Frailty, Complexity, and Priorities in the Use of Advanced Palliative Care Resources in Nursing Homes

Medicina (Lithuania) - Tập 57 Số 1 - Trang 70
Emilio Mota‐Romero1, Beatriz Tallón-Martín2, María P. García-Ruiz3, Daniel Puente‐Fernández4, María Paz García‐Caro5, Rafael Montoya‐Juárez5
1Primary Care Center Dr. Salvador Caballero García Andalusian, Health Service, Government of Andalusia, 18012 Granada, Andalusia, Spain
2Geroinnova Nursing-Home, Fuente Vaqueros, 18340 Granada, Andalusia, Spain
3Caridad y Consolación Nursing-Home, 23008 Jaén, Andalusia, Spain
4Doctoral Program in Clinical Medicine and Public Health, University of Granada, 18016 Granada, Andalusia, Spain
5Department of Nursing, Mind, Brain and Behaviour Research Institute, University of Granada, 18016 Granada, Andalusia, Spain

Tóm tắt

Background and objectives: This study aimed to determine the frailty, prognosis, complexity, and palliative care complexity of nursing home residents with palliative care needs and define the characteristics of the cases eligible for receiving advanced palliative care according to the resources available at each nursing home. Materials and Methods: In this multi-centre, descriptive, and cross-sectional study, trained nurses from eight nursing homes in southern Spain selected 149 residents with palliative care needs. The following instruments were used: the Frail-VIG index, the case complexity index (CCI), the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal), the palliative prognosis index, the Barthel index (dependency), Pfeiffer’s test (cognitive impairment), and the Charlson comorbidity index. A consensus was reached on the complexity criteria of the Diagnostic Instrument of Complexity in Palliative Care that could be addressed in the nursing home (no priority) and those that required a one-off (priority 2) or full (priority 1) intervention of advanced palliative care resources. Non-parametric tests were used to compare non-priority patients and patients with some kind of priority. Results: A high percentage of residents presented frailty (80.6%), clinical complexity (80.5%), and palliative care complexity (65.8%). A lower percentage of residents had a poor prognosis (10.1%) and an extremely poor prognosis (2%). Twelve priority 1 and 14 priority 2 elements were identified as not matching the palliative care complexity elements that had been previously identified. Of the studied cases, 20.1% had priority 1 status and 38.3% had priority 2 status. Residents with some kind of priority had greater levels of dependency (p < 0.001), cognitive impairment (p < 0.001), and poorer prognoses (p < 0.001). Priority 1 patients exhibited higher rates of refractory delirium (p = 0.003), skin ulcers (p = 0.041), and dyspnoea (p = 0.020). Conclusions: The results indicate that there are high levels of frailty, clinical complexity, and palliative care complexity in nursing homes. The resources available at each nursing home must be considered to determine when advanced palliative care resources are required.

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Tài liệu tham khảo

Routasalo, 2015, Older people in the emergency department: A literature review, Int. J. Older People Nurs., 10, 284, 10.1111/opn.12090

Dufour, I., Chouinard, M., Dubuc, N., Beaudin, J., Lafontaine, S., and Hudon, C. (2019). Factors associated with frequent use of emergency-department services in a geriatric population: A systematic review. BMC Geriatr., 19.

Pines, 2013, Emergency department visits for nonurgent conditions: Systematic literature review, Am. J. Manag. Care, 19, 47

Hwang, 2013, Transforming emergency care for older adults, Health Aff., 32, 2116, 10.1377/hlthaff.2013.0670

Mackinnon, 2011, The association between a prolonged stay in the emergency department and adverse events in older patients admitted to hospital: A retrospective cohort study, BMJ Qual. Saf., 20, 564, 10.1136/bmjqs.2009.034926

Reitinger, 2013, Palliative care in long-term care settings for older people:findings from an EAPC taskforce, Eur. J. Palliat. Care, 20, 251

Spasova, S., Baeten, R., Coster, S., Ghailani, D., Peña-Casas, R., and Vanhercke, B. (2018). Challenges in Long-Term Care in Europe, European Commission. A study of national policies, European Social Policy Network (ESPN).

Blay, 2013, Identificación de personas con enfermedades crónicas avanzadas y necesidad de atención paliativa en servicios sanitarios y sociales: Elaboración del instrumento NECPAL CCOMS-ICO©, Med. Clin., 140, 241, 10.1016/j.medcli.2012.06.027

Carron, 2017, Nursing home residents at the Emergency Department: A 6-year retrospective analysis in a Swiss academic hospital, Intern Emerg. Med., 12, 229, 10.1007/s11739-016-1459-x

Coderch, 2018, Hospital emergencies arising from nursing homes in a region: Evolution, characteristics and appropriateness, Gac. Sanit., 32, 27

Hermans, 2017, Palliative care needs and symptoms of nursing home residents with and without dementia: A cross-sectional study, Geriatr. Gerontol. Int., 17, 1501, 10.1111/ggi.12903

Blay, 2019, Busca tu 1%: Prevalencia y mortalidad de una cohorte comunitaria de personas con enfermedad crónica avanzada y necesidades paliativas, Aten Primaria, 51, 71, 10.1016/j.aprim.2017.07.004

Liyanage, 2018, Identifying palliative care needs in residential care, Aust. J. Prim. Health, 24, 524, 10.1071/PY17168

Hendriks, 2015, From admission to death: Prevalence and course of pain, agitation, and shortness of breath, and treatment of these symptoms in nursing home residents with dementia, J. Am. Med. Dir. Assoc., 16, 475, 10.1016/j.jamda.2014.12.016

Costa, V., Earle, C.C., Esplen, M.J., Fowler, R., Goldman, R., Grossman, D., Levin, L., Manuel, D.G., Sharkey, S., and Tanueputro, P. (2016). The determinants of home and nursing home death: A systematic review and meta-analysis. BMC Palliat. Care, 15.

Jansen, 2014, Drug treatment at the end of life: An epidemiologic study in nursing homes, Scand. J. Prim. Health Care, 32, 187, 10.3109/02813432.2014.972068

2019, Prognostic Models Associated with 6-Month Survival of Patients Admitted to Nursing Homes, Gerontology, 65, 40, 10.1159/000490243

Goodman, 2017, End of life care in nursing homes in Spain: Exploratory analysis and evidences of validity of a new scale, Appl. Nurs. Res., 37, 6, 10.1016/j.apnr.2017.07.001

Morris, 2017, Caring About Residents’ Experiences and Symptoms (CARES) Program: A Model of Palliative Care Consultation in the Nursing Home, Am. J. Hosp. Palliat. Care, 34, 466, 10.1177/1049909116641606

Miller, 2016, Palliative Care Consultations in Nursing Homes and Reductions in Acute Care Use and Potentially Burdensome End-of-Life Transitions, J. Am. Geriatr. Soc., 64, 2280, 10.1111/jgs.14469

Martin-Roselló, M. (2021, January 13). IDC-PAL: Instrumento Diagnóstico de la Complejidad en Cuidados Paliativos: Documento de Apoyo al PAI Cuidados Paliativos. Available online: http://www.repositoriosalud.es/handle/10668/1530.

2017, El valor del Instrumento Diagnóstico de la Complejidad en Cuidados Paliativos para identificar la complejidad en pacientes tributarios de cuidados paliativos, Med. Pal., 24, 196

Consejería de Asuntos Sociales (2007). Normativa Sobre Centros Residenciales de Personas Mayores, Junta de Andalucía.

Otero, 2012, Utilización de un proxy al índice de Charlson para estudiar la asociación entre comorbilidad y mortalidad a corto y largo plazo en mayores, Aten Prim., 44, 153, 10.1016/j.aprim.2011.01.012

Bilbao, 2018, Psychometric characteristics of the Spanish version of the Barthel Index, Aging Clin. Exp. Res., 30, 489, 10.1007/s40520-017-0809-5

Vilches, 2001, Adaptación y validación al castellano del cuestionario de Pfeiffer (SPMSQ) para detectar la existencia de deterioro cognitivo en personas mayores de 65 años, Med. Clín., 117, 129

Mann, 2013, Searching for an operational definition of frailty: A delphi method based consensus statement. The frailty operative definition-consensus conference project, J. Gerontol., 68, 62, 10.1093/gerona/gls119

Martori, 2017, Índice frágil-VIG: Diseño y evaluación de un índice de fragilidad basado en la Valoración Integral Geriátrica [Frail-VIG index: Design and evaluation of a new frailty index based on the Comprehensive Geriatric Assessment], Rev. Esp. Ger. Geron., 52, 119, 10.1016/j.regg.2016.09.003

Ruiz-Miralles, M.L., Richart-Martínez, M., García-Sanjuan, S., Gallud Romero, J., and Cabañero-Martínez, M.J. (2020). Design and validation of a complex case evaluation index. Sist. Sanit. Navar., in press.

Safford, 2007, Patient complexity: More than comorbidity. The vector model of complexity, J. Gen. Int. Med., 22, 382, 10.1007/s11606-007-0307-0

2013, Recalibración del Palliative Prognostic Index en pacientes con enfermedades médicas avanzadas, Rev. Clin. Esp., 213, 323, 10.1016/j.rce.2013.04.007

2012, Utilidad del Palliative Performance Scale v2 para la estimación de supervivencia en enfermos con cáncer avanzado, Med. Paliat., 19, 133, 10.1016/j.medipa.2012.01.009

Kojima, 2015, Prevalence of Frailty in Nursing Homes: A Systematic Review and Meta-Analysis, J. Am. Med. Dir. Assoc., 16, 940, 10.1016/j.jamda.2015.06.025

Amblàs-Novellas, J., Martori, J.C., Espaulella, J., Oller, R., Molist-Brunet, N., Inzitari, M., and Romero-Ortuno, R. (2018). Frail-VIG index: A concise frailty evaluation tool for rapid geriatric assessment. BMC Geriatr., 18.

2016, Comparing theoretical and real complex chronic populations: Cross-sectional study, Int. J. Integr. Care, 18, 16

Grant, 2011, Defining patient complexity from the primary care physician’s perspective: A cohort study, Ann. Intern Med., 155, 797, 10.7326/0003-4819-155-12-201112200-00001

Amblàs-Novellas, J., Santaeugènia, S.J., Vela, E., Clèries, M., and Contel, J.C. (2020). What lies beneath: A retrospective, population-based cohort study investigating clinical and resource-use characteristics of institutionalized older people in Catalonia. BMC Geriatr., 20.

2017, Evaluación de necesidades paliativas en el paciente con enfermedad renal crónica en hemodiálisis, Enfer. Nefrol., 20, 215, 10.4321/S2254-28842017000300003

Bolt, 2019, Nursing staff needs in providing palliative care for people with dementia at home or in long-term care facilities: A scoping review, Int. J. Nurs. Stud., 96, 143, 10.1016/j.ijnurstu.2018.12.011

2013, Delirium en centros residenciales para personas mayores. Estudio de la prevalencia y los factores asociados [Delirium in nursing homes. Prevalence and risk factors], Rev. Esp. Ger. Geron., 48, 177, 10.1016/j.regg.2012.10.005

Kristiansen, 2019, Nurses’ experiences of caring for older patients afflicted by delirium in a neurological department, J. Clin. Nurs., 28, 920, 10.1111/jocn.14709

Alvariza, 2017, Palliative care during the final week of life of older people in nursing homes: A register-based study, Pal. Suppor. Care, 15, 417, 10.1017/S1478951516000948

Janus, 2016, Psychotropic drug prescriptions in Western European nursing homes, Int. Psychogeriatr., 28, 1775, 10.1017/S1041610216001150

2016, A Review of Adverse Outcomes Associated with Psychoactive Drug Use in Nursing Home Residents with Dementia, Drugs Aging, 33, 865, 10.1007/s40266-016-0414-x

Hertogh, 2016, Prospective Observations of Discomfort, Pain, and Dyspnea in Nursing Home Residents With Dementia and Pneumonia, J. Am. Med. Dir. Assoc., 17, 128, 10.1016/j.jamda.2015.08.010

Anthony, 2019, Prevalence of pressure ulcers in long-term care: A global review, J. Wound Care, 28, 702, 10.12968/jowc.2019.28.11.702

Wilson, 2019, The direct cost of pressure injuries in an Australian residential aged care setting, Int. Wound J., 16, 64, 10.1111/iwj.12992

Puente-Fernández, D., Roldán-López, C.B., Campos-Calderón, C.P., Hueso-Montoro, C., García-Caro, M.P., and Montoya-Juarez, R. (2020). Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes. J. Clin. Med., 9.

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Medicina (Lithuania)

Tập 57 Số 1

70

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