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Home hospice

Kevin M Fain, Carlos Castillo-Salgado, David D Dore, Jodi B Segal, Andrew R Zullo, G Caleb Alexander
OBJECTIVE: We quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naïve prescribing. DESIGN: Cross-sectional study. SETTING: Linked Minimum Data Set (MDS) assessments; Online Survey, Certification and Reporting (OSCAR) records; and Medicare Part D claims. PARTICIPANTS: From a cross-section of all long-stay US nursing home residents in 2008 with an MDS assessment and Medicare Part D enrollment, we identified individuals (≥65 years old) who initiated transdermal fentanyl, excluding those with Alzheimer disease, severe cognitive impairment, cancer, or receipt of hospice care...
October 6, 2016: Journal of the American Medical Directors Association
Rachael L Morton, Angela C Webster, Kevin McGeechan, Kirsten Howard, Fliss E M Murtagh, Nicholas A Gray, Peter G Kerr, Michael J Germain, Paul Snelling
BACKGROUND AND OBJECTIVES: We aimed to determine the proportion of patients who switched to dialysis after confirmed plans for conservative care and compare survival and end of life care among patients choosing conservative care with those initiating RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A cohort study of 721 patients on incident dialysis, patients receiving transplants, and conservatively managed patients from 66 Australian renal units entered into the Patient Information about Options for Treatment Study from July 1 to September 30, 2009 were followed for 3 years...
October 3, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Shi-Yi Wang, Melissa D Aldridge, Maureen Canavan, Emily Cherlin, Elizabeth Bradley
OBJECTIVES: To identify hospice and patient characteristics associated with the use of continuous home care (CHC), and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment. METHODS: Using 100% fee-for-service Medicare claims data for beneficiaries aged 66 years or older who died between July and December 2011, we identified the percentage of hospice agencies in which patients used CHC in 2011 and determined hospice and patient characteristics associated with use of CHC...
September 30, 2016: Journal of Pain and Symptom Management
Meagan Cea, M C Reid, Charles Inturrisi, Lisa R Witkin, Holly G Prigerson, Yuhua Bao
CONTEXT: Knowledge is limited regarding pain assessment and management practices, as well as pain-related outcomes in hospice care. OBJECTIVES: To generate national estimates of pain assessment and management practices and outcomes of pain control among patients 65 years or older receiving hospice care in the U.S. and to identify hospice discharge and agency characteristics predicting study outcomes. METHODS: The 2007 National Home Health and Hospice Care Survey was analyzed...
September 29, 2016: Journal of Pain and Symptom Management
Melanie J Cozad, Lisa C Lindley, Sandy J Mixer
The use of agency nurses offers flexibility in filling registered nurse (RN) openings during times of shortage, yet little is known about their use in specialized palliative care. In an effort to fill this knowledge gap, this study determined whether significant relationships existed between full-time and part-time RN vacancies and the use of agency RNs within specialized hospices that deliver perinatal end-of-life care to women and their families in the event of miscarriage, ectopic pregnancy, or other neonatal complications resulting in death...
September 27, 2016: Policy, Politics & Nursing Practice
Zahra Rahemi, Christine Lisa Williams
This integrative review was conducted to examine the evidence for understanding diversity in end-of-life preferences among older adults of underrepresented groups. Findings from 21 studies were critically examined, grouped, and compared across studies, populations, and settings. Five major themes emerged: advance directives, hospice and palliative care, communication, knowledge and information, and home and family. Despite multidisciplinary attention, content and methodological limitations narrowed understanding of what matters most to these groups when making decisions at end of life...
September 26, 2016: ANS. Advances in Nursing Science
Kathryn S Agarwal, Rabia Kazim, Jiaqiong Xu, Soo Borson, George E Taffet
OBJECTIVES: To determine whether 30-day readmissions were associated with presence of cognitive impairment more in elderly adults with heart failure (HF) than in those with other diagnoses and whether medical teams recognized cognitive impairment. DESIGN: One-year prospective cohort quality improvement program of cognitive screening and retrospective chart review of documentation and outcomes. SETTING: Academic tertiary care hospital medical unit with a cardiovascular focus and an enhanced discharge program of individualized patient education...
September 27, 2016: Journal of the American Geriatrics Society
Clare Gardiner, Christine Ingleton, Tony Ryan, Sue Ward, Merryn Gott
BACKGROUND: It is important to understand the costs of palliative and end-of-life care in order to inform decisions regarding cost allocation. However, economic research in palliative care is very limited and little is known about the range and extent of the costs that are involved in palliative care provision. AIM: To undertake a systematic review of the health and social care literature to determine the range of financial costs related to a palliative care approach and explore approaches used to measure these costs...
September 26, 2016: Palliative Medicine
Hong-Lin Chen, Wang-Qin Shen, Peng Liu
Although it is among the most commonly used pressure ulcer risk assessment tools, the Braden Scale may lack strong predictive validity when used in the long-term care setting. A meta-analysis was conducted of English-language articles published in the PubMed database and Web of Science from the indices' inception through July 2015 to assess the predictive validity of the Braden Scale for pressure ulcers in long-term care residents. Search terms included pressure ulcer, pressure sore, bedsore, decubitus, long-term care, nursing home, skilled nursing facility, hospice, and Braden...
September 2016: Ostomy/wound Management
Carol Tishelman, Olav Lindqvist, Senada Hajdarevic, Birgit H Rasmussen, Ida Goliath
The web of relationships between wellbeing and the environments in which people live has long been recognized. However, relatively little research has been conducted about end-of-life surroundings from the perspective of the dying person. In this study, we investigate which aspects of their surroundings are particularly meaningful for the people inhabiting them in the last phases of life, based on participant-produced photographs with follow-up interviews. Twenty-three people were purposefully recruited via specialized in-patient palliative care/hospice units, specialized palliative care home care teams, and residential care facilities for the elderly...
November 2016: Social Science & Medicine
Denys T Lau, Lisa L Dwyer, Joseph W Shega
OBJECTIVES: To examine laxative use by individuals in hospice who were taking opioids during the last week of life. DESIGN: Retrospective cross-sectional. SETTING: 2007 National Home and Hospice Care Survey. PARTICIPANTS: Individuals in hospice aged 65 and older who were taking opioids during the last week of life (N = 2,825). MEASUREMENTS: Hospice staff were asked the names of all medications and drugs that participants were taking 7 days before and on the day of death while in hospice, including any standing, routine, or as-needed medications...
September 19, 2016: Journal of the American Geriatrics Society
Wei Gao, Julia Verne, Janet Peacock, Charles Stiller, Claudia Wells, Anne Greenough, Irene J Higginson
BACKGROUND: Efforts to improve end of life care (EoLC) have made tangible impacts on care in adults, including enabling more people to die at their preferred place of death (PoD), usually home or hospices. Little is known how the PoD in children and young people (CYP, ≤24 years) has changed over time, especially in the context of a series of national initiatives for EoLC improvement since the late 1990s. To inform evidence-based policy-making and service development, we evaluated the national trends of PoD and the associated factors in CYP who died with cancer...
2016: BMC Cancer
Susan C Miller, Julie C Lima, Orna Intrator, Edward Martin, Janet Bull, Laura C Hanson
OBJECTIVES: To evaluate how receipt and timing of nursing home (NH) palliative care consultations (primarily by nurse practitioners with palliative care expertise) are associated with end-of-life care transitions and acute care use DESIGN: Propensity score-matched retrospective cohort study. SETTING: Forty-six NHs in two states. PARTICIPANTS: Nursing home residents who died from 2006 to 2010 stratified according to days between initial consultation and death (≤7, 8-30, 31-60, 61-180)...
September 19, 2016: Journal of the American Geriatrics Society
Phoebe G Prioleau, Tacara N Soones, Katherine Ornstein, Meng Zhang, Cardinale B Smith, Ania Wajnberg
OBJECTIVES: To investigate factors associated with place of death of individuals in the Mount Sinai Visiting Doctors Program (MSVD). DESIGN: A retrospective chart review was performed of all MSVD participants who died in 2012 to assess predictors of place of death in the last month of life. SETTING: MSVD, a home-based primary and palliative care program in New York. PARTICIPANTS: MSVD participants who were discharged from the program because of death between January 2012 and December 2012 and died at home, in inpatient hospice, or in the hospital (N = 183)...
September 19, 2016: Journal of the American Geriatrics Society
Marieberta Vidal, David Hui, Janet Williams, Eduardo Bruera
CONTEXT: Decreased oral intake is very common at the end of life. Dehydration can aggravate symptoms such as fatigue, myoclonus and confusion. Intravenous hydration at home can be logistically difficult and expensive. Hypodermoclysis (HDC) is easy to provide and inexpensive; however, it is rarely used to provide hydration at the end of life in the home setting. OBJECTIVES: The purpose of this study was to determine if caregivers were capable of administering hypodermoclysis in the home hospice setting...
September 15, 2016: Journal of Pain and Symptom Management
Jerry H Gurwitz, Catherine DuBeau, Kathleen Mazor, Meera Sreedhara, Celeste Lemay, Ann Spenard, Michelle Pandolfi, Florence Johnson, Terry Field
OBJECTIVES: To describe the epidemiology of indwelling urinary catheter use in nursing homes (NHs). DESIGN: Observational cohort study. SETTING: A purposeful sampling strategy was used to identify a diverse sample of 28 Connecticut NHs, defined in terms of ownership, quality ratings, and bed size. PARTICIPANTS: Long-stay (>100 days) residents of study NHs with an indwelling urinary catheter present at any time over a 1-year period...
September 19, 2016: Journal of the American Geriatrics Society
Catherine E Dingley, Margaret Clayton, Djin Lai, Katherine Doyon, Maija Reblin, Lee Ellington
BACKGROUND: Activated patients have the skills, knowledge, and confidence to manage their care, resulting in positive outcomes such as lower hospital readmission and fewer adverse consequences due to poor communication with providers. Despite extensive evidence on patient activation, little is known about activation in the home hospice setting, when family caregivers assume more responsibility in care management. OBJECTIVE: We examined caregiver and nurse communication behaviors associated with caregiver activation during home hospice visits of patients with advanced cancer using a prospective observational design...
September 14, 2016: Cancer Nursing
Gabriel A Brooks, Sherri O Stuver, Yichen Zhang, Stephanie Gottsch, Belen Fraile, Kristen McNiff, Anton Dodek, Joseph O Jacobson
BACKGROUND: A majority of patients with poor-prognosis cancer express a preference for in-home death; however, in-hospital deaths are common. OBJECTIVE: We sought to identify characteristics associated with in-hospital death. DESIGN: Case series. SETTING/SUBJECTS: Commercially insured patients with cancer who died between July 2010 and December 2013 and who had at least two outpatient visits at a tertiary cancer center during the last six months of life...
September 14, 2016: Journal of Palliative Medicine
Jessica R Bauman, Zofia Piotrowska, Alona Muzikansky, Emily Gallagher, Emily Scribner, Brandon Temel, Lecia V Sequist, Rebecca S Heist, Jennifer S Temel
BACKGROUND/OBJECTIVE: Patients with metastatic nonsmall cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations benefit from improved survival and quality of life with EGFR-directed therapy. We sought to explore if these improvements in cancer care impacted the delivery of end-of-life (EOL) care in this population. DESIGN: We retrospectively reviewed medical records of patients cared for at our institution with the diagnosis of metastatic EGFR-mutant NSCLC who died by January 2015...
September 14, 2016: Journal of Palliative Medicine
Anna E Bone, Wei Gao, Barbara Gomes, Katherine E Sleeman, Matthew Maddocks, Juliet Wright, Deokhee Yi, Irene J Higginson, Catherine J Evans
OBJECTIVES: To identify factors associated with end-of-life (EoL) transition from usual place of care to the hospital as place of death for people aged 75 and older. DESIGN: Population-based mortality follow-back survey. SETTING: Deaths over 6 months in 2012 in two unitary authorities in England covering 800 square miles with more than 1 million residents. PARTICIPANTS: A random sample of people aged 75 and older who died in a care home or hospital and all those who died at home or in a hospice unit (N = 882)...
September 9, 2016: Journal of the American Geriatrics Society
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