Tarja Konttila1, Ulla Harriet Finne-Soveri2, Riitta Leskinen3, Katriina Niemelä4, Riitta Antikainen3. 1. Kuusamo Public Health Care, Kuusamo, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland. Electronic address: tarja.konttila@kuusamo.fi. 2. National Institute for Health and Welfare, Helsinki, Finland. 3. Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland; Oulu City Hospital, Oulu, Finland. 4. Coronaria Hoiva Oy, Oulu, Finland.
Abstract
BACKGROUND: Increased awareness of the clinical course of nursing home residents with advanced dementia and advance care planning (ACP) has become the cornerstone of good palliative care. OBJECTIVE: The aim of our study is to describe changes in ACP in the form of physician treatment orders (PTOs), symptom prevalence and possible burdensome interventions among nursing home (NH) residents who died between 2004-2009 and 2010-2013 METHODS: Retrospective study RESULTS: The number of PTOs regarding forgoing antibiotics or parenteral antibiotics, forgoing artificial nutrition or hydration or forgoing hospitalisation doubled between 2004-2009 and 2010-2013 (38.1% vs. 64.9%, p < 0.001; 40.0% vs. 81.7%, p < 0.001; 28.1% vs. 69.5%, p < 0.001, respectively). PTOs were also done significantly earlier in 2010-2013 than in 2004-2009. The prevalence of distressing symptoms and possible burdensome interventions remained unchanged, although the prevalence of consistency with the PTOs was high. CONCLUSION: Despite the increased number of PTOs, this had little effect on symptom prevalence and possible burdensome interventions experienced by NH residents in the last days of life.
BACKGROUND: Increased awareness of the clinical course of nursing home residents with advanced dementia and advance care planning (ACP) has become the cornerstone of good palliative care. OBJECTIVE: The aim of our study is to describe changes in ACP in the form of physician treatment orders (PTOs), symptom prevalence and possible burdensome interventions among nursing home (NH) residents who died between 2004-2009 and 2010-2013 METHODS: Retrospective study RESULTS: The number of PTOs regarding forgoing antibiotics or parenteral antibiotics, forgoing artificial nutrition or hydration or forgoing hospitalisation doubled between 2004-2009 and 2010-2013 (38.1% vs. 64.9%, p < 0.001; 40.0% vs. 81.7%, p < 0.001; 28.1% vs. 69.5%, p < 0.001, respectively). PTOs were also done significantly earlier in 2010-2013 than in 2004-2009. The prevalence of distressing symptoms and possible burdensome interventions remained unchanged, although the prevalence of consistency with the PTOs was high. CONCLUSION: Despite the increased number of PTOs, this had little effect on symptom prevalence and possible burdensome interventions experienced by NH residents in the last days of life.
Authors: Andrea Giordano; Ludovica De Panfilis; Marta Perin; Laura Servidio; Marta Cascioli; Maria Grazia Grasso; Alessandra Lugaresi; Eugenio Pucci; Simone Veronese; Alessandra Solari Journal: Int J Environ Res Public Health Date: 2022-01-12 Impact factor: 3.390
Authors: Saila Haapasalmi; Reetta P Piili; Riina Metsänoja; Pirkko-Liisa I Kellokumpu-Lehtinen; Juho T Lehto Journal: BMC Palliat Care Date: 2021-07-26 Impact factor: 3.234