Predictors of Physical Restraint Use in Hospitalized Veterans at End of Life: An Analysis of Data from the BEACON Trial

Kvale, Elizabeth; Dionne‐Odom, J. Nicholas; Redden, David T.; Bailey, F. Amos; Bakitas, Marie; Goode, Patricia S.; Williams, Beverly Rosa; Haddock, Kathlyn Sue; Burgio, Kathryn L.

doi:10.1089/jpm.2014.0354

Cited by 10 publications

(11 citation statements)

References 42 publications

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“… 7 , 12 This work extends other findings by reporting on physical restraint use, which is increasingly recognized as a burdensome intervention at the end of life. 35 In addition, although 2 previous small cohort studies reported high rates of antibiotic prescription among nursing home residents with advanced dementia at the end of life, the present study confirms these rates in a large population-based cohort. 18 , 44 …”

Section: Discussionsupporting

confidence: 82%

Sex-Specific Differences in End-of-Life Burdensome Interventions and Antibiotic Therapy in Nursing Home Residents With Advanced Dementia

et al. 2019

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Key Points Question What are the population-based frequency, factors, and sex-specific differences in burdensome interventions and antibiotic therapy at the very end of life among nursing home residents with advanced dementia? Findings In this population-based cohort study of 27 243 decedent nursing home residents with advanced dementia, men were statistically significantly more likely than women to experience burdensome interventions (ie, transitions of care, invasive procedures, and physical restraints) and receive antibiotics; only a minority of residents saw a palliative care physician in the year before death, but those who did were significantly less likely to experience an end-of-life transition of care and to receive antibiotics. Meaning Study findings underscore the importance of sex-specific analysis in dementia research and the expanding roles of palliative care and antimicrobial stewardship in the nursing home setting.

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Section: Discussionsupporting

confidence: 82%

Sex-Specific Differences in End-of-Life Burdensome Interventions and Antibiotic Therapy in Nursing Home Residents With Advanced Dementia

et al. 2019

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“…Factors that have been associated with the use of physical restraints in patients in ICUs were older age, MV use, and a low patient-to-nurse ratio [ 35 , 36 ]. Unfortunately, 16.3% of deceased patients had experienced physical restraints by the time of death, and approximately one out of four ICU patients died in restraints [ 37 ]. Our study may be the first to explore the utilization of inpatient physical restraints in the care of ICU COPD patients with and without cancer who received inpatient PC and also point out the difference between them.…”

Section: Discussionmentioning

confidence: 99%

Burden of Healthcare Utilization among Chronic Obstructive Pulmonary Disease Patients with and without Cancer Receiving Palliative Care: A Population-Based Study in Taiwan

Cheng

Chen

et al. 2020

IJERPH

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Chronic obstructive pulmonary disease (COPD) is a chronic disease that burdens patients worldwide. This study aims to discover the burdens of health services among COPD patients who received palliative care (PC). Study subjects were identified as COPD patients with ICU and PC records between 2009 and 2013 in Taiwan’s National Health Insurance Research Database. The burdens of healthcare utilization were analyzed using logistic regression to estimate the difference between those with and without cancer. Of all 1215 COPD patients receiving PC, patients without cancer were older and had more comorbidities, higher rates of ICU admissions, and longer ICU stays than those with cancer. COPD patients with cancer received significantly more blood transfusions (Odds Ratio, OR: 1.66; 95% C.I.: 1.11–2.49) and computed tomography scans (OR: 1.88; 95% C.I.: 1.10–3.22) compared with those without cancer. Bronchoscopic interventions (OR: 0.26; 95% C.I.: 0.07–0.97) and inpatient physical restraints (OR: 0.24; 95% C.I.: 0.08–0.72) were significantly more utilized in patients without cancer. COPD patients without cancer appeared to receive more invasive healthcare interventions than those without cancer. The unmet needs and preferences of patients in the life-limiting stage should be taken into consideration for the quality of care in the ICU environment.

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“…While it is strongly recommended that no individuals including people with advanced dementia should be forcefed, tube feeding provides a safer way of administering foods and fluids to maintain the nutritional status of people categorised as having unsafe swallowing [14,90,91]. NG tube is rarely considered an option in people with late-stage dementia due to lack of cognition and intolerance [5,92]. Evidence also shows that PEG feeding is associated with a lower incidence of aspiration when compared with NG tube feeding [93].…”

Section: Perceived Benefits Of Tube Feeding In Advanced Dementia Indimentioning

confidence: 99%

Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits

Ijaopo

2019

Journal of Aging Research

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Background. Dementia remains a growing concern for societies globally, particularly as people now live longer. About 90% of individuals with advanced dementia suffer from eating problems that lead to general health decline and ultimately impacts upon the physical, psychological, and economic wellbeing of the individuals, caregivers, and the wider society. Objective. To evaluate the burdens and perceived benefits of tube feeding in individuals with advanced dementia. Design. Narrative review. Methods. Computerized databases, including PubMed, Embase, Medline, CINAHL, PsycInfo, and Google Scholar were searched from 2000 to 2019 to identify research papers, originally written in or translated into English language, which investigated oral versus tube feeding outcome in individuals with advanced dementia. Results. Over 400 articles were retrieved. After quality assessment and careful review of the identified articles, only those that met the inclusion criteria were included for review. Conclusion. Tube feeding neither stops dementia disease progression nor prevents imminent death. Each decision for feeding tube placement in individuals with advanced dementia should be made on a case-by-case basis and involve a multidisciplinary team comprising experienced physicians, nurses, family surrogates, and the relevant allied health professionals. Careful considerations of the benefit-harm ratio should be discussed and checked with surrogate families if they would be consistent with the wishes of the demented person. Further research is required to establish whether tube feeding of individuals with advanced dementia provides more burdens than benefits or vice-versa and evaluate the impacts on quality of life and survival.

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Predictors of Physical Restraint Use in Hospitalized Veterans at End of Life: An Analysis of Data from the BEACON Trial

Abstract: This is the first study to document that one in six hospitalized veterans were restrained at the time of death and to identify predictors of restraint use. Further research is needed to identify intervention opportunities.

Cited by 10 publications

References 42 publications

Sex-Specific Differences in End-of-Life Burdensome Interventions and Antibiotic Therapy in Nursing Home Residents With Advanced Dementia

Sex-Specific Differences in End-of-Life Burdensome Interventions and Antibiotic Therapy in Nursing Home Residents With Advanced Dementia

Burden of Healthcare Utilization among Chronic Obstructive Pulmonary Disease Patients with and without Cancer Receiving Palliative Care: A Population-Based Study in Taiwan

Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits

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