The Trend of Aggressive Treatments in End-of-Life Care for Older People With Dementia After a Policy Change in Taiwan

Hsu, Yi‐Chao; Chou, Ming Yueh; Chen, Hsiu-Min; Chang, Wen Yin; Chu, Chih‐Sheng; Wang, Yu Chun; Hsu, Chiao-Lin; Liang, Chih‐Kuang; Lee, Ching‐Chih; Lin, Yu Te

doi:10.1016/j.jamda.2020.04.011

Cited by 7 publications

(4 citation statements)

References 37 publications

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“…With the promotion of palliative care in Taiwan, most older adults no longer want to receive ineffective medical treatments such as CPR, and they value their hospice rights. A study analyzing Taiwan’s health insurance database reported a significant drop in the proportion of older adults with dementia receiving CPR, from 31% in 2010 to 15% in 2013 [ 21 ]. A mixed study noted considerable agreement between an elderly Taiwanese population and their surrogates regarding their refusal to undergo CPR in end-of-life care [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Taiwanese Older Adults Prefer to Use Antibiotics and Intravenous Infusion at the End of Life based on a Cartoon Version of the Life Support Preferences Questionnaire

Cheng

Liu

et al. 2023

IJERPH

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Asians believe discussing death-related topics is inauspicious and may bring bad luck. It is critical to explore the end-of-life care preferences of the Asian elderly with less-threatening tools. The study examined older adults’ preferences regarding end-of-life treatments by applying a cartoon version of the Life Support Preferences Questionnaire (LSPQ). A cross-sectional survey was conducted to understand older adults’ preferences for end-of-life treatments. A total of 342 older adults participated in the study, comprising 268 elderly patients from a veterans hospital located in northern Taiwan and 74 elderly family members of the patients. Regardless of scenario, cardiopulmonary resuscitation (CPR) had the lowest score, indicating that older adults considered it a less desirable medical treatment. By contrast, antibiotics and intravenous infusions had the highest scores, indicating that older adults tended to prefer them. End-of-life care preferences were significantly different in genders. CPR and surgical preferences of older adults differed significantly with education level. Different demographic characteristics had different end-of-life treatment preferences, and future research may develop advance care planning programs for different attributes. This cartoon version of the LSPQ can help healthcare professionals to understand older adults’ preferences for end-of-life care and warrants further empirical research.

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Section: Discussionmentioning

confidence: 99%

Taiwanese Older Adults Prefer to Use Antibiotics and Intravenous Infusion at the End of Life based on a Cartoon Version of the Life Support Preferences Questionnaire

Cheng

Liu

et al. 2023

IJERPH

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“…Several reasons are listed: (1) doctors and family members do not regard advanced dementia as a terminal disease; (2) excessive focus on cognitive and physical impairments can limit palliative care options; (3) patients with dementia often present distinct illness trajectories over a long period between diagnosis and death, often without an acute deterioration [ 47 ]. Before the introduction of the PAA, most doctors in Taiwan favored active treatment of patients with dementia to ensure that the patient’s medical needs were met and to avoid legal repercussions [ 48 ].…”

Section: Methodsmentioning

confidence: 99%

Gender differences in the intention to withhold life-sustaining treatments involving severe dementia for self and on behalf of parent or spouse

et al. 2022

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Background Few studies have explored gender differences in the attitudes toward advanced care planning and the intention to withhold life-sustaining treatments (LSTs) involving severe dementia in Asian countries. We examined gender differences in the attitude toward the Patient Autonomy Act (PAA) in Taiwan and how the gender differences in these attitudes affect the intention to withhold LSTs for severe dementia. We also investigated self–other differences in the intention to withhold LSTs between genders. Methods Between March and October 2019, a structured questionnaire was distributed to hospitalized patients’ family members through face-to-face contact in an academic medical center. Exploratory factor analysis and independent and paired-sample t-tests were used to describe gender differences. Mediation analyses controlled for age, marital status, and education level were conducted to examine whether the attitude toward the PAA mediates the gender effect on the intention to withhold LSTs for severe dementia. Results Eighty respondents filled out the questionnaire. Exploratory factor analysis of the attitude toward the PAA revealed three key domains: regarding the PAA as (1) promoting a sense of abandonment, (2) supporting patient autonomy, and (3) contributing to the collective good. Relative to the men, the women had lower average scores for promoting a sense of abandonment (7.48 vs. 8.94, p = 0.030), higher scores for supporting patient autonomy (8.74 vs. 7.94, p = 0.006), and higher scores for contributing to the collective good (8.64 vs. 7.47, p = 0.001). Compared with the women, the men were less likely to withhold LSTs for severe dementia (15.84 vs. 18.88, p = 0.01). Mediation analysis revealed that the attitude toward the PAA fully mediated the gender differences in the intention to withhold LSTs for severe dementia. Both men and women were more likely to withhold LSTs for themselves than for their parents. Compared with the women, the men were more likely to withhold resuscitation for themselves than for their parents (p = 0.05). Women were more likely to agree to enteral tube feeding and a tracheotomy for their husbands than for themselves; men made consistent decisions for themselves and their wives in those LST scenarios. Conclusion Gender influences the attitude toward advanced care planning and consequently affects the intention to withhold LSTs, indicating that there may be a difference in how men and women perceive EOL decision-making for severe dementia in Taiwan. Further studies are warranted.

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“…For older people with dementia, emergency department visits or hospitalization near the end-of-life are considered, population-wise, a marker of healthcare aggressiveness [15]. For the patient, the family and the care team, care transitions near the end-of-life may be disruptive and are often associated with healthcare-associated infections, pressure ulcers, and worsening mental, functional, and behavioral status [16].…”

Section: Introductionmentioning

confidence: 99%

Nursing Home Residents Hospitalization at the End of Life: Experience and Predictors in Portuguese Nursing Homes

Bárrios

Nunes

Teixeira

et al. 2023

IJERPH

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(1) Background: Nursing Home (NH) residents are a population with health and social vulnerabilities, for whom emergency department visits or hospitalization near the end of life can be considered a marker of healthcare aggressiveness. With the present study, we intend to identify and characterize acute care transitions in the last year of life in Portuguese NH residents, to characterize care integration between the different care levels, and identify predictors of death at hospital and potentially burdensome transitions; (2) Methods: a retrospective after-death study was performed, covering 18 months prior to the emergence of the COVID-19 pandemic, in a nationwide sample of Portuguese NH with 614 residents; (3) Results: 176 deceased patients were included. More than half of NH residents died at hospital. One-third experienced a potentially burdensome care transition in the last 3 days of life, and 48.3% in the last 90 days. Younger age and higher technical staff support were associated with death at hospital and a higher likelihood of burdensome transitions in the last year of life, and Palliative Care team support with less. Advanced Care planning was almost absent; (4) Conclusions: The studied population was frail and old without advance directives in place, and subject to frequent hospitalization and potentially burdensome transitions near the end of life. Unlike other studies, staff provisioning did not improve the outcomes. The results may be related to a low social and professional awareness of Palliative Care and warrant further study.

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The Trend of Aggressive Treatments in End-of-Life Care for Older People With Dementia After a Policy Change in Taiwan

Cited by 7 publications

References 37 publications

Taiwanese Older Adults Prefer to Use Antibiotics and Intravenous Infusion at the End of Life based on a Cartoon Version of the Life Support Preferences Questionnaire

Taiwanese Older Adults Prefer to Use Antibiotics and Intravenous Infusion at the End of Life based on a Cartoon Version of the Life Support Preferences Questionnaire

Gender differences in the intention to withhold life-sustaining treatments involving severe dementia for self and on behalf of parent or spouse

Nursing Home Residents Hospitalization at the End of Life: Experience and Predictors in Portuguese Nursing Homes

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