Dying in hospital of terminal heart failure or severe dementia: the                 circumstances associated with death and the opinions of caregivers

Formiga, Francesç; Olmedo, Claudia; López‐Soto, Alfons; Navarro, Margarita; Culla, Alex; Pujol, Ramón

doi:10.1177/0269216306073256

Cited by 42 publications

(60 citation statements)

References 27 publications

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“…Physicians and other health professionals caring for older adults should receive additional palliative care training to assure the quality of care received by patients dying in hospitals [23,24] . Information should be collected about the preferences of patients with terminal illnesses [8,25] to improve end-of-life care and help them to achieve a dignified death.…”

Section: Discussionmentioning

confidence: 99%

Hospital Deaths of People Aged 90 and Over: End-of-Life Palliative Care Management

et al. 2008

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Background: In developed countries, hospital deaths at very advanced age are increasingly common.Few studies have addressed end-of-life care in very elderly patients with non-cancer chronic diseases. Objective: To evaluate the circumstances related to end-stage death of non-cancer nonagenarians in an acute care hospital. The results were compared with those from a sample of younger patients. Methods: We conducted a prospective assessment in two teaching hospitals of the written instructions for the following actions: do not resuscitate (DNR) orders, the graduation of therapeutic decisions, information provided to relatives about prognosis, total withdrawal of normal drug therapy and provision of palliative care. Results: 80 patients over 89 years of age with end-stage congestive heart failure (57.5%) or dementia (42.5%) were included. The control group comprised 52 younger patients (65–74 years). DNR orders were specified in 56% of cases, graduation of therapeutic decisions in 35%, and knowledge of relatives regarding the prognosis in 61%. Drug therapy was withdrawn in 66% of cases and terminal palliative care was initiated in 69%. In the nonagenarians who died, we detected a predominance of females (p = 0.001), a higher percentage of DNR orders (p = 0.02) and a higher percentage of graduation of therapeutic measures (p = 0.02) in comparison with younger patients. Conclusion: Our results indicate that there are marked differences according the palliative care provided to oldest-old patients with end-stage non-cancer chronic diseases admitted to an acute care hospital. In any case, care should be improved for both age groups.

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Section: Discussionmentioning

confidence: 99%

Hospital Deaths of People Aged 90 and Over: End-of-Life Palliative Care Management

et al. 2008

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“…Studies (see Box 1 for the methods of the literature search [29][30][31][32]) report pain in 12% to 76% of patients [28,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]. The lower percentages were reported in studies using the Minimum Data Set (MDS) [43], which is mandated in US nursing homes and is known for underreporting [48], in regards to "uncontrolled pain" [38] and in more recent work related to pain [44]. In general, 21% to 83% of dementia patients have been reported to be in pain at some point in their disease process [49,50] and pain may increase as death approaches [44,51].…”

Section: Symptoms and Treatment At The End Of Lifementioning

confidence: 99%

“…The results of selected studies have been integrated in a recent review, showing considerable unmet needs in families [85]. Through the beginning of 2010 (Box 1, Table 1), at least 45 studies [28,[33][34][35][36][37][38][40][41][42][43]46,47,52,60,61,63,65,66,80,[86][87][88][89][90][91][92][93][94][95][96][97][98][99]110] in another 26 publications [39,44,45,53,54,64,67,69,[111][112][113][114][115]…”

Section: Research Trends In Dementia At the End Of Lifementioning

confidence: 99%

Dying with Dementia: What We Know after More than a Decade of Research

Steen

2010

JAD

224

177

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Abstract. Death with dementia is increasingly common. Although prognostication is difficult, it is an incurable life-limiting illness for which palliative care for the patient is often appropriate. Dementia patients are otherwise at risk of overtreatment with burdensome and possibly non-beneficial interventions and undertreatment of symptoms. Although recent studies indicate encouraging trends of improved palliative care, little evidence supports effectiveness of specific treatments. As of January 2010, at least 45 studies, almost all performed after 2000, have reported on treatment, comfort, symptom burden, and families' satisfaction with care. Over half (25; 56%) of these studies were in US settings, and most were small or retrospective. Few randomized trials and prospective observational studies have been performed so far, but several promising studies have been completed recently or are underway in various countries. Guidelines for care and treatment, still mostly consensus-based, support the benefits of advance care planning, continuity of care, and family and practitioner education. Assessment tools for pain, prognosis, and family evaluations of care have been developed and some have been shown to be effective in clinical practice. With increasing numbers of well-designed, large-scale studies, research in the next decade may result in better evidence-based guidelines and practice.

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“…While research shows that the majority of people spend their final days in inpatient settings (Heyland, Lavery, Tranmer, Shortt, & Taylor, 2000), acute medical wards and LTC units are particularly problematic places to die (Formiga, Olmedo, Lopez-Soto, Navarro, Culla, & Pujol, 2007;Kayser-Jones, 2002;Kayser-Jones et al, 2003;Stajduhar & Davies, 2005;Willard & Luker, 2006). Part of the challenge lies in how practice is organized and structured within those settings.…”

Section: Implications For Interprofessional Practicementioning

confidence: 99%

“…Thus, palliative care is not an explicit aspect of the practice models that dominate those settings. Moreover, the way in which such practice is organized and enacted is not well aligned with coordinated palliative care planning and/ or interprofessional collaboration to support the dying process (Formiga et al, 2007;Kayser-Jones, 2002;Kayser-Jones et al, 2003;Stajduhar & Davies, 2005;Willard & Luker, 2006).…”

Section: Implications For Interprofessional Practicementioning

confidence: 99%

End-of-life Care and Interprofessional Communication: Not Simply a Matter of "More"

Doane

Stajduhar

Causton

et al. 2012

Health and Interprofessional Practice

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INTRODUCTION A well-functioning interprofessional team has been identified as a central requirement for high quality palliative care. In particular, interprofessional communication and teamwork have been directly linked to patient and family health outcomes. However, evidence suggests that substandard communication and team collaboration between healthcare providers is a persistent challenge that is heightened during palliative care in in-patient settings. This research examined the mechanisms of communication that shaped and impeded interprofessional team practice and coordinated palliative care on acute medical and long-term care units.

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Dying in hospital of terminal heart failure or severe dementia: the circumstances associated with death and the opinions of caregivers

Abstract: Our results suggest that some aspects of the palliative care provided to elderly patients with end-stage chronic diseases, admitted to acute care hospitals, could be improved. Such aspects include the clinical information provided and the successful control of specific symptoms.

Cited by 42 publications

References 27 publications

Hospital Deaths of People Aged 90 and Over: End-of-Life Palliative Care Management

Hospital Deaths of People Aged 90 and Over: End-of-Life Palliative Care Management

Dying with Dementia: What We Know after More than a Decade of Research

End-of-life Care and Interprofessional Communication: Not Simply a Matter of "More"

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