Determinants of Home Death in Palliative Home Care: Using the interRAI Palliative Care to Assess End-of-Life Care

Brink, Peter; Smith, Trevor F.

doi:10.1177/1049909108319261

Cited by 23 publications

(22 citation statements)

References 16 publications

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“…Older adults living alone have not been shown to be high users of primary care [27], and services for patients with lung cancer were found to relate to need rather than living circumstances [28]. Readmission to hospital is more common amongst people living alone [29], and older people who live alone have been shown to be more likely to die in hospital [30,31]. The lower proportion of home deaths[32] could be related to the absence of co-residents [6] or in some cases, reduced access to specialist palliative care [13,30].…”

Section: Discussionmentioning

confidence: 99%

What is different about living alone with cancer in older age? A qualitative study of experiences and preferences for care

et al. 2013

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BackgroundIncreasing numbers of older patients with advanced cancer live alone but there is little research on how well health services meet their needs. The aim of this study was to compare the experiences and future preferences for care between two groups of older people with cancer in their last year of life; those who live alone, and those who live with co-resident carers.MethodsIn-depth qualitative interviews were conducted with 32 people aged between 70 and 95 years who were living with cancer. They were recruited from general practices and hospice day care, when the responsible health professional answered no to the question, of whether they would be surprised if the patient died within twelve months. Twenty participants lived alone. Interviews were recorded and transcribed and the data analysed using a Framework approach, focussing on the differences and commonalities between the two groups.ResultsMany experiences were common to all participants, but had broader consequences for people who lived alone. Five themes are presented from the data: a perception that it is a disadvantage to live alone as a patient, the importance of relational continuity with health professionals, informal appraisal of care, place of care and future plans. People who lived alone perceived emotional and practical barriers to accessing care, and many shared an anxiety that they would have to move into a care home. Participants were concerned with remaining life, and all who lived alone had made plans for death but not for dying. Uncertainty of timescales and a desire to wait until they knew that death was imminent were some of the reasons given for not planning for future care needs.ConclusionsOlder people who live alone with cancer have emotional and practical concerns that are overlooked by their professional carers. Discussion and planning for the future, along with continuity in primary care may hold the key to enhancing end-of-life care for this group of patients.

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Section: Discussionmentioning

confidence: 99%

What is different about living alone with cancer in older age? A qualitative study of experiences and preferences for care

et al. 2013

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“…Irrespective of methodology and country of origin, these studies demonstrated that people were less likely to die at home when they lived alone ( Table 1 ). In several studies, people living alone were described briefly as a subgroup of the total study sample of people receiving palliative care having a decreased likelihood of a home death (Ahlner-Elmqvist et al, 2004 ; Brink & Frise Smith, 2008 ; Cohen et al, 2006 ; Grundy et al, 2004 ; Gyllenhammar et al, 2003 ; Jordhøy et al, 2003 ; Tang & McCorkle, 2003 ; Tiernan et al, 2002 ). These studies demonstrating disadvantage in place of care and death are complemented by subjective data.…”

Section: Resultsmentioning

confidence: 99%

The support needs of terminally ill people living alone at home: a narrative review

Aoun

Breen

Howting

2014

Health Psychology and Behavioral Medicine

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Context: The number of terminally ill people who live alone at home and without a caregiver is growing and exerting pressure on the stretched resources of home-based palliative care services. Objectives: We aimed to highlight the unmet support needs of terminally ill people who live alone at home and have no primary caregiver and identify specific models of care that have been used to address these gaps. Methods: We conducted a narrative review of empirical research published in peer-reviewed journals in English using a systematic approach, searching databases 2002–2013. This review identified 547 abstracts as being potentially relevant. Of these, 95 were retrieved and assessed, with 37 studies finally reviewed. Results: Majority of the studies highlighted the reduced likelihood of this group to be cared for and die at home and the experiences of more psychosocial distress and more hospital admissions than people with a primary caregiver. Few studies reported on the development of models of care but showed that the challenges faced by this group may be mitigated by interventions tailored to meet their specific needs. Conclusion: This is the first review to highlight the growing challenges facing community palliative care services in supporting the increasing number of people living alone who require care. There is a need for more studies to examine the effectiveness of informal support networks and suitable models of care and to provide directions that will inform service planning for this growing and challenging group.

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“…These findings were partially reiterated in another Canadian study that identified two key determinants in achieving a home death: the express wish to die at home and having a family member providing care and support at home; notably, the capacity of the family to provide support was seen to be enhanced by the provision of comprehensive home-based palliative care services. 50 Conversely, of course, occupants may view home as an unsuitable death scene. Many terminally ill people clearly delineate between home as a place of dying and home as a place of death.…”

Section: -Health Promoting Palliative Carementioning

confidence: 99%

Whose Business is Dying? Death, the Home and Palliative Care

Rosenberg

2011

CSR

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The process of dying at home brings the nexus between the paternalism of conventional palliative care and a social understanding of end of life care into sharp focus. Away from institutional places of care, issues of ownership, compliance and communal responsibility are heightened. At this interface, palliative care services are confronted with the irony of relinquishing their 'ownership' of dying whilst leading communities to reclaim their principal role in the business of dying. This benign – but enduring – paternalism remains a barrier to a paradigmatic shift towards a more complete understanding of the business of dying. Whilst nascent attempts to promote community engagement in end of life issues are evident in the interface between palliative care and public health, dying remains, for the most part, the remit of health care services. In this article, I contend that the business of dying is incompletely attended. This lack of attention will be partially redressed here by considering the home as a fitting death scene.

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Determinants of Home Death in Palliative Home Care: Using the interRAI Palliative Care to Assess End-of-Life Care

Cited by 23 publications

References 16 publications

What is different about living alone with cancer in older age? A qualitative study of experiences and preferences for care

What is different about living alone with cancer in older age? A qualitative study of experiences and preferences for care

The support needs of terminally ill people living alone at home: a narrative review

Whose Business is Dying? Death, the Home and Palliative Care

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