What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis

Stow, Daniel; Spiers, Gemma; Matthews, Fiona E.; Hanratty, Barbara

doi:10.1177/0269216319828650

Cited by 64 publications

(51 citation statements)

References 44 publications

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“…In the USA, patients with frailty are more than twice as likely to die in the intensive care unit than patients with cancer and the families of frail patients are less likely to rate their end-of-life care as excellent 3. Frail older people frequently prefer less aggressive medical care than they receive, but this is often not accurately recorded in their records 4 5. One large multicentre prospective study found that for those patients who prefer comfort care only, this was accurately documented in just 16% of cases 5…”

Section: Introductionmentioning

confidence: 99%

“…This ‘frail dying trajectory’ is characterised by higher levels of disability in the last year of life and unpredictability around the timing of death,6 and is estimated to be the most common type of dying trajectory, accounting for approximately 40% of deaths 7. Patients with frailty have been identified as having palliative care needs at similar levels to people with cancer,4 but differences in attitudes towards dying and talking about death have been noted between frail patients and those with cancer or organ failure, in part related to unpredictability of death and dying 8…”

Section: Introductionmentioning

confidence: 99%

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Advance care plans and hospitalized frail older adults: a systematic review

Hopkins

Bentley

Phillips

et al. 2020

BMJ Support Palliat Care

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IntroductionFrail older people are known to have low rates of advance care planning (ACP). Many frail patients prefer less aggressive treatment, but these preferences are often not known or respected. Frail patients often have multiple hospital admissions, potentially providing opportunities for ACP.ObjectiveTo systematically review the literature concerning ACP with frail older people in the acute hospital, with particular reference to: (1) Does ACP improve outcomes? (2) What are the views of patients, relatives and healthcare professionals regarding ACP? (3) Does ACP currently occur? (4) What are the facilitators and barriers to ACP?DesignSystematic literature review and narrative synthesis. Electronic search of MEDLINE, CINAHL, ASSIA, PsycINFO and Embase databases from January 1990 to May 2019 inclusive. Studies in the acute setting of populations with a mean age >75 years, not focused on a disease-specific terminal condition were included.Results16 133 articles were retrieved, 14 met inclusion criteria. No studies used an objective measure of frailty. One randomised controlled trial (RCT) found that ACP improves outcomes for older patients. Although 74%–84% of capacitous older inpatients are receptive to ACP, rates of ACP are 0%–5%; the reasons for this discrepancy have been little studied. The nature of ACP in clinical practice is unknown thus the extent to which it reflects the RCT intervention cannot be assessed. The outcomes that are important to patients are poorly understood and family and physician experiences have not been explored.ConclusionsA better understanding of this area could help to improve end-of-life care for frail older people.PROSPERO registration numberCRD42017080246.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Advance care plans and hospitalized frail older adults: a systematic review

Hopkins

Bentley

Phillips

et al. 2020

BMJ Support Palliat Care

View full text Add to dashboard Cite

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“…Von den Hausärzten werden in diesem Zusammenhang auch Unsicherheiten zum Ausdruck gebracht, wann der geeignete Zeitpunkt gekommen ist, Patienten in die SAPV einzuschreiben (s. Zitat oben: HA07, Z. [17][18][19].…”

Section: Koordinieren Eines Tragfähigen Versorgungsnetzesunclassified

“…Hinsichtlich der Versorgung älterer nicht onkologisch erkrankter Menschen scheint eine Integration der SAPV in die hausärztliche Versorgung weiterhin eine untergeordnete Rolle zu spielen. In einem aktuellen systematischen Review kommen Stow et al zu dem Schluss, dass gebrechliche ältere Menschen am Lebensende vergleichbare palliative Bedürfnisse aufweisen wie onkologisch erkrankte Menschen [18]. Nauck et al heben hervor, dass lebenslimitiert erkrankte Patienten mit komplexem Symptomgeschehen und Unterstützungsbedarf des privaten Umfelds unabhängig von der Grunderkrankung von der SAPV profitieren können [19].…”

Section: Einordnung Der Ergebnisse In Den Forschungskontextunclassified

„Das ist auch unser Ziel, dass wir diese Patienten in ruhigem Fahrwasser behandeln“ – Palliativversorgung älterer Menschen mit lebensbegrenzenden Erkrankungen in der hausärztlichen Praxis: Eine qualitative Studie

Freihoff

Tetzlaff

Schneider

et al. 2020

Zeitschrift für Palliativmedizin

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Zusammenfassung Hintergrund Praktische Erfahrungen und Studien untermauern die Relevanz der Palliativversorgung (PV) für ältere Menschen mit lebensbegrenzenden Erkrankungen. Ziel dieser Studie ist, die hausärztliche Versorgung älterer Menschen in der letzten Lebensphase zu untersuchen. Methodik Als Teil der Ist-Analyse des Interventionsprojekts „Proaktive Palliativversorgung älterer Patienten in der letzten Lebensphase (ProPall, BMBF-01GY1710)“ wurden leitfadenorientierte Interviews mit Hausärzten geführt und inhaltsanalytisch ausgewertet. Ergebnisse Im Frühjahr/Sommer 2018 wurden 15 Hausärzte aus 12 Praxen in 2 Regionen in Niedersachsen interviewt. Die Interviewanalyse zeigt, dass die Hausärzte eine umfassende Begleitung älterer Patienten als integralen Bestandteil ihrer Tätigkeit ansehen. Sie beschreiben ihre Rolle als Lotse im ,Dickicht der Medizin‘ und Begleiter bis zum Ende. Um ein ,ruhiges Sterben‘ im vertrauten Umfeld zu ermöglichen, ist es den Hausärzten wichtig, Leiden zu lindern, die Versorgung zu koordinieren und neben den Erkrankten auch ihre Angehörigen zu begleiten. Bedarf für PV schreiben die Hausärzte vorrangig Patienten mit Krebserkrankungen sowie im Endstadium nicht maligner chronischer Erkrankungen zu. Schlussfolgerung Verstärkte Anstrengungen sind erforderlich, um insbesondere bei älteren Menschen mit lebenslimitierenden nicht onkologischen Erkrankungen PV frühzeitiger in die hausärztliche Versorgung zu integrieren.

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“…. Att uppmärksamma och konkretisera vad skörhet innebär är av betydelse för att möta en person som är skör, oavsett om det är fysiskt, psykiskt eller socialt (Stow, Spiers, Matthews & Hanratty, 2019). Ett begrepp som ligger nära skörhet är sårbarhet.…”

Section: Skörhetunclassified

Existentiell ensamhet hos sköra äldre personer : ett närståendeperspektiv

Larsson¹

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The aim of this thesis was to explore existential loneliness from the perspective of significant others, to contrast their perceptions with frail older people's experiences and to describe significant others' and family care advisors' views on existential support. This thesis is part of a larger research project about existential loneliness among frail older people, the LONE study. The thesis embraces three qualitative and one quantitative study. A total of 29 significant others, 15 frail older people and 120 family care advisors participated in the studies. The significant others were husbands, wives, daughters, sons, other relatives and friends to frail older people. The concept 'frail older people' was defined as older persons (≥ 75 years old) dependent on long-term health-or social care. The qualitative studies were based on multistage focus-group interviews (study I) and individual interviews (studies II and III). The quantitative study (IV) had a cross-sectional design and was based on a questionnaire specifically developed for the current study. Different methods to analyse data were used; hermeneutics (study I), content analysis (study II), a case study with thematic analysis (study III) and descriptive statistics (study IV). Findings from the four studies show that existential loneliness emerges when: 1) Longing for, but also striving for, a deeper feeling of connectedness, 2) Being in, but also enduring, an unwanted separation, and 3) Not finding, but still trying to recreate meaning. This thesis also shows that existential loneliness is often experienced in so-called limit situations in life and arises in difficult choices related to close relationships, in connection with experiences of meaninglessness and in the absence of connection to something or someone. The results show that existential loneliness emerges in the process of balancing between what was and what is to come in the unknown future. Significant others navigate themselves, and sometimes together with the older person, through an unfamiliar existence that makes them feel ambivalent about the de-LATE IN LIFE-A HERMENEUTICAL APPROACH

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What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis

Cited by 64 publications

References 44 publications

Advance care plans and hospitalized frail older adults: a systematic review

Advance care plans and hospitalized frail older adults: a systematic review

„Das ist auch unser Ziel, dass wir diese Patienten in ruhigem Fahrwasser behandeln“ – Palliativversorgung älterer Menschen mit lebensbegrenzenden Erkrankungen in der hausärztlichen Praxis: Eine qualitative Studie

Existentiell ensamhet hos sköra äldre personer : ett närståendeperspektiv

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