Challenges for professional care of advanced dementia

Chang, Esther; Daly, John W.; Johnson, Amanda; Harrison, Kathleen McDavid; Easterbrook, Sally; Bidewell, John; Stewart, Heather; Noel, Michael; Hancock, Karen

doi:10.1111/j.1440-172x.2008.01723.x

Cited by 82 publications

(117 citation statements)

References 17 publications

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“…Thus, the focus of nursing care in nursing homes needs to be on palliative care as much as restorative care. However, knowledge of palliative care and symptom management adapted to older people [4] as well as to those suffering from dementia is lacking in nursing homes [39]. …”

Section: Discussionmentioning

confidence: 99%

Predicting mortality of residents at admission to nursing home: A longitudinal cohort study

Hjaltadóttir

Hallberg

Ekwall

et al. 2011

BMC Health Serv Res

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BackgroundAn increasing numbers of deaths occur in nursing homes. Knowledge of the course of development over the years in death rates and predictors of mortality is important for officials responsible for organizing care to be able to ensure that staff is knowledgeable in the areas of care needed. The aim of this study was to investigate the time from residents' admission to Icelandic nursing homes to death and the predictive power of demographic variables, health status (health stability, pain, depression and cognitive performance) and functional profile (ADL and social engagement) for 3-year mortality in yearly cohorts from 1996-2006.MethodsThe samples consisted of residents (N = 2206) admitted to nursing homes in Iceland in 1996-2006, who were assessed once at baseline with a Minimum Data Set (MDS) within 90 days of their admittance to the nursing home. The follow-up time for survival of each cohort was 36 months from admission. Based on Kaplan-Meier analysis (log rank test) and non-parametric correlation analyses (Spearman's rho), variables associated with survival time with a p-value < 0.05 were entered into a multivariate Cox regression model.ResultsThe median survival time was 31 months, and no significant difference was detected in the mortality rate between cohorts. Age, gender (HR 1.52), place admitted from (HR 1.27), ADL functioning (HR 1.33-1.80), health stability (HR 1.61-16.12) and ability to engage in social activities (HR 1.51-1.65) were significant predictors of mortality. A total of 28.8% of residents died within a year, 43.4% within two years and 53.1% of the residents died within 3 years.ConclusionIt is noteworthy that despite financial constraints, the mortality rate did not change over the study period. Health stability was a strong predictor of mortality, in addition to ADL performance. Considering these variables is thus valuable when deciding on the type of service an elderly person needs. The mortality rate showed that more than 50% died within 3 years, and almost a third of the residents may have needed palliative care within a year of admission. Considering the short survival time from admission, it seems relevant that staff is trained in providing palliative care as much as restorative care.

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Section: Discussionmentioning

confidence: 99%

Predicting mortality of residents at admission to nursing home: A longitudinal cohort study

Hjaltadóttir

Hallberg

Ekwall

et al. 2011

BMC Health Serv Res

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“…We estimate the association between comorbidity burden and the following outcomes: emergency department admission, intensive care unit (ICU) admission, inpatient hospitalization, disenrollment from hospice, and hospital death. In addition, given the known challenges in caring for individuals with dementia, [17][18][19] we separately estimate the prevalence of comorbid dementia in the sample and the association between comorbid dementia and the previously listed outcomes.…”

mentioning

confidence: 99%

The Effect of Comorbidity Burden on Health Care Utilization for Patients with Cancer Using Hospice

Legler

Bradley

Carlson

2011

Journal of Palliative Medicine

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Background: The treatment of patients with advanced cancer with multiple comorbid illnesses is complex. Although an increasing number of such patients are being referred to hospice, the comorbidity burden of this patient population is largely unknown but has implications for the complexity of care provided by hospices. This study reports the comorbidity burden in a national sample of hospice users with cancer and estimates the effect of higher comorbidity on health care use and site of death. Methods: Cross-sectional study using Surveillance, Epidemiology and End Results-Medicare data for hospice users who died of cancer in 2002 (N ¼ 27,166). We measured comorbidity burden using the Charlson comorbidity index and used multivariable generalized estimating equations to estimate the association between comorbidity burden and the following outcomes: emergency department and intensive care unit (ICU) admission, hospitalization, hospice disenrollment, and hospital death. Results: Patients with cancer who used hospice had an average Charlson comorbidity index value of 1.24, including 18.8% who suffered from comorbid dementia. In analyses adjusted for patient demographics, site of primary cancer, and number of days with hospice, higher comorbidity burden was associated with higher likelihood of emergency department admission (odds ratio [OR] ¼ 1.69, 95% confidence interval [CI] 1.52, 1.87), ICU admission (OR ¼ 3.28, 95% CI 2.45, 4.38), inpatient hospitalization (OR ¼ 2.14, 95% CI 1.90, 2.42), hospice disenrollment (OR ¼ 1.41, 95% CI 1.29, 1.56) and hospital death (OR ¼ 2.51, 95% CI 2.08, 3.02). Conclusion: These findings underscore the complexity of the hospice patient population and highlight a potential need to risk adjust the per diem hospice reimbursement rates to account for increased resource requirements for hospices serving patients with higher comorbidity burden.

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“…They had a thorough understanding of the nature of the disease process associated with dementia and thus were able to realize that the behavior was a result of the disease, rather than a personal attack against them.” (43) Lack of knowledge about dementia also meant that some staff treated the inevitable “organic decline” of late-stage patients as a behavioral problem. (45) In the acute care environment, a need for specialized dementia training was indicated, with some staff described as unsympathetic, referring to dementia patients pejoratively, or doing things that caused them distress, which also frustrated some staff members who witnessed this. (28,29) …”

Section: Resultsmentioning

confidence: 99%

A Meta-Ethnography of Paid Dementia Care Workers’ Perspectives on Their Jobs

2012

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BackgroundWhile much work has been to evaluate paid workers’ perspectives on the care they provide dementia patients, there is no evidence of any systematic review of this topic.MethodsWe conducted a meta-ethnography of the topic “paid dementia care workers’ perspectives on their jobs.” Multiple databases were searched for qualitative work that reported on workers’ opinions and perspectives on their jobs in dementia care, including all settings and types of jobs. A final group of 34 articles were included, and their themes and constructs synthesized using a meta-ethnographic approach developed by Noblit and Hare.ResultsFive overarching themes uncovered: approach to care, education and training, emotional impact of the work, organizational factors, and relationships on the job. We also describe how the themes are related to each other.ConclusionsInterplay of the theme areas shows the importance of dementia- specific education and training in terms of the approach to care and emotional impact of the work. Closing the gap between policy and practice is critical, but achieving this will require that attention be paid to dementia-specific education for all workers, including care leaders.

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Challenges for professional care of advanced dementia

Cited by 82 publications

References 17 publications

Predicting mortality of residents at admission to nursing home: A longitudinal cohort study

Predicting mortality of residents at admission to nursing home: A longitudinal cohort study

The Effect of Comorbidity Burden on Health Care Utilization for Patients with Cancer Using Hospice

A Meta-Ethnography of Paid Dementia Care Workers’ Perspectives on Their Jobs

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