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Palliative care during the final week of life of older people in nursing homes : A register-based study

Smedbäck, Jonas; Öhlén, Joakim; Årestedt, Kristofer; Alvariza, Anette; Fürst, Carl Johan LU and Håkanson, Cecilia (2017) In Palliative and Supportive Care 15(4). p.417-424
Abstract

Objective:: Our aim was to explore the presence of symptoms, symptom relief, and other key aspects of palliative care during the final week of life among older people residing in nursing homes. Method:: Our study employed data from the Swedish Palliative Care Register on all registered individuals aged 60 and older who had died in nursing homes during the years 2011 and 2012. Variables pertaining to monitoring and treatment of symptoms, end-of-life discussions, circumstances around the death, and the individual characteristics of deceased individuals were explored using descriptive statistics. Results:: The most common underlying causes of death among the 49,172 deceased nursing home residents were circulatory diseases (42.2%) and... (More)

Objective:: Our aim was to explore the presence of symptoms, symptom relief, and other key aspects of palliative care during the final week of life among older people residing in nursing homes. Method:: Our study employed data from the Swedish Palliative Care Register on all registered individuals aged 60 and older who had died in nursing homes during the years 2011 and 2012. Variables pertaining to monitoring and treatment of symptoms, end-of-life discussions, circumstances around the death, and the individual characteristics of deceased individuals were explored using descriptive statistics. Results:: The most common underlying causes of death among the 49,172 deceased nursing home residents were circulatory diseases (42.2%) and dementia (22.7%). The most prevalent symptom was pain (58.7%), followed by rattles (42.4%), anxiety (33.0%), confusion (21.8%), shortness of breath (14.0%), and nausea (11.1%). Pain was the symptom with the highest degree of total relief (46.3%), whereas shortness of breath and confusion were totally relieved in 6.1 and 4.3% of all individuals, respectively. The use of valid instruments for symptom assessment was reported for pain in 12.3% and for other symptoms in 7.8% of subjects. The most prevalent individual prescriptions for injection PRN (pro re nata, according to circumstances) were for pain treatment (79.5%) and rattles (72.8%). End-of-life discussions were performed with 27.3% of all the deceased individuals and with 53.9% of their relatives. Of all individuals, 82.1% had someone present at death, and 15.8% died alone. Of all the nursing home resident deaths recorded, 45.3% died in their preferred place. Significance of results:: There were large variations in degree of relief from different symptoms during the final week of life. Pain was the most prevalent symptom, and it was also the symptom with the highest proportion of total/partial relief. Other symptoms were less prevalent but also less well-relieved. Our results indicate a need for improvement of palliative care in nursing home settings, focusing on management of distressing symptoms and promotion of end-of-life discussions.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
End of life, Nursing home, Older people, Palliative care, Quality of care, Symptom relief
in
Palliative and Supportive Care
volume
15
issue
4
pages
417 - 424
publisher
Cambridge University Press
external identifiers
  • scopus:85008385996
  • wos:000405604300003
ISSN
1478-9515
DOI
10.1017/S1478951516000948
language
English
LU publication?
yes
id
7b5388f3-d41c-4ca8-b929-f6ab82234166
date added to LUP
2017-02-01 13:08:22
date last changed
2018-07-08 04:21:00
@article{7b5388f3-d41c-4ca8-b929-f6ab82234166,
  abstract     = {<p>Objective:: Our aim was to explore the presence of symptoms, symptom relief, and other key aspects of palliative care during the final week of life among older people residing in nursing homes. Method:: Our study employed data from the Swedish Palliative Care Register on all registered individuals aged 60 and older who had died in nursing homes during the years 2011 and 2012. Variables pertaining to monitoring and treatment of symptoms, end-of-life discussions, circumstances around the death, and the individual characteristics of deceased individuals were explored using descriptive statistics. Results:: The most common underlying causes of death among the 49,172 deceased nursing home residents were circulatory diseases (42.2%) and dementia (22.7%). The most prevalent symptom was pain (58.7%), followed by rattles (42.4%), anxiety (33.0%), confusion (21.8%), shortness of breath (14.0%), and nausea (11.1%). Pain was the symptom with the highest degree of total relief (46.3%), whereas shortness of breath and confusion were totally relieved in 6.1 and 4.3% of all individuals, respectively. The use of valid instruments for symptom assessment was reported for pain in 12.3% and for other symptoms in 7.8% of subjects. The most prevalent individual prescriptions for injection PRN (pro re nata, according to circumstances) were for pain treatment (79.5%) and rattles (72.8%). End-of-life discussions were performed with 27.3% of all the deceased individuals and with 53.9% of their relatives. Of all individuals, 82.1% had someone present at death, and 15.8% died alone. Of all the nursing home resident deaths recorded, 45.3% died in their preferred place. Significance of results:: There were large variations in degree of relief from different symptoms during the final week of life. Pain was the most prevalent symptom, and it was also the symptom with the highest proportion of total/partial relief. Other symptoms were less prevalent but also less well-relieved. Our results indicate a need for improvement of palliative care in nursing home settings, focusing on management of distressing symptoms and promotion of end-of-life discussions.</p>},
  author       = {Smedbäck, Jonas and Öhlén, Joakim and Årestedt, Kristofer and Alvariza, Anette and Fürst, Carl Johan and Håkanson, Cecilia},
  issn         = {1478-9515},
  keyword      = {End of life,Nursing home,Older people,Palliative care,Quality of care,Symptom relief},
  language     = {eng},
  month        = {01},
  number       = {4},
  pages        = {417--424},
  publisher    = {Cambridge University Press},
  series       = {Palliative and Supportive Care},
  title        = {Palliative care during the final week of life of older people in nursing homes : A register-based study},
  url          = {http://dx.doi.org/10.1017/S1478951516000948},
  volume       = {15},
  year         = {2017},
}