End-of-Life Care in Nursing Homes with Greater versus Less Palliative Care Knowledge and Practice

Miller, Susan C.; Lima, Julie C.; Thompson, Sarah

doi:10.1089/jpm.2014.0393

Cited by 37 publications

(26 citation statements)

References 27 publications

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“…Table 4 Discussion This study presents data on a large cohort of NH residents with advanced dementia who died in a NH located in a large region of northern Italy. In contrast to previous studies, in which one-third of NH residents were hospitalized in the last month of life and the rate of death in hospital was almost 66%, [21][22] the vast majority of our residents died in the NHs: only 4.7% of them were admitted to hospital or sent to the emergency department. This low figure may be considered positive, as hospitalization can be aggressive and of limited clinical benefit for people with advanced dementia.…”

Section: Days Before Deathcontrasting

confidence: 97%

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

Toscani¹,

Finetti²,

Giunco

et al. 2019

Preprint

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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.

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Section: Days Before Deathcontrasting

confidence: 97%

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

Toscani¹,

Finetti²,

Giunco

et al. 2019

Preprint

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“…This in line with the results of previous work which report a reduction in hospital admissions following interventions delivering educational sessions to care home staff on EoLC (Roberts,12 2015) or facilitating geriatrician input into nursing homes (Lisk et al, 2012). Palliative care knowledge and practice within nursing homes is associated with a reduction in futile interventions/acute care use (Miller et al, 2015); targeting EoLC training and education to the needs of care home staff may reduce inappropriate admissions to hospital at the EoL. Such a reduction is important for many reasons: One of the challenges encountered during this study related to the ability to engage continually with care homes during times of leadership change.…”

supporting

confidence: 87%

Developing, implementing and evaluating an end of life care intervention

Cox

Arber

Bailey

et al. 2017

Nursing Older People

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To develop, implement and evaluate a collaborative intervention in care homes seeking to increase the confidence and competence of staff in end of life care and enable more people to receive end of life care in their usual place of residence.\ud Aim To develop, implement and evaluate a collaborative intervention in care homes seeking to increase the confidence and competence of staff in end of life care and enable more people to receive end of life care in their usual place of residence.\ud \ud Method A two-phase exploratory mixed methods design was used, evaluating the effect of an end of life care toolkit and associated training in care homes, facilitated by a specialist palliative care team. Six care homes in England were recruited to the intervention; 24 staff participated in discussion groups; 54 staff attended at least one training session; and pre- and post-intervention questionnaires were completed by 78 and 103 staff respectively.\ud \ud Results Staff confidence in receiving emotional and clinical support and managing end of life care symptoms increased post-intervention, but confidence in discussing death and dying with residents and relatives decreased. Audit data indicate greater reduction in the number of residents from participating care homes dying in hospital than those from comparison homes.\ud \ud Conclusion Collaborative end of life care interventions support care home staff to manage end of life and may enable residents to have choice about their place of death

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“…Prior literature suggests that DONs are best suited to provide accurate appraisal of their NHs EOL care processes; their assessments are congruent with those of the facility-based MDs, and they align well with other highly correlated metrics obtained from separate sources. 18,[37][38][39] Second, the survey response rate was modest and the participating NHs were somewhat different, compared with the national random sample of facilities. However, because the purpose of this study was to explore whether a relationship exists between communication and the two outcomes of interest, not to describe patterns of communication in U.S. NHs, the low response rate is not a significant limitation for this study.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Care in Nursing Homes: From Care Processes to Quality

Temkin-GreenerHelena

LiQinghua

LiYue

et al. 2016

Journal of Palliative Medicine

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Background/Objective: Nursing homes (NHs) are an important setting for the provision of palliative and endof-life (EOL) care. Excessive reliance on hospitalizations at EOL and infrequent enrollment in hospice are key quality concerns in this setting. We examined the association between communication-among NH providers and between providers and residents/family members-and two EOL quality measures (QMs): in-hospital deaths and hospice use. Design and Methods: We developed two measures of communication by using a survey tool implemented in a random sample of U.S. NHs in 2011-12. Using secondary data (Minimum Data Set, Medicare, and hospice claims), we developed two risk-adjusted quality metrics for in-hospital death and hospice use. In the 1201 NHs, which completed the survey, we identified 54,526 residents, age 65+, who died in 2011. Psychometric assessment of the two communication measures included principal factor and internal consistency reliability analyses. Random-effect logistic and weighted least-square regression models were estimated to develop facility-level risk-adjusted QMs, and to assess the effect of communication measures on the quality metrics. Results: Better communication with residents/family members was statistically significantly ( p = 0.015) associated with fewer in-hospital deaths. However, better communication among providers was significantly ( p = 0.006) associated with lower use of hospice. Conclusions: Investing in NHs to improve communication between providers and residents/family may lead to fewer in-hospital deaths. Improved communication between providers appears to reduce, rather than increase, NH-to-hospice referrals. The actual impact of improved provider communication on residents' EOL care quality needs to be better understood.

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End-of-Life Care in Nursing Homes with Greater versus Less Palliative Care Knowledge and Practice

Cited by 37 publications

References 27 publications

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

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

Developing, implementing and evaluating an end of life care intervention

End-of-Life Care in Nursing Homes: From Care Processes to Quality

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