End-of-Life Care in the Nursing Home
2011; Elsevier BV; Volume: 12; Issue: 2 Linguagem: Inglês
10.1016/j.jamda.2010.11.012
ISSN1538-9375
Autores Tópico(s)Family and Patient Care in Intensive Care Units
ResumoEnd-of-life care focuses on the care of a person in the last 2 years of their life. Twenty percent of deaths in the United States are in nursing home residents. 1 Flory J. Yinong Y.X. Gurol I. et al. Place of death: U.S. trends since 1980. Health Aff (Millwood). 2004; 23: 194-200 Crossref PubMed Scopus (105) Google Scholar One third of persons in nursing homes die within 1 year of admission and approximately two-thirds die within 2 years. 2 Tsuji I. Whalen S. Finucane T.E. Predictors of nursing home placement in community-based long-term care. J Am Geriatr Soc. 1995; 43: 761-766 PubMed Google Scholar Thus, by definition, much of nursing home care is end-of-life care. End-of-life care is artificially divided into palliative care, where the focus is on curing as well as alleviating symptoms, as well as hospice care, which is legally defined as care in the last 6 months of life. It needs to be recognized that this distinction is artificial, particularly as physicians are notoriously bad at determining the remaining life span of a patient. In 2009, there were 2,450,000 deaths in the United States of which 41.6% were cared for by a hospice program at their time of death. 3 National Hospice and Palliative Care Organization. Available at: http://www.nhpco.org/i4a/index.cfm?pageid=5953 (membership required). Accessed November 20, 2010. Google Scholar Nearly half of these individuals were dead within 14 days of starting hospice care. Of these persons, 28.5% lived in either a nursing home or a residential facility. The top 5 diagnoses for hospice deaths were cancer (40.1%), unspecified disability (13.1%), heart disease (11.5%), dementia (11.2%), and lung disease (8.2%). This issue of the Journal focuses on the many aspects of end-of-life care in nursing homes. 4 Parker-Oliver D. Oliver D.B. End-of-life care in the nursing home: Redefining roles. J Am Med Dir Assoc. 2011; 12: 84-85 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 5 Wong R.Y. Improving end-of-life care for patients with non-cancer illness: The time is now. J Am Med Dir Assoc. 2011; 12: 86-87 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 6 Rodin M.B. Parker Oliver D. Hospice providers in the nursing homes: Why is a negative study important?. J Am Med Dir Assoc. 2011; 12: 88-90 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 7 Carlson M.D.A. Lim B. Meier D.E. Strategies and innovative models for delivering palliative care in nursing homes. J Am Med Dir Assoc. 2011; 12: 91-98 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar , 8 Kerwin D. Claus T.H. Severe Alzheimer's disease: Treatment effects on function and care requirements. J Am Med Dir Assoc. 2011; 12: 99-104 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar , 9 Woo J. Cheng J. Lee J. et al. Evaluation of a continuous quality improvement initiative for end-of-life care for older non-cancer patients. J Am Med Dir Assoc. 2011; 12: 105-113 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 10 Waldrop D.P. Nyquist K. The transition from routine care to end-of-life care in a nursing home: Exploring staff perspectives. J Am Med Dir Assoc. 2011; 12: 114-120 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 11 Azoulay D. Jacobs J.M. Cialic R. et al. Opioids, survival, and advanced cancer in the hospice setting. J Am Med Dir Assoc. 2011; 12: 129-134 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar , 12 Flock P. Terrien J. A pilot study to explore next of kin's perspective on end-of-life care in the nursing home. J Am Med Dir Assoc. 2011; 12: 135-142 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar , 13 Chu L.-W. Luk J.K.H. Hui E. et al. Advance directives and end-of-life care preferences among Chinese nursing home residents in Hong Kong. J Am Med Dir Assoc. 2011; 12: 143-152 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 14 Cesari M. Colloca G. Cerullo F. et al. Onco-geriatric approach for the management of older patients with cancer. J Am Med Dir Assoc. 2011; 12: 153-159 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Previously we have pointed out the importance of appropriate transitions to hospice care. 15 Morley J.E. Transitions. J Am Med Dir Assoc. 2010; 11: 607-611 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar , 16 Lester P. Stefanacci R.G. Chen D.B. Nursing home procedures on transitions of care. J Am Med Dir Assoc. 2009; 10: 634-638 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 17 Ouslander J.G. Perloe M. Givens J.H. et al. Reducing potentially avoidable hospitalizations of nursing home residents: Results of a pilot quality improvement project. J Am Med Dir Assoc. 2009; 10: 644-652 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 18 Steinberg K.E. Reducing unnecessary hospitalizations: Apple pie!. J Am Med Dir Assoc. 2009; 10: 595-596 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar This issue is in response to an article in the Journal in 2005 suggesting a dearth of research on end-of-life care in nursing homes. 19 Oliver D.P. Porock D. Zweig S. End-of-Life care in U.S. nursing homes: A review of the evidence. J Am Med Dir Assoc. 2005; 6: S21-S30 Abstract Full Text Full Text PDF PubMed Google Scholar
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