Modalities of palliative care in hospitalized patients with advanced AIDS

Abstract

This prospective multidisciplinary survey started in October 1994. The survey assessed the modalities of care of hospitalized patients with advanced AIDS in an Infectious and Tropical Diseases Unit with regards to the practices of palliative care in a Palliative Care Unit. Seventy-eight (78) AIDS patients with CD4 < or = 30/mm3 who had 102 consecutive hospitalizations were recruited. Types (symptomatic or curative) and number of drugs administered to the patients, as well as biological and radiological investigations performed were recorded. Symptoms were concomitantly assessed on a weekly basis by self-evaluation of the patients themselves and by physicians. The results showed that the practices of care were different in the two units according to the specific goals and norms of each unit. A higher density of care was delivered at the Infectious and Tropical Diseases Unit. Symptoms assessed by both patients and physicians were underestimated by physicians in frequency and in intensity. In conclusion, an integrated approach including objective and subjective criteria should enable a better adjustment of the palliative and curative therapeutic strategies in advanced AIDS. These would concomitantly take into account the wishes of the patient and the goals regarding care in the unit where the patient is hospitalized.

Association of cognitive impairment and elderly mortality: differences between two cohorts ascertained 6-years apart in China

“…The MMSE as a general measure of cognitive impairment has been an important predictor of all-cause mortality [28,29]. To date, although few studies have explored the relationship between cognitive impairment and all-cause mortality in China [30][31][32], the existing results support our conclusion that cognitive impairment is independently associated with an increased risk of death in the elderly [13,14]. Moreover, MMSE scores are known to be influenced by education [16].…”

“…One possible reason that cognitive impairment of younger elderly poses a greater risk of mortality may be due to their ability to develop cognitive impairment faster compared to the oldest old, thus triggering a greater risk of mortality. The varying association of cognitive impairment and all-cause mortality in different age groups might be due to the survival bias that the oldest old represent hardy survivors who have successfully adapted to cognitive impairment [31]. Another possible explanation is that the oldest old have a higher risk of mortality, a common competing risk for cognitive impairment, thus causing loss to follow up bias and confusing the association [13].…”

Association of Cognitive Impairment and Elderly Mortality: Differences between two cohorts ascertained 6-years apart in China

“…The varying association of cognitive impairment and all-cause mortality in different age groups might be due to the survival bias that the oldest old represent hardy survivors who have successfully adapted to cognitive impairment 31 . Another possible explanation is that the oldest old have a higher risk of mortality, a common competing risk for cognitive impairment, thus causing loss to follow up bias and confusing the association 13 .…”

Does palliative care improve outcomes for patients with HIV/AIDS? A systematic review of the evidence

“…24 Patient self reports are also subject to bias because of more unwell patients being unable or unwilling to participate. 23 There is currently a modest amount of clinical research into HIV palliative care, and future efforts should include both qualitative and quantitative approaches to inform feasibility, acceptability, processes, and preferences as well as outcomes. In addition, well standardised quantitative palliative specific outcome measures such as the Support Team Assessment Schedule (STAS) 21 and the Palliative Outcome Scale (POS) 52 should be considered, as well as a range of quality of care 53 and quality of life measures 54 in HIV management.…”

“…In a further observational study, relative to 77 patients receiving standard hospital inpatient care, 10 patients attending a hospital inpatient palliative care unit (PCU) were less likely to have been prescribed antiretrovirals (34% v 10%) and antimicrobial agents (60% v 0%), more likely to have ceased treatment for curable infections (23% v 80%), and more likely to have been prescribed step 3 analgesics (18% v 80%). 23 Depression was also far less common in the PCU (55% v 10%), although a similar frequency of pain was assessed (46% v 50%). However, …”