Palliative Care Needs of Seriously Ill, Older Adults Presenting to the Emergency Department

Grudzen, Corita; Richardson, Lynne D.; Morrison, Matthew; Cho, Elizabeth; Morrison, R. Sean

doi:10.1111/j.1553-2712.2010.00907.x

Cited by 121 publications

(105 citation statements)

References 18 publications

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“…(3,20,21) Patients with chronic illness trajectories of dying often have complex needs at the end of their lives. (2) This necessitates the application of EOL care principles adapted to emergency medicine practice, such as rapid goals-of-care discussions, ethical medical decision-making, terminal symptom management, a focus on culturally sensitive comfort care and a private space for dignified dying. (18,22) Therefore, EOL care as part of a palliative approach would be more appropriate for these patients than the aggressive resuscitative approach that most ED physicians are accustomed to.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…However, this may not be appropriate when managing seriously ill patients with advanced chronic illness trajectories of dying and poor prognosis. (2,3) End-of-life (EOL) care, as part of a palliative approach, may be more suitable in this patient population.(4) Good EOL care acknowledges the multidimensional aspects of dying by providing for the patient's physical, psychological, social and spiritual needs. It focuses on comfort care and holistically addresses the needs of dying patients and their family members.…”

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confidence: 99%

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Death among elderly patients in the emergency department: a needs assessment for end-of-life care

Kuan

et al. 2017

smedj

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INTRODUCTIONDeath is not a rare entity in the emergency department (ED).(1) However, management of death and dying is rarely considered a core aspect of emergency medicine expertise. By nature of their training, most emergency providers are accustomed to dealing with acute and severe illnesses in the ED with a maximally aggressive resuscitation approach. However, this may not be appropriate when managing seriously ill patients with advanced chronic illness trajectories of dying and poor prognosis. (2,3) End-of-life (EOL) care, as part of a palliative approach, may be more suitable in this patient population.(4) Good EOL care acknowledges the multidimensional aspects of dying by providing for the patient's physical, psychological, social and spiritual needs. It focuses on comfort care and holistically addresses the needs of dying patients and their family members.(5) This ensures that these patients receive a good death, one that is in accordance with their wishes and is in keeping with clinical, cultural and ethical standards. Elderly patients with serious chronic diseases often present to the ED in the last moments of their life, many with identifiable trajectories of dying.(7) Three distinct chronic illness trajectories of dying are commonly described: advanced cancer, organ failure and chronic frailty. In patients with advanced cancer, the decline is fairly predictable, with an initial high functional state followed by a sharp deterioration as they enter the terminal phase of their life. In contrast, the trajectory of patients with organ failure is marked by acute exacerbations of illness requiring intensive treatment, with an overall progressive decline in function. Patients with chronic frailty and degenerative neurological diseases often have a low baseline level of function and a protracted course of decline over years. A fourth classical trajectory of dying is that of sudden death in a healthy patient, or one with stable or early chronic illness (Fig. 1).(8) Analysis of trajectories of dying allows for better understanding of a patient's dying process, aids in prognostication and guides EOL decision-making by the physician, as well as the patient and family. (9) Older patients (aged ≥ 65 years) represent the fastest-growing cohort in the Singapore population.(10) As the population ages and the prevalence of chronic diseases increases, the need for good EOL care is becoming increasingly important.(11) To the best of our knowledge, no studies have been done to characterise the nature of death among this group of patients presenting to the ED, particularly in the Asian population setting. Understanding this burden of care will allow us to identify priorities for improving EOL care in the ED. Hence, this study aimed to determine the incidence and nature of death, as well as the trajectories of dying among patients aged 65 years and above in the ED. Secondarily, it aimed to determine the number of early deaths that occurred in the ward after admission from the ED.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Death among elderly patients in the emergency department: a needs assessment for end-of-life care

Kuan

et al. 2017

smedj

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“…18 Knowledge and skills development for adequate pain management should be a priority for health professionals. Also, public health managers should be sensitized to this possibility in order to provide the units with standard resources for effective control of pain in 95% of cancer patients, 19,[20][21][22] and thus promote patient welliness. 7,12 There are several hypotheses for the inadequate control of pain: from difficulty of the medical staff to properly measure the complaint, to the arrogance-ignorance paradox in the medical profession; 22 in addition, there is also insufficient medical knowledge about opioids and pain treatment, and lack of pain medication or difficulty to obtain opioids, combined with the legal difficulties to prescribe such drugs.…”

Section: Discussionmentioning

confidence: 99%

Cancer patients, emergencies service and provision of palliative care

Miranda

Vidal

Mello

et al. 2016

Rev. Assoc. Med. Bras.

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Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011) with a minimum length of hospital stay of two hours. Student's t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%). 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%), breast (13.6%) and prostate (10.5%); 70.7% were in advanced stages (IV, 47.1%); 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals.

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“…111 By determining patient and caregiver goals of care through skilled communication, treating distressing symptoms while coordinating care, providing practical support for patients and caregivers, and mobilizing community support and resources to ensure a secure and safe living environment, palliative care teams help meet patient and caregiver needs so that they can avoid unwanted and expensive crisis care. [112][113][114] Many large US hospitals now have palliative care services, but availability across settings is highly variable by region and by state. Only a small fraction of the patients and families who could benefit receive it.…”

Section: May 8 2018mentioning

confidence: 99%

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

Dunbar¹,

Khavjou²,

Bakas³

et al. 2018

Circulation

202

102

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INTRODUCTION:In a recent report, the American Heart Association estimated that medical costs and productivity losses of cardiovascular disease (CVD) are expected to grow from $555 billion in 2015 to $1.1 trillion in 2035. Although the burden is significant, the estimate does not include the costs of family, informal, or unpaid caregiving provided to patients with CVD. In this analysis, we estimated projections of costs of informal caregiving attributable to CVD for 2015 to 2035. METHODS:We used data from the 2014 Health and Retirement Survey to estimate hours of informal caregiving for individuals with CVD by age/sex/race using a zero-inflated binomial model and controlling for sociodemographic factors and health conditions. Costs of informal caregiving were estimated separately for hypertension, coronary heart disease, heart failure, stroke, and other heart disease. We analyzed data from a nationally representative sample of 16 731 noninstitutionalized adults ≥54 years of age. The value of caregiving hours was monetized by the use of home health aide workers' wages. The per-person costs were multiplied by census population counts to estimate nation-level costs and to be consistent with other American Heart Association analyses of burden of CVD, and the costs were projected from 2015 through 2035, assuming that within each age/sex/racial group, CVD prevalence and caregiving hours remain constant. RESULTS:The costs of informal caregiving for patients with CVD were estimated to be $61 billion in 2015 and are projected to increase to $128 billion in 2035. Costs of informal caregiving of patients with stroke constitute more than half of the total costs of CVD informal caregiving ($31 billion in 2015 and $66 billion in 2035). By age, costs are the highest among those 65 to 79 years of age in 2015 but are expected to be surpassed by costs among those ≥80 years of age by 2035. Costs of informal caregiving for patients with CVD represent an additional 11% of medical and productivity costs attributable to CVD. CONCLUSIONS:The burden of informal caregiving for patients with CVD is significant; accounting for these costs increases total CVD costs to $616 billion in 2015 and $1.2 trillion in 2035. These estimates have important research and policy implications, and they may be used to guide policy development to reduce the burden of CVD on patients and their caregivers.

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Palliative Care Needs of Seriously Ill, Older Adults Presenting to the Emergency Department

Cited by 121 publications

References 18 publications

Death among elderly patients in the emergency department: a needs assessment for end-of-life care

Death among elderly patients in the emergency department: a needs assessment for end-of-life care

Cancer patients, emergencies service and provision of palliative care

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

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