End‐of‐life treatment decisions in nursing home residents dying with dementia in the Netherlands

Hendriks, Simone A.; Smalbrugge, Martin; Deliëns, Luc; Koopmans, Raymond T.C.M.; Hertogh, Cees M.P.M.; Steen, Jenny T. van der

doi:10.1002/gps.4650

Cited by 48 publications

(43 citation statements)

References 34 publications

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“…In our results, contrary to the initial hypothesis, no statistically significant difference was found in antibiotic consumption between groups, as opposed to what was observed by Hendriks et al [16] in their study, which showed greater antibiotic intake in patients with dementia.…”

Section: Discussioncontrasting

confidence: 99%

“…Health professionals often face dilemmas regarding whether the time has come to not start or to withdraw treatments and interventions because they do not add quality of life [15]. A study conducted in the Netherlands [16] recommended that professionals should respond early to palliative care needs and encourage discussions with patients with dementia and their families about how to deal with therapeutic procedures and drug therapy at the end of life.…”

Section: Introductionmentioning

confidence: 99%

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Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia

Puente‐Fernández

Campos-Calderón²,

Esteban-Burgos

et al. 2020

IJERPH

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The aim of this study was to compare the symptomatology, palliative care outcomes, therapeutic procedures, diagnostic tests, and pharmacological treatments for people with dementia (PWD) and without dementia (PW/OD) admitted to Spanish nursing homes. Design: This was a cross-sectional study which is part of a long-term prospective follow-up of elderly people performed in nursing homes to measure end-of-life care processes. Participants: 107 nursing home patients with advanced or terminal chronic diseases were selected according to the criteria of the Palliative Care Spanish Society. Setting: Two trained nurses from each nursing home were responsible for participant selection and data collection. They must have treated the residents and had a minimum seniority of 6 months in the nursing home. Measurements: Sociodemographic data; Edmonton Symptom Assessment Scale; Palliative Care Outcome Scale; and prevalence of diagnostic tests, pharmacological treatments, and therapeutic procedures were evaluated. Results: Pain, fatigue, and nausea were found to be significantly higher in the nondementia group and insomnia, poor appetite, and drowsiness were significantly higher in the dementia group. Patient anxiety, support, feeling that life was worth living, self-worth, and practical matters management were higher in the nondementia group. Regarding drugs, use of corticoids was higher in the nondementia group, while use of anxiolytics was higher in the dementia group. Diagnostic procedures such as urine analysis and X-ray were higher in the dementia group. Conclusions: Differences in symptom perception, diagnostic tests, and pharmacological procedures were found between patients with and without dementia. Specific diagnostic tools need to be developed for patients with dementia.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia

Puente‐Fernández

Campos-Calderón²,

Esteban-Burgos

et al. 2020

IJERPH

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“…We did not expect any change in DNR/DNH orders, owing to the difficulties of the staff and residents to address the issue, as has also been observed in other European studies. 34 Considering the limited nature of the educational intervention, and the lack of follow-up and reinforcement, the results obtained in this study are promising. Previous studies with a more robust design 35 and longer NH staff educational interventions (6 months) failed to show any impact on the quality of life of dementia patients.…”

Section: Discussionmentioning

confidence: 80%

The Impact of Nursing Homes Staff Education on End-of-Life Care in Residents With Advanced Dementia: A Quality Improvement Study

Giulio

Finetti²,

Giunco

et al. 2019

Journal of Pain and Symptom Management

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Context. End-of-life care in nursing homes (NHs) needs improvement. We carried out a study in 29 NHs in the Lombardy Region (Italy). Objectives. The objective of this study was to compare end-of-life care in NH residents with advanced dementia before and after an educational intervention aimed to improving palliative care. Methods. The intervention consisted of a seven-hour lecture, followed by two 3-hour meetings consisting of case discussions. The intervention was held in each NH and well attended by NH staff. This multicenter, comparative, observational study included up to 20 residents with advanced dementia from each NH: the last 10 who died before the intervention (preintervention group, 245 residents) and the first 10 who died at least three months after the intervention (postintervention group, 237 residents). Data for these residents were collected from records for 60 days and seven days before death. Results. The use of ''comfort hydration'' (<1000 mL/day subcutaneously) tended to increase from 16.9% to 26.8% in the postintervention group. The number of residents receiving a palliative approach for nutrition and hydration increased, though not significantly, from 24% preintervention to 31.5% postintervention. On the other hand, the proportion of tube-fed residents and residents receiving intravenous hydration decreased from 15.5% to 10.5%, and from 52% to 42%, respectively. Cardiopulmonary resuscitations decreased also from 52/245 (21%) to 18/237 (7.6%) cases (P ¼ 0.002). Conclusion. The short educational intervention modified some practices relevant to the quality of end-of-life care of advanced dementia patients in NHs, possibly raising and reinforcing beliefs and attitudes already largely present. J Pain Symptom Manage 2019;57:93e99.

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“…25 The limited use of subcutaneous fluids administration in our study could be ascribed to a lack of knowledgeof this technique on the part of NH staff. 26 The figures we report related to feeding tubes, namely the number of patients who died with a feeding tube in place, are higher than those reported in a Dutch 27 and a US study, which showed a decrease in tube feeding over 15 years (from 11.7% in 2000 to 5.7% in 2014). 28 Nevertheless, our results reflect a substantial positive trend when compared with the findings of a previous study (tube feeding 21.0% vs tube feeding and parenteral nutrition 16.6%; intravenous hydration 66% vs 48.4%) carried out in 2005 in a smaller sample of NHs in the same region.…”

Section: Days Before Deathmentioning

confidence: 64%

The last week of life of nursing home residents with advanced dementia: a retrospective study

Toscani¹,

Finetti²,

Giunco

et al. 2019

Preprint

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Background: Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. Methods: This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the seven days before death. Results: Most residents (97.1%) died in the NH. In the seven days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of four days before death. Conclusions: Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals’ lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.

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End‐of‐life treatment decisions in nursing home residents dying with dementia in the Netherlands

Cited by 48 publications

References 34 publications

Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia

Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia

The Impact of Nursing Homes Staff Education on End-of-Life Care in Residents With Advanced Dementia: A Quality Improvement Study

The last week of life of nursing home residents with advanced dementia: a retrospective study

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