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

Abstract

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.

Inadequate human resources, equipment and training: A qualitative assessment of the objectives of the NUHELP end-of-life care programme in the context of the COVID-19 pandemic

“…25 The capacity to handle complex cases at the nursing homes depended on the human, material and training resources available at the facilities and on the degree of coordination with public services, including primary care facilities in particular. As Mota-Romero et al 26 highlight, nursing home professionals should identify complex cases that are especially difficult to handle and be aware of the external resources available to them so that they can refer these patients where necessary.…”

Reliability of Frail and Barthel Tests for Detecting Frailty in Palliative Oncological Patients in a Home Hospitalization Unit: A Comparative Study

“…The internal consistency of the Frail VIG Scale and the Barthel Scale was measured using Cronbach's α coefficient. The criterion of Cronbach's alpha > 0.70 and the Intraclass Correlation Coefficients (ICC) > 0.70 were used to assess the internal reliability and test-retest reliability, respectively [32]. The value of ICC was calculated again after a 1 week interval.…”

Patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting in Norway

“…

By 2050, the world's population of people aged 60 years and older will double (2.1 billion), and older people often have multimorbidity and complex healthcare needs (World Health Organisation, 2022). In many countries, healthcare service delivery models have shifted toward minimally institutional or non-institution-based care services (Ashley et al, 2017).Institution-based care has been reduced (Mota-Romero, Tallón-Martín, et al, 2021) in favour of, for example, home-based care

…”

“…Institution-based care has been reduced (Mota-Romero, Tallón-Martín, et al, 2021) in favour of, for example, home-based care…”

“…Coordinated, patient-centred healthcare services require organizational competence (Hellesø et al, 2016), and nursing home residents need care that is advanced (Mota-Romero, Tallón-Martín, et al, 2021). Patient-centred care should form the basis for all care decisions and quality measurements (NEJM Catalyst, 2017).…”