Pain Trajectories of Nursing Home Residents Nearing Death

Thompson, Genevieve; Doupe, Malcolm; Reid, Robert; Baumbusch, Jennifer; Estabrooks, Carole A.

doi:10.1016/j.jamda.2017.03.002

Cited by 9 publications

(16 citation statements)

References 48 publications

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“…Nevertheless, it is necessary to point out that the consulted studies used prevalence, not intensity, to assess symptoms. Thompson et al [10] conducted a prospective study in which they assessed pain in the last six months of life of residents in nursing homes, showing that the intensity of their pain remained stable during a short follow-up period, except in the last days of life, when it increased.…”

Section: Discussionmentioning

confidence: 99%

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Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes

Puente‐Fernández

Roldán-López

Campos-Calderón³

et al. 2020

JCM

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The aim of the study is to evaluate the intensity of symptoms, and any treatment and therapeutic procedures received by advanced chronic patients in nursing homes. A multi-centre prospective study was conducted in six nursing homes for five months. A nurse trainer selected palliative care patients from whom the sample was randomly selected for inclusion. The Edmonton Symptoms Assessment Scale, therapeutic procedures, and treatment were evaluated. Parametric and non-parametric tests were used to evaluate month-to-month differences and differences between those who died and those who did not. A total of 107 residents were evaluated. At the end of the follow-up, 39 had (34.6%) died. All symptoms (p < 0.050) increased in intensity in the last week of life. Symptoms were more intense in those who had died at follow-up (p < 0.05). The use of aerosol sprays (p = 0.008), oxygen therapy (p < 0.001), opioids (p < 0.001), antibiotics (p = 0.004), and bronchodilators (p = 0.003) increased in the last week of life. Peripheral venous catheters (p = 0.022), corticoids (p = 0.007), antiemetics (p < 0.001), and antidepressants (p < 0.05) were used more in the patients who died. In conclusion, the use of therapeutic procedures (such as urinary catheters, peripheral venous catheter placement, and enteral feeding) and drugs (such as antibiotics, anxiolytics, and new antidepressant prescriptions) should be carefully considered in this clinical setting.

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Section: Discussionmentioning

confidence: 99%

“…All of these symptoms increase in intensity and prevalence as the end of life approaches [4,9]. Most of the studies that have evaluated end-of-life symptoms in nursing homes are retrospective studies [3,6,[9][10][11]. They may exhibit selection bias and problems caused by poorly recorded or unrecorded data.…”

Section: Introductionmentioning

confidence: 99%

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes

Puente‐Fernández

Roldán-López

Campos-Calderón³

et al. 2020

JCM

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“…26 We have access to RAI-MDS 2.0 data at the resident level. 4 To link a cross-sectional sample of RAI-MDS 2.0 data to nursing assistants' survey data, we chose each resident's latest quarterly assessment collected during the same quarter of survey data collection and linked the two data sources at the care unit level. For variables that are not available in quarterly assessments but only from full assessments (diagnosis of arthritis, diagnosis of osteoporosis), we carried forward the variables from residents' most recent full assessment.…”

Section: Residentsmentioning

confidence: 99%

“…3 At the end of life, 38% of residents without serious cognitive impairment experienced worsened pain or consistently high levels of pain up until death. 4 Pain is untreated or undertreated for approximately 40% of residents with persistent pain. 3 Approximately 64% of nursing home residents live with moderate to severe cognitive impairment, and this rate is underestimated by at least 10%.…”

Section: Introductionmentioning

confidence: 99%

Nursing assistants' use of best practices and pain in older adults living in nursing homes

Song

Bolt

Thorne

et al. 2023

J American Geriatrics Society

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BackgroundInadequate pain management persists in nursing homes. Nursing assistants provide the most direct care in nursing homes, and significantly improving the quality of care requires their adoption of best care practices informed by the best available evidence. We assessed the association between nursing assistants' use of best practices and residents' pain levels.MethodsWe performed a cross‐sectional analysis of data collected between September 2019 and February 2020 from a stratified random sample of 87 urban nursing homes in western Canada. We linked administrative data (the Resident Assessment Instrument‐Minimum Data Set [RAI‐MDS], 2.0) for 10,093 residents and survey data for 3547 nursing assistants (response rate: 74.2%) at the care unit level. Outcome of interest was residents' pain level, measured by the pain scale derived from RAI‐MDS, 2.0. The exposure variable was nursing assistants' use of best practices, measured with validated self‐report scales and aggregated to the unit level. Two‐level random‐intercept multinomial logistic regression accounted for the clustering effect of residents within care units. Covariates included resident demographics and clinical characteristics and characteristics of nursing assistants, unit, and nursing home.ResultsOf the residents, 3305 (30.3%) were identified as having pain. On resident care units with higher levels of best practice use among nursing assistants, residents had 32% higher odds of having mild pain (odds ratio, 1.32; 95% confidence interval, 1.01–1.71; p = 0.040), compared with residents on care units with lower levels of best practice use among nursing assistants. The care units did not differ in reported moderate or severe pain among residents.ConclusionsWe observed that higher unit‐level best practice use among nursing assistants was associated with mild resident pain. This association warrants further research to identify key individual and organizational factors that promote effective pain assessment and management.

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“…Secondly, research shows the need for palliative care development in nursing homes [31]. Residents of nursing homes tend to be burdened with a vast number of symptoms, are often transferred to hospitals and are not consulted with regard to their end-of-life care preferences [282932333435].…”

Section: Case Under Analysismentioning

confidence: 99%

Integrated Palliative Care for Nursing Home Residents: Exploring the Challenges in the Collaboration between Nursing Homes, Home Care and Hospitals

Hermans¹,

Sevenants²,

Declercq³

et al. 2019

International Journal of Integrated Care

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Introduction: Nursing home residents are a vulnerable and frail segment of the population, characterised by their complex and palliative care needs. To ensure an integrated approach to palliative care for this target group, working on a collaborative basis with multiple providers across organisational boundaries is necessary. Considering that coordinators of palliative networks support and coordinate collaboration, the research question is: ‘how do network coordinators perceive the process of collaboration between organisations in Flemish palliative networks?’ Methods: A dual-phase sequential mixed-methods design was applied. First, the coordinators of each of the fifteen palliative networks in Flanders completed a survey in which they evaluated ten aspects of collaboration for two types of cooperation: between nursing homes and home care, and between nursing homes and hospitals. Next, the survey results thus obtained were discussed to improve understanding in a focus group composed of the above coordinators, and which was analysed on the basis of content analysis. Results: In both forms of cooperation, the ‘formalisation’ and ‘governance’ were the aspects that yielded the lowest mean scores. The coordinators in the focus group expressed a need for more formalised interaction among organisations with regard to palliative care, the establishment of formal channels of communication and the exchange of information, as well as the development of shared leadership. Conclusions: The perspectives of the coordinators on inter-organisational collaboration are a valuable starting point for interventions directed at the stronger integration of palliative care for residents of long term-care facilities.

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Pain Trajectories of Nursing Home Residents Nearing Death

Cited by 9 publications

References 48 publications

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes

Nursing assistants' use of best practices and pain in older adults living in nursing homes

Integrated Palliative Care for Nursing Home Residents: Exploring the Challenges in the Collaboration between Nursing Homes, Home Care and Hospitals

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