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Publicatie
Factors Related to Establishing a Comfort Care Goal in Nursing Home Patients with Dementia: A Cohort Study Among Family and Professional Caregivers
Tijdschriftbijdrage - Tijdschriftartikel
Abstract Background: Many people with dementia die in long-term care settings. These patients may benefit from a palliative care goal, focused on comfort. Admission may be a good time to revisit or develop care plans.
OBJECTIVE:
To describe care goals in nursing home patients with dementia and factors associated with establishing a comfort care goal.
DESIGN:
We used generalized estimating equation regression analyses for baseline analyses and multinomial logistic regression analyses for longitudinal analyses.
SETTING:
Prospective data collection in 28 Dutch facilities, mostly nursing homes (2007-2010; Dutch End of Life in Dementia study, DEOLD).
RESULTS:
Eight weeks after admission (baseline), 56.7% of 326 patients had a comfort care goal. At death, 89.5% had a comfort care goal. Adjusted for illness severity, patients with a baseline comfort care goal were more likely to have a religious affiliation, to be less competent to make decisions, and to have a short survival prediction. Their families were less likely to prefer life-prolongation and more likely to be satisfied with family-physician communication. Compared with patients with a comfort care goal established later during their stay, patients with a baseline comfort care goal also more frequently had a more highly educated family member.
CONCLUSIONS:
Initially, over half of the patients had a care goal focused on comfort, increasing to the large majority of the patients at death. Optimizing patient-family-physician communication upon admission may support the early establishing of a comfort care goal. Patient condition and family views play a role, and physicians should be aware that religious affiliation and education may also affect the (timing of) setting a comfort care goal.
OBJECTIVE:
To describe care goals in nursing home patients with dementia and factors associated with establishing a comfort care goal.
DESIGN:
We used generalized estimating equation regression analyses for baseline analyses and multinomial logistic regression analyses for longitudinal analyses.
SETTING:
Prospective data collection in 28 Dutch facilities, mostly nursing homes (2007-2010; Dutch End of Life in Dementia study, DEOLD).
RESULTS:
Eight weeks after admission (baseline), 56.7% of 326 patients had a comfort care goal. At death, 89.5% had a comfort care goal. Adjusted for illness severity, patients with a baseline comfort care goal were more likely to have a religious affiliation, to be less competent to make decisions, and to have a short survival prediction. Their families were less likely to prefer life-prolongation and more likely to be satisfied with family-physician communication. Compared with patients with a comfort care goal established later during their stay, patients with a baseline comfort care goal also more frequently had a more highly educated family member.
CONCLUSIONS:
Initially, over half of the patients had a care goal focused on comfort, increasing to the large majority of the patients at death. Optimizing patient-family-physician communication upon admission may support the early establishing of a comfort care goal. Patient condition and family views play a role, and physicians should be aware that religious affiliation and education may also affect the (timing of) setting a comfort care goal.
Tijdschrift: Journal of Palliative Medicine
ISSN: 1096-6218
Issue: 12
Volume: 17
Pagina's: 1317-1327
Jaar van publicatie:2014
Trefwoorden:Factors, related, establishing, comfort, care, goal, nursing, home, patients, dementia, cohort, study, family, professional, caregivers
CSS-citation score:1