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End of life care practice and symptom management outcomes of nursing home residents with dementia: secondary analyses of IQUARE trial
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
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Number of Authors: 72019 (English)In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 10, no 6, p. 947-955Article in journal (Refereed) Published
Abstract [en]

Purpose End-of-life care is a central issue in nursing homes. Poor care outcomes have been reported, especially among residents with dementia. Our aim was two-fold: to assess whether the diagnosis of dementia was associated with specific patterns of care and symptom management for residents with dementia during the last 6 months of life, and to compare these patterns of care between residents with dementia who died within 6 months and those who survived longer. Methods Secondary prospective analyses of the IQUARE trial (trial registration number NCT01703689). 175 nursing homes in South West France. Residents with and without dementia at baseline (May-June 2011), stratified according to their vital status at 6-month follow-up. Results Of 6275 residents enrolled in IQUARE study (including 2688 with dementia), 494 (7.9%) died within 6 months. Compared to residents without dementia (n = 254), those with dementia (n = 240) were less likely to be self-sufficient (OR = 0.08, 95% CI 0.01-0.64). They were more likely to have physical restraints (OR = 1.65, 95% CI 1.08-2.51) and less likely to be prescribed benzodiazepines (OR = 0.58, 95% CI 0.38-0.88). Among residents with dementia, those who died during the first 6 months of follow-up were more likely to be identified with a formal end-of-life status (OR = 5.71, 95% CI 3.48-9.37) although such identification remains low with only 15% of them. They were more likely to experience pain (OR = 1.43, 95% CI 1.04-1.97) and to be physically restrained (OR = 1.46, 95% CI 1.08-1.98). However, pain relief and psychological distress management were not improved. Conclusions Poor quality indicators such as physical restraints are associated with end-of-life care for residents with dementia. Among symptom management outcomes, pain medication remains low even if pain complaint increased at life end.

Place, publisher, year, edition, pages
2019. Vol. 10, no 6, p. 947-955
Keywords [en]
Palliative care, Dementia, Nursing homes, Symptom management, End-of-life, Physical restraint
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:su:diva-176673DOI: 10.1007/s41999-019-00234-9ISI: 000496659300015OAI: oai:DiVA.org:su-176673DiVA, id: diva2:1379416
Available from: 2019-12-17 Created: 2019-12-17 Last updated: 2019-12-17Bibliographically approved

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