BACKGROUND: Many people with dementia die in long-term care settings. These patients may benefit from a palliative care goal, focused on comfort. Admission may be a good time to revisit or develop care plans. OBJECTIVE: To describe care goals in nursing home patients with dementia and factors associated with establishing a comfort care goal. DESIGN: We used generalized estimating equation regression analyses for baseline analyses and multinomial logistic regression analyses for longitudinal analyses. SETTING: Prospective data collection in 28 Dutch facilities, mostly nursing homes (2007-2010; Dutch End of Life in Dementia study, DEOLD). RESULTS: Eight weeks after admission (baseline), 56.7% of 326 patients had a comfort care goal. At death, 89.5% had a comfort care goal. Adjusted for illness severity, patients with a baseline comfort care goal were more likely to have a religious affiliation, to be less competent to make decisions, and to have a short survival prediction. Their families were less likely to prefer life-prolongation and more likely to be satisfied with family-physician communication. Compared with patients with a comfort care goal established later during their stay, patients with a baseline comfort care goal also more frequently had a more highly educated family member. CONCLUSIONS: Initially, over half of the patients had a care goal focused on comfort, increasing to the large majority of the patients at death. Optimizing patient-family-physician communication upon admission may support the early establishing of a comfort care goal. Patient condition and family views play a role, and physicians should be aware that religious affiliation and education may also affect the (timing of) setting a comfort care goal.
BACKGROUND: Many people with dementia die in long-term care settings. These patients may benefit from a palliative care goal, focused on comfort. Admission may be a good time to revisit or develop care plans. OBJECTIVE: To describe care goals in nursing home patients with dementia and factors associated with establishing a comfort care goal. DESIGN: We used generalized estimating equation regression analyses for baseline analyses and multinomial logistic regression analyses for longitudinal analyses. SETTING: Prospective data collection in 28 Dutch facilities, mostly nursing homes (2007-2010; Dutch End of Life in Dementia study, DEOLD). RESULTS: Eight weeks after admission (baseline), 56.7% of 326 patients had a comfort care goal. At death, 89.5% had a comfort care goal. Adjusted for illness severity, patients with a baseline comfort care goal were more likely to have a religious affiliation, to be less competent to make decisions, and to have a short survival prediction. Their families were less likely to prefer life-prolongation and more likely to be satisfied with family-physician communication. Compared with patients with a comfort care goal established later during their stay, patients with a baseline comfort care goal also more frequently had a more highly educated family member. CONCLUSIONS: Initially, over half of the patients had a care goal focused on comfort, increasing to the large majority of the patients at death. Optimizing patient-family-physician communication upon admission may support the early establishing of a comfort care goal. Patient condition and family views play a role, and physicians should be aware that religious affiliation and education may also affect the (timing of) setting a comfort care goal.
Authors: Margaret R Helton; Jenny T van der Steen; Timothy P Daaleman; George R Gamble; Miel W Ribbe Journal: Ann Fam Med Date: 2006 May-Jun Impact factor: 5.166
Authors: Elizabeth L Sampson; Louise Jones; Ingela C V Thuné-Boyle; Riitta Kukkastenvehmas; Michael King; Baptiste Leurent; Adrian Tookman; Martin R Blanchard Journal: Palliat Med Date: 2011-01-12 Impact factor: 4.762
Authors: Adam D Schickedanz; Dean Schillinger; C Seth Landefeld; Sara J Knight; Brie A Williams; Rebecca L Sudore Journal: J Am Geriatr Soc Date: 2009-01 Impact factor: 5.562
Authors: Betty S Black; Linda A Fogarty; Hilary Phillips; Thomas Finucane; David J Loreck; Alva Baker; David M Blass; Peter V Rabins Journal: J Aging Health Date: 2009-03-05
Authors: Susan L Mitchell; Joan M Teno; Dan K Kiely; Michele L Shaffer; Richard N Jones; Holly G Prigerson; Ladislav Volicer; Jane L Givens; Mary Beth Hamel Journal: N Engl J Med Date: 2009-10-15 Impact factor: 91.245