Bethel Ann Powers1, Nancy M Watson. 1. Elaine C. Hubbard Center for Clinical Nursing Research on Aging, University of Rochester School of Nursing, Rochester, New York 14642, USA. bethel_powers@urmc.rochester.edu
Abstract
OBJECTIVE: To describe the meaning and practice of palliative care (PC) for nursing home (NH) residents with dementia at end of life (EOL). DESIGN: Concurrent mixed methods (quantitative retrospective chart review and qualitative field study). SETTING: Three NHs with varying approaches to EOL care: in-house non-Medicare hospice, Medicare hospice by outside agency, and Medicare hospice by outside agency plus specialized staff and comfort care unit. RESULTS: Residents' course fluctuated between curative and comfort care, with a noticeable increase in symptoms right before death. Hospice care was short. Most died of complications of dementia. Families found care decisions based on residents' uncertain disease course difficult. CONCLUSION: The role of PC for NH residents with dementia at EOL is complex and poorly understood. As they are in a residential setting, decisions need to be made about how residents live, as well as how they die, thus balancing quality of living/comfort with disease management.
OBJECTIVE: To describe the meaning and practice of palliative care (PC) for nursing home (NH) residents with dementia at end of life (EOL). DESIGN: Concurrent mixed methods (quantitative retrospective chart review and qualitative field study). SETTING: Three NHs with varying approaches to EOL care: in-house non-Medicare hospice, Medicare hospice by outside agency, and Medicare hospice by outside agency plus specialized staff and comfort care unit. RESULTS: Residents' course fluctuated between curative and comfort care, with a noticeable increase in symptoms right before death. Hospice care was short. Most died of complications of dementia. Families found care decisions based on residents' uncertain disease course difficult. CONCLUSION: The role of PC for NH residents with dementia at EOL is complex and poorly understood. As they are in a residential setting, decisions need to be made about how residents live, as well as how they die, thus balancing quality of living/comfort with disease management.
Authors: Susan E Hickman; Christine A Nelson; Alvin H Moss; Susan W Tolle; Nancy A Perrin; Bernard J Hammes Journal: J Am Geriatr Soc Date: 2011-10-22 Impact factor: 5.562
Authors: Mirjam C van Soest-Poortvliet; Jenny T van der Steen; Henrica C W de Vet; Cees M P M Hertogh; Bregje D Onwuteaka-Philipsen; Luc H J Deliens Journal: J Palliat Med Date: 2014-12 Impact factor: 2.947