Challenges of Shared Decision Making in Older Patients with <scp>COVID</scp>‐19

Dhand, Abhay; Leanne, F; Vegunta, Rathnamitreyee; Aronow, Wilbert S.; Nabors, Christopher

doi:10.1111/jgs.16991

Cited by 7 publications

(5 citation statements)

References 5 publications

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“… 44 The absence of family or other caregivers had adversely affected shared decision‐making for older persons requiring aggressive treatments or complex care. 45 Although technological solutions have been heavily used to connect patients, families, and medical teams virtually during the pandemic, face‐to‐face interactions remain the gold standard for complex decision‐making involving multiple parties. 32 Even in situations where exceptions to visitor restrictions exist, we expect that such exceptions would be extended only to family or caregivers and may exclude others, such as clergy or close family friends, who may nonetheless offer relief and comfort to terminal patients.…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end‐of‐life care

Wedel

Liu

et al. 2022

JACEP Open

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Section: Discussionmentioning

confidence: 99%

COVID‐19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end‐of‐life care

Wedel

Liu

et al. 2022

JACEP Open

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“…A survey of the general population conducted by Köther et al in 2020 [ 43 ] revealed a preference to participate in situations unrelated to COVID-19 (55.2%) than to take decisions related to the pandemic (39.9%). Furthermore, the absence of health care protocols on decision-making and the restrictions on visits by family members limited the scope for discussion of the patient’s wishes and of the risks and benefits of the guidelines for action and for reacting to new situations [ 44 ]. These factors, together with the above-described problem that difficult conversations had to be conducted telematically, represented major challenges to the decision-making process.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on the Perceived Quality of Palliative Care in Nursing Homes

Mota-Romero

Campos-Calderón

Puente‐Fernández

et al. 2022

JCM

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The Nursing Homes End-of-life Programme (NUHELP) was developed in 2017 and is based on quality standards of palliative care, but it was not implemented due to the outbreak of the COVID-19 pandemic. Objectives: To describe perceptions among staff at nursing homes and primary health care (PHC) centres regarding the relevance, feasibility, and degree of achievement of quality standards for palliative care in nursing homes and to determine the differences in these perceptions before and after the pandemic. Methodology: Cross-sectional descriptive study. Professionals at eight nursing homes and related PHC centres who participated in NUHELP development assessed 42 palliative care standards at two time points (2018 and 2022). The Mann–Whitney U test was applied to analyse differences in the scores between these two times and between perceptions at nursing homes and at PHC centres. Results: The study population consisted of 58 professionals in 2018 and 50 in 2022. The standard regarding communication with persons affected by the death of a family member was considered less relevant (p = 0.05), and that concerning the culturally sensitive and dignified treatment of the body was less fully achieved (p = 0.03) in 2022 than in 2018. Social support (p = 0.04), sharing information among the care team (p = 0.04), patient participation (p = 0.04) and information about the treatment provided (p = 0.03) were all more poorly achieved in 2022 than in 2018. The perceptions of nursing home and PHC workers differed in several respects. Conclusions: Professional intercommunication and social support should be reinforced, and residents should be more actively involved in decision-making.

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“…Older patients were also more likely to change their advance care directives/ resuscitation wishes during their hospitalization. The potential for rapid mental decline in the setting of COVID-19 underscores the need for patients and their families to proactively anticipate circumstances in which surrogate decision-making could be necessary, and to timely craft suitable advanced directives [22,23].…”

Section: Discussionmentioning

confidence: 99%

Coronavirus disease 2019 (COVID-19) in older patients: outcomes and risks of mortality

Nabors¹,

Sridhar²,

Aronow³

et al. 2021

amsa

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Introduction:To understand how age and other factors impacted outcomes, we examined characteristics of patients aged 65 years and older hospitalized with COVID-19. Material and methods: This was a retrospective cohort study that included all patients aged 65 years and older with laboratory-confirmed COVID-19, who were admitted to a suburban New York academic medical centre between 15 March and 13 May 2020, and discharged. Results: Of 196 patients, the median age was 76 years, with 57% male, and 66% white. A greater proportion of "older" (77-105 years) compared to "old" (65-76 years) patients were admitted with a primary diagnosis other than COVID-19 (34% vs. 15%), were afebrile (80% vs. 67%), and had a clear initial chest X-ray (19% vs. 8%). Older patients had a higher prevalence of dementia (26% vs. 1.0%), cardiac (42% vs. 28%), and vascular disease (20% vs. 9%). Overall survival was lower among older compared to old patients (55% vs. 74%, p = 0.026) and when mechanical ventilation (20% vs. 46%, p = 0.29) or vasopressors (15% vs. 41%, p = 0.46) were required (20% vs. 46%, p = 0.029) and when new hepatic dysfunction (24% vs. 65%, p < 0.001) or new renal failure (29% vs. 56%, p = 0.015) developed. Factors at presentation that were associated with significantly lower survival included hypoxaemia, elevation of total white blood cell count, procalcitonin, and d-dimer. Conclusions: Overall mortality was 34%. Survival was 2-to 3-fold higher for those aged 65-76 years compared to those aged 77 years and older who required advanced therapies such as mechanical ventilation. Improving clinical parameters were associated with significantly higher survival, regardless of age.

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Challenges of Shared Decision Making in Older Patients with COVID‐19

Cited by 7 publications

References 5 publications

COVID‐19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end‐of‐life care

COVID‐19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end‐of‐life care

Impact of the COVID-19 Pandemic on the Perceived Quality of Palliative Care in Nursing Homes

Coronavirus disease 2019 (COVID-19) in older patients: outcomes and risks of mortality

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