious attendance, and social participation. Results In 2011, 24% of self-responding, community-dwelling older adults (65+ years), approximately 7.7 million people, were characterized as socially isolated, including 1.3 million (4%) who were characterized as severely socially isolated. Multinomial multivariable logistic regression indicated that being unmarried, male, having low education, and low income were all independently associated with social isolation. Black and Hispanic older adults had lower odds of social isolation compared with white older adults, after adjusting for covariates. Discussion Social isolation is an important and potentially modifiable risk that affects a significant proportion of the older adult population.

Addressing COVID-19 Worry and Social Isolation in Home-Based Primary Care

2020 ◽  
Author(s):  
Rachel Elizabeth Weiskittle ◽  
Michelle Mlinac ◽  
LICSW Nicole Downing
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Social Workers ◽  
Social Isolation ◽  
Mental Health Providers ◽  
Health Providers ◽  
Home Based Primary Care ◽  
Home Based ◽  
Socially Isolated

Social distancing measures following the outbreak of COVID-19 have led to a rapid shift to virtual and telephone care. Social workers and mental health providers in VA home-based primary care (HBPC) teams face challenges providing psychosocial support to their homebound, medically complex, socially isolated patient population who are high risk for poor health outcomes related to COVID-19. We developed and disseminated an 8-week telephone or virtual group intervention for front-line HBPC social workers and mental health providers to use with socially isolated, medically complex older adults. The intervention draws on skills from evidence-based psychotherapies for older adults including Acceptance and Commitment Therapy, Cognitive-Behavioral Therapy, and Problem-Solving Therapy. The manual was disseminated to VA HBPC clinicians and geriatrics providers across the United States in March 2020 for expeditious implementation. Eighteen HBPC teams and three VA Primary Care teams reported immediate delivery of a local virtual or telephone group using the manual. In this paper we describe the manual’s development and clinical recommendations for its application across geriatric care settings. Future evaluation will identify ways to meet longer-term social isolation and evolving mental health needs for this patient population as the pandemic continues.

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