Palliative care symptoms, concerns and well-being of older people with frailty and complex care needs upon hospital discharge: a cross-sectional study

Abstract

Background Little is known about the nature and intensity of palliative care needs of hospitalised older people. We aimed to describe the palliative care symptoms, concerns, and well-being of older people with frailty and complex care needs upon discharge from hospital to home, and to examine the relationship between palliative care symptoms and concerns, and well-being. Methods Cross-sectional study using baseline survey data of a pilot randomised controlled trial. Hospital staff identified patients (≥ 70 years) about to be discharged home, with a clinical frailty score of 5 to 7 and complex needs based on physician-assessment. Patients completed structured interviews, using the Integrated Palliative Care Outcome Scale (IPOS), ICEpop CAPability measure for supportive care (ICECAP-SCM) and IPOS Views on Care quality of life item. We calculated descriptive statistics. Results We assessed 37 older people with complex needs (49% women, mean age 84, standard deviation 6.1). Symptoms rated as causing severe problems were weakness (46%) and poor mobility (40%); 75% reported that their family felt anxious at least occasionally. Of the 17 IPOS items, 41% of patients rated five or more symptoms as causing severe problems, while 14% reported that they were not severely affected by any symptom. 87% expressed feeling supported. There was a negative correlation between symptoms (IPOS) and well-being (ICECAP); r = -0.41. Conclusion We identified a large variety of symptoms experienced by older people identified as having frailty and complex needs upon hospital discharge. Many were severely affected by multiple needs. This population should be considered for palliative care follow-up at home.

Understanding the extent to which PROMs and PREMs used with older people with severe frailty capture their multidimensional needs: A scoping review

“…Studies identified were conducted in eight high-income countries and one upper middle-income country. These included the Netherlands, 21 , 24 , 26 , 27 , 30 , 31 USA, 23 , 28 , 33 UK, 25 , 32 Australia, 34 Belgium, 29 Canada, 22 Spain, 36 Sweden 35 and Brazil. 37 …”

“…Study settings were described as community care, 21 , 25 – 27 , 37 integrated care, 28 , 31 long term care, 34 – 36 acute care, 23 , 24 , 29 mixed community and acute settings 22 , 33 specialist palliative community care 32 and population level study. 30 …”

“…Studies identified were conducted in eight high-income countries and one upper middle-income country. These included the Netherlands, 21,24,26,27,30,31 USA, 23,28,33 UK, 25,32 Australia, 34 Belgium, 29 Canada, 22 Spain, 36 Sweden 35 and Brazil. 37 Study settings were described as community care, 21,25-27,37 integrated care, 28,31 long term care, [34][35][36] acute care, 23,24,29 mixed community and acute settings 22,33 specialist palliative community care 32 and population level study.…”

A non-randomised controlled study to assess the effectiveness of a new proactive multidisciplinary care intervention for older people living with frailty

“…The primary outcome was wellbeing at 2-4 weeks (T1), measured using the Integrated Palliative care Outcome Scale (IPOS) [ 10 ]. IPOS is a valid and reliable self-reported measure used to assess symptoms and other concerns (overall wellbeing) among those with advanced illness [ 10 ] and at risk of frailty [ 11 , 12 ]. It can be reported as a total score (17 items: scoring 0-68; higher scores indicating worse wellbeing), or subscales: physical subscale (10 items: scoring 0-40); psychological (4 items: scoring 0-16); communication/practical subscale (3 items: scoring 0-12) [ 10 ] .…”

Correction: Palliative care symptoms, concerns and well-being of older people with frailty and complex care needs upon hospital discharge: a cross-sectional study

“…Following the publication of the original article [ 1 ], the author reported that Figs. 1 and 2 were not complete as submitted.…”