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Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective

Åvik Persson, Helene LU ; Sandgren, Anna; Fürst, Carl Johan LU ; Ahlström, Gerd LU and Behm, Lina LU (2018) In BMC Geriatrics 18(134). p.1-11
Abstract
Background
Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team’s perspective.

Methods
The focus group method was used to... (More)
Background
Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team’s perspective.

Methods
The focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey.

Results
The analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category “Going into a bubble” illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category “The body begins to shut down” illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death.

Conclusions
This study conveys new knowledge concerning the multidisciplinary team’s collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Dying, Multidisciplinary team, Nursing home, Older person, Palliative Care, Signs
in
BMC Geriatrics
volume
18
issue
134
pages
1 - 11
publisher
BioMed Central
external identifiers
  • scopus:85048634189
ISSN
1471-2318
DOI
10.1186/s12877-018-0825-0
language
English
LU publication?
yes
id
0ddc4a55-b04d-46d8-adba-17f657f7ead5
date added to LUP
2018-06-20 13:47:02
date last changed
2019-03-08 03:27:10
@article{0ddc4a55-b04d-46d8-adba-17f657f7ead5,
  abstract     = {Background<br/>Nursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team’s perspective.<br/><br/>Methods<br/>The focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey.<br/><br/>Results<br/>The analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category “Going into a bubble” illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category “The body begins to shut down” illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death.<br/><br/>Conclusions<br/>This study conveys new knowledge concerning the multidisciplinary team’s collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.},
  articleno    = {134},
  author       = {Åvik Persson, Helene and Sandgren, Anna and Fürst, Carl Johan and Ahlström, Gerd and Behm, Lina},
  issn         = {1471-2318},
  keyword      = {Dying,Multidisciplinary team,Nursing home,Older person,Palliative Care,Signs},
  language     = {eng},
  month        = {06},
  number       = {134},
  pages        = {1--11},
  publisher    = {BioMed Central},
  series       = {BMC Geriatrics},
  title        = {Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team’s perspective},
  url          = {http://dx.doi.org/10.1186/s12877-018-0825-0},
  volume       = {18},
  year         = {2018},
}