Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective

Abstract

BackgroundNursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team’s perspective.MethodsThe focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey.ResultsThe analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category “Going into a bubble” illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category “The body begins to shut down” illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death.ConclusionsThis study conveys new knowledge concerning the multidisciplinary team’s collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.

Older Persons’ Thoughts about Death and Dying and their Experiences of End-of-Life Care: A Qualitative Study

“…The results in this study also highlight wishes among older persons at the end stage of life, i.e., dying quickly without pain or suffering quick was expressed as the ideal way of dying. The results indicate that older persons were not afraid of death, which is supported by earlier studies [3,4,8,16]. In the present study, death was considered a natural and inevitable part of life.…”

“…Their worries were especially related to a fear of pain and a long, protracted death. The nding on the fear of dying among older persons is supported by the ndings of several other studies [6, 16,17]. The results in this study also highlight wishes among older persons at the end stage of life, i.e., dying quickly without pain or suffering quick was expressed as the ideal way of dying.…”

“…It is challenging to determine when an older person's end-of-life stage begins [14] since diseases usually progress over a period of time. Early signs preceding death could be di cult for nursing home staff to detect [15], even though the nal year of life is often associated with symptoms such as pain, depression, confusion, and distress [11,16]. Thus, most persons living in nursing homes are in the nal stage of life and bene t from palliative care.…”

The Development of a Digital Dysphagia Guide with Care Homes: Co-Production and Evaluation of a Nutrition Support Tool

“…These experience based co-design processes [38] are an important method to ensure that innovation and particularly product development makes sense to front line staff and that the wisdom from everyday practice is captured for the design. Action methods can be seen to achieve more sustained implementation in care home developments [39,40].…”

Older persons’ thoughts about death and dying and their experiences of end-of-life care: a qualitative study

“…It is challenging to determine when an older person's end-of-life stage begins [14] since diseases usually progress over a period of time. Early signs preceding death could be di cult for nursing home staff to detect [15], even though the nal year of life is often associated with symptoms such as pain, depression, confusion, and distress [11,16]. Thus, most persons living in nursing homes are in the nal stage of life and bene t from palliative care.…”