Is Hospice Associated with Improved End‐of‐Life Care in Nursing Homes and Assisted Living Facilities?

Munn, Jean; Hanson, Laura C.; Zimmerman, Sheryl; Sloane, Philip D.; Mitchell, C. Madeline

doi:10.1111/j.1532-5415.2005.00636.x

Cited by 58 publications

(58 citation statements)

References 25 publications

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“…However, most studies have been small, retrospective, or both. In retrospective work, US hospice care for dementia patients has been associated with favorable evaluations by families, similar to hospice care for other conditions [61] and better compared with traditional dementia care [46], but it is unclear to what extent these findings can be attributed to enrollment in hospice and an expectation of death [45] when end-of-life care may be better perceived. This suggests that preparing families for death is a way to improve care.…”

Section: Research Trends In Dementia At the End Of Lifementioning

confidence: 99%

“…In contrast, pain and shortness of breath are frequently reported in dementia patients. 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].…”

Section: Symptoms and Treatment At The End Of Lifementioning

confidence: 99%

“…Tube feeding varied between 4% and 39% in several US studies [39,45,47,63,66], and was 73% in Israel [67]. Hospitalization shortly before death was frequent in multi-site studies in US nursing homes [45,47,66].…”

Section: Symptoms and Treatment At The End Of Lifementioning

confidence: 99%

“…Hospitalization shortly before death was frequent in multi-site studies in US nursing homes [45,47,66].…”

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%

See 4 more Smart Citations

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

Steen

2010

JAD

219

174

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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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Section: Research Trends In Dementia At the End Of Lifementioning

confidence: 99%

Section: Symptoms and Treatment At The End Of Lifementioning

confidence: 99%

Section: Symptoms and Treatment At The End Of Lifementioning

confidence: 99%

“…Hospitalization shortly before death was frequent in multi-site studies in US nursing homes [45,47,66].…”

Section: Symptoms and Treatment At The End Of Lifementioning

confidence: 99%

Section: Research Trends In Dementia At the End Of Lifementioning

confidence: 99%

See 3 more Smart Citations

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

Steen

2010

JAD

219

174

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End-of-life Care for Patients with Alzheimer’s Disease

Steen

Deliëns

2009

Self Management of Chronic Disease

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Sterven met dementie: wat weten wij ervan?

Steen¹,

Ribbe²

2007

GEEG

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Dying with dementia: what do we know about it? Death with dementia is increasingly common, yet research on end of life with dementia and end-of-life care for such patients has been sparse. This article reviews recent studies in this area, most of which were done in US nursing homes. Research focused on five domains: prognosis, decision making, treatment, patient's health and suffering, and family's circumstances and satisfaction with care. Prognostication focused on developing risk scores for mortality within 6 months or a year, and while decision making was usually studied qualitatively, the other three domains were largely covered by a series of small, retrospective studies. Future direction in research is discussed, including the ongoing CASCADE project in Boston and the Dutch End of Life with Dementia Study (DEOLD). Both of these prospective studies in nursing home residents assess decision making, as well as factors associated with family's satisfaction and patient suffering. These studies will provide insight into interventions that are most likely to improve end of life care of patients with dementia in the respective countries and elsewhere.Tijdschr Gerontol Geriatr 2007; 38: 288-297 Samenvatting Steeds meer mensen zijn bij overlijden dement. Toch is er tot voor kort nauwelijks onderzoek gedaan naar sterven met dementie en de zorg rondom het levenseinde. In dit overzichtsartikel wordt een stand van zaken gegeven over onderzoek op dit gebied. Er zijn vijf deelgebieden te onderscheiden: prognose, besluitvorming, behandelingen, gezondheidstoestand / lijden van de patie¨nt, en de situatie van de familie en diens tevredenheid met de zorg. Het meeste onderzoek vond plaats in Amerika, in verpleeghuizen. Er zijn risicoscores voor overlijden binnen een half of e´e´n jaar ontwikkeld, en in diverse settings is kwalitatief onderzoek naar besluitvorming uitgevoerd. De laatste drie gebieden zijn voornamelijk in kaart gebracht door een serie kleine, retrospectieve onderzoeken. Twee lopende prospectieve onderzoeken bij verpleeghuispatie¨nten volgen besluitvorming en gaan niet alleen in op de mate van lijden van de patie¨nt en (on)tevredenheid van familie bij het levenseinde, maar bovenal op associaties met lijden en (on)tevredenheid. Dit zijn het CASCADE project in Boston en omgeving en het Nederlandse onderzoek 'Zorg bij Dementie'. Deze onderzoeken moeten het mogelijk maken om inzicht te krijgen in de meest geschikte interventies om zorg rondom het levenseinde van patie¨nten met dementie in de betreffende landen en elders te verbeteren.Keywords besluitvorming Á dementie Á levenseinde zorg Á verpleeghuizen InleidingOp dit moment heeft e´e´n op de negen Nederlanders bij overlijden dementie. De komende decennia zal dit naar verwachting toenemen tot e´e´n op de vier. In geı¨ndustria-liseerde landen overlijden de meeste personen met dementie in een verpleeghuis. [1][2][3][4] Onderzoek naar zorg rond het levenseinde richtte zich tot voor kort echter voornamelijk op patie¨nten met kanker. Zij zijn vaak zelf in staat o...

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Is Hospice Associated with Improved End‐of‐Life Care in Nursing Homes and Assisted Living Facilities?

Cited by 58 publications

References 25 publications

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

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

End-of-life Care for Patients with Alzheimer’s Disease

Sterven met dementie: wat weten wij ervan?

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