Palliative home care and dying at home is an option for patients living alone

Abstract

despite converting to low-dose methadone, initial frequency of dosing was not excessive.Other studies have supported the finding that the morphine to methadone ratio is significantly positively correlated to the previous MEDD and have reported median ratios for specific morphine dosage bands. 2,5 However, when comparing the results of these studies, there are marked differences in these median ratios and in the quoted ranges. The very wide range of ratios in our study highlights the difficulty in predicting methadone conversion ratios and suggests that, until more consistent data are available, the ad libitum approach is the most appropriate conversion method for our patient population. It is important to be aware of the correlation with previous MEDD and using a maximum single methadone dose of 30 mg allows for the fact that those switching from higher dose opioids require relatively lower doses of methadone.There are no trials comparing different methods of switching from other opioids to methadone and comparison of data is difficult due to differing populations. It is clear that further research is needed to establish the safety and efficacy of the various conversion methods in current use. References1 Tse DMW, Sham MMK, Ng DKH, Ma HM. An ad libitum schedule for conversion of morphine to methadone in advanced cancer patients: an open uncontrolled prospective study in a Chinese population. Palliat Med 2003; 17: 206 ¡/11. 2 Morley JS, Makin MK. The use of methadone in cancer pain poorly responsive to other opioids. Pain Rev 1998; 5: 51 ¡/58. 3 Lawlor PG, Turner KS, Hanson J, Bruera ED. Dose ratio between morphine and methadone in patients with cancer pain: a retrospective study.

End-of-life care for nursing home residents dying from cancer in Nova Scotia, Canada, 2000–2003

“…Residence in a nursing home may be an enabler in allowing a person to die out of hospital because they provide more 24/7 longterm supportive care than normally can be provided at home by family and friends, especially for the elderly living alone. For those living alone, full-time supportive care is important in allowing for an out-of-hospital death [20].…”

From neighbour to carer: An exploratory study on the role of non-kin-carers in end-of-life care at home for older people living alone

“…It was like her last breath and then … indeed … then it was over. (15,Friend) In particular, the 24-h availability of palliative care services was a great relief for the non-kin-carers.…”

“…It is only recently that the implications of living alone for place of death have been under study, providing corresponding findings. 6,14,15 An explicit wish to die at home and the access to an around-the-clock palliative care team are prerequisites for allowing home death of people living alone. 15 The presence of non-kin-carers has doubled the chances of a home death for older people living alone in one study.…”

“…6,14,15 An explicit wish to die at home and the access to an around-the-clock palliative care team are prerequisites for allowing home death of people living alone. 15 The presence of non-kin-carers has doubled the chances of a home death for older people living alone in one study. 14 However, until now, none has yet explored the role of non-kin-carers in end-of-life care of older people living alone in more detail.…”

Equal receipt of specialized palliative care in breast and prostate cancer: a register study

“…ASIH takes care of all medical aspects, with any needed help in daily activities taken care of by the municipality’s home service. It is possible for patients living alone to receive palliative home care and die at home [ 14 ].…”