Quality of dying and quality of end-of-life care of nursing home residents in six countries: An epidemiological study

Pivodic, Lara; Smets, Tinne; Noortgate, Nele Van Den; Onwuteaka-Philipsen, Bregje D.; Engels, Yvonne; Szczerbińska, Katarzyna; Finne-Soveri, Harriet; Froggatt, Katherine; Gambassi, Giovanni; Deliëns, Luc; Block, Lieve Van den

doi:10.1177/0269216318800610

Cited by 100 publications

(100 citation statements)

References 38 publications

(68 reference statements)

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“…The main limitation of this analysis that the PACE study was developed to compare the outcomes, quality and costs of palliative and end-of-life care between countries 22. Consequently, much of the data collected were related to either the last month or week of life.…”

Section: Discussionmentioning

confidence: 99%

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Length of stay in long-term care facilities: a comparison of residents in six European countries. Results of the PACE cross-sectional study

et al. 2020

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ObjectivesThis paper aims to investigate resident, facility and country characteristics associated with length of stay in long-term care facilities (LTCFs) across six European countries.SettingData from a cross-sectional study of deceased residents, conducted in LTCFs in Belgium, England, Finland, Italy, the Netherlands and Poland.ParticipantsAll residents aged 65 years and older at admission who died in a 3-month period residing in a proportional random sample of LTCFs were included.Primary and secondary outcome measuresThe primary outcome was length of stay in days, calculated from date of admission and date of death. Resident, facility and country characteristics were included in a proportional hazards model.ResultsThe proportion of deaths within 1 year of admission was 42% (range 32%–63%). Older age at admission (HR 1.04, 95% CI 1.03 to 1.06), being married/in a civil partnership at time of death (HR 1.47, 95% CI 1.13 to 1.89), having cancer at time of death (HR 1.60, 95% CI 1.22 to 2.10) and admission from a hospital (HR 1.84, 95% CI 1.43 to 2.37) or another LTCF (HR 1.81, 95% CI 1.37 to 2.40) were associated with shorter lengths of stay across all countries. Being female (HR 0.72, 95% CI 0.57 to 0.90) was associated with longer lengths of stay.ConclusionsLength of stay varied significantly between countries. Factors prior to LTCF admission, in particular the availability of resources that allow an older adult to remain living in the community, appear to influence length of stay. Further research is needed to explore the availability of long-term care in the community prior to admission and its influence on the trajectories of LTCF residents in Europe.

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Section: Discussionmentioning

confidence: 99%

“…In England, LTCFs were also recruited from Enabling Research in Care Homes, a network of LTCFs with an interest in research participation 20. The methods used to recruit the LTCF and ethical approvals are discussed in the study protocol and primary outcomes publication 21 22…”

Section: Methodsmentioning

confidence: 99%

Length of stay in long-term care facilities: a comparison of residents in six European countries. Results of the PACE cross-sectional study

et al. 2020

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“…22 Moreover, EDs are not the most appropriate place for dying. 12 It has been found that the quality of end-of-life care and quality of dying of nursing home residents were insufficient in Europe, 23 even though the number of deaths in nursing homes is growing in many countries worldwide. 24,25 If additional palliative care guidelines and practice tools are needed to improve quality of dying nursing home residents, ED should not be a solution for dying.…”

Section: Discussionmentioning

confidence: 99%

Difficulty of the decision‐making process in emergency departments for end‐of‐life patients

Douplat

Berthiller

Schott

et al. 2019

Evaluation Clinical Practice

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Background In emergency departments, for some patients, death is preceded by a decision of withholding or withdrawing life‐sustaining treatments. This concerns mainly patients over 80, with many comorbidities. The decision‐making process of these decisions in emergency departments has not been extensively studied, especially for noncommunicating patients. Aim The purpose of this study is to describe the decision‐making process of withholding and withdrawing life‐sustaining treatments in emergency departments for noncommunicating patients and the outcome of said patients. Design We conducted a prospective multicenter study in three emergency departments of university hospitals from September 2015 to January 2017. Results We included 109 patients in the study. Fifty‐eight (53.2%) patients were coming from nursing homes and 52 (47.7%) patients had dementia. Decisions of withholding life‐sustaining treatment concerned 93 patients (85.3%) and were more frequent when a surrogate decision maker was present 61 (65.6%) versus seven (43.8%) patients. The most relevant factors that lead to these decisions were previous functional limitation (71.6%) and age (69.7%). Decision was taken by two physicians for 80 patients (73.4%). The nursing staff and general practitioner were, respectively, involved in 31 (28.4%) and two (1.8%) patients. A majority of the patients had no advance directives (89.9%), and the relatives were implicated in the decision‐making process for 96 patients (88.1%). Death in emergency departments occurred for 47 patients (43.1%), and after 21 days, 84 patients (77.1 %) died. Conclusion There is little anticipation in end‐of‐life decisions. Discussion with patients concerning their end‐of‐life wishes and the writing of advance directives, especially for patients with chronic diseases, must be encouraged early.

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“…5,12 This is compounded by a workforce that is under-resourced (70% of direct RAC workers are personal care attendants 13 ), lacking in palliative care knowledge and skills, and access to suitably experienced and skilled specialist palliative care clinicians. 14,15 These barriers are greatest in rural locations due to distance that restricts access to services, training and mentoring, 14,16 and lack of equity of service provision between rural and city areas. 17 For example, in 2017, the national full-time equivalent (FTE) for employed palliative care nurses per 100 000 population was 12.0 FTE in major cities, dropping to 9.7 in outer regional areas, 5.0 in remote areas and 1.9 in very remote areas; the FTE for employed palliative medicine physicians was 1.1, 0.7, 0 and 0, respectively.…”

Section: Introductionmentioning

confidence: 99%

The impact of introducing Palliative Care Needs Rounds into rural residential aged care: A quasi‐experimental study

Rainsford

Liu

Johnston

et al. 2020

Australian J Rural Health

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Objective: This study examined the impact of introducing Palliative Care Needs Rounds (hereafter Needs Rounds) into residential aged care on hospitalisations (emergency department presentations, admissions and length of stay) and documentation of advance care plans. Design: A quasi-experimental study. Setting: Two residential aged care facilities in one rural town in the Snowy Monaro region of New South Wales, Australia. Participants: The intervention group consisted of all residents who died during the study period (April 2018-March 2019), and included a subgroup of decedents who were discussed in a Needs Round. The control cohort included all residents who died in the three-year period prior to introducing Needs Rounds (2015-2017). Intervention: Needs Rounds are monthly onsite triage/risk stratification meetings where case-based education and staff support help to identify residents most at risk of dying without an adequate plan in place. Needs Rounds were attended by residential aged care staff and led by a palliative medicine physician. Main outcome measures: Decedents' hospitalisations (emergency department presentations, admissions and length of stay) in the last three months of life, place of death and documentation of advance care plans. Results: Eleven Needs Rounds were conducted between April and September 2018. The number of documented advance care plans increased (P < .01). There were no statistically significant changes in hospitalisations or in-hospital deaths. Conclusion: Needs Rounds are an effective approach to increase the documentation of advance care plans within rural residential aged care. Further studies are required to explore the rural influence on outcomes including hospital transfers and preferred place of death.

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Quality of dying and quality of end-of-life care of nursing home residents in six countries: An epidemiological study

Cited by 100 publications

References 38 publications

Length of stay in long-term care facilities: a comparison of residents in six European countries. Results of the PACE cross-sectional study

Length of stay in long-term care facilities: a comparison of residents in six European countries. Results of the PACE cross-sectional study

Difficulty of the decision‐making process in emergency departments for end‐of‐life patients

The impact of introducing Palliative Care Needs Rounds into rural residential aged care: A quasi‐experimental study

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