Daisy J M Ermers1, Marit P H van Beuningen-van Wijk2, Evi Peters Rit3, Sonja C Stalpers-Konijnenburg4, Diana G Taekema4, Frank H Bosch5,6, Yvonne Engels7, Patricia J W B van Mierlo4,8. 1. Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, PO Box 9101, Nijmegen, HB, 6500, The Netherlands. daisy.ermers@radboudumc.nl. 2. Department of Pulmonology, Rijnstate, Arnhem, The Netherlands. 3. Department of Geriatrics, Meander medical center, Amersfoort, The Netherlands. 4. Department of Geriatrics, Rijnstate, Arnhem, The Netherlands. 5. Department of Intensive Care Medicine, Rijnstate, Arnhem, The Netherlands. 6. Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands. 7. Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, PO Box 9101, Nijmegen, HB, 6500, The Netherlands. 8. Center of Supportive and Palliative Care, Rijnstate, Arnhem, The Netherlands.
Abstract
BACKGROUND: In many cases, life-sustaining treatment preferences are not timely discussed with older patients. Advance care planning (ACP) offers medical professionals an opportunity to discuss patients' preferences. We assessed how often these preferences were known when older patients were referred to the emergency department (ED) for an acute geriatric assessment. METHODS: We conducted a descriptive study on patients referred to the ED for an acute geriatric assessment in a Dutch hospital. Patients were referred by general practitioners (GPs), or in the case of nursing home residents, by elderly care physicians. The referring physician was asked if preferences regarding life-sustaining treatments were known. The primary outcome was the number of patients for whom preferences were known. Secondary outcomes included which preferences, and which variables predict known preferences. RESULTS: Between 2015 and 2017, 348 patients were included in our study. At least one preference regarding life-sustaining treatments was known at referral in 45.4% (158/348) cases. In these cases, cardiopulmonary resuscitation (CPR) policy was always included. Preferences regarding invasive ventilation policy and ICU admission were known in 17% (59/348) and 10.3% (36/348) of the cases respectively. Known preferences were more frequent in cases referred by the elderly care physician than the GP (P < 0.001). CONCLUSIONS: In less than half the patients, at least one preference regarding life-sustaining treatments was known at the time of referral to the ED for an acute geriatric assessment; in most cases it concerned CPR policy. We recommend optimizing ACP conversations in a non-acute setting to provide more appropriate, desired, and personalized care to older patients referred to the ED.
BACKGROUND: In many cases, life-sustaining treatment preferences are not timely discussed with older patients. Advance care planning (ACP) offers medical professionals an opportunity to discuss patients' preferences. We assessed how often these preferences were known when older patients were referred to the emergency department (ED) for an acute geriatric assessment. METHODS: We conducted a descriptive study on patients referred to the ED for an acute geriatric assessment in a Dutch hospital. Patients were referred by general practitioners (GPs), or in the case of nursing home residents, by elderly care physicians. The referring physician was asked if preferences regarding life-sustaining treatments were known. The primary outcome was the number of patients for whom preferences were known. Secondary outcomes included which preferences, and which variables predict known preferences. RESULTS: Between 2015 and 2017, 348 patients were included in our study. At least one preference regarding life-sustaining treatments was known at referral in 45.4% (158/348) cases. In these cases, cardiopulmonary resuscitation (CPR) policy was always included. Preferences regarding invasive ventilation policy and ICU admission were known in 17% (59/348) and 10.3% (36/348) of the cases respectively. Known preferences were more frequent in cases referred by the elderly care physician than the GP (P < 0.001). CONCLUSIONS: In less than half the patients, at least one preference regarding life-sustaining treatments was known at the time of referral to the ED for an acute geriatric assessment; in most cases it concerned CPR policy. We recommend optimizing ACP conversations in a non-acute setting to provide more appropriate, desired, and personalized care to older patients referred to the ED.
Authors: Bram Tilburgs; Raymond Koopmans; Myrra Vernooij-Dassen; Eddy Adang; Henk Schers; Steven Teerenstra; Marjolein van de Pol; Carolien Smits; Yvonne Engels; Marieke Perry Journal: J Am Med Dir Assoc Date: 2019-11-20 Impact factor: 4.669
Authors: Charlotte Scheerens; Luc Deliens; Simon Van Belle; Guy Joos; Peter Pype; Kenneth Chambaere Journal: NPJ Prim Care Respir Med Date: 2018-06-20 Impact factor: 2.871
Authors: Aline De Vleminck; Dirk Houttekier; Koen Pardon; Reginald Deschepper; Chantal Van Audenhove; Robert Vander Stichele; Luc Deliens Journal: Scand J Prim Health Care Date: 2013-12 Impact factor: 2.581