scholarly journals Health Care Outcomes and Advance Care Planning in Older Adults Who Receive Home-Based Palliative Care: A Pilot Cohort Study

2015 ◽  
Vol 18 (1) ◽  
pp. 38-44 ◽  
Author(s):  
Christina Y. Chen ◽  
Bjorg Thorsteinsdottir ◽  
Stephen S. Cha ◽  
Gregory J. Hanson ◽  
Stephanie M. Peterson ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Palliative Care ◽  
Cohort Study ◽  
Advance Care Planning ◽  
Care Planning ◽  
Health Care Outcomes ◽  
Home Based ◽  
Care Outcomes ◽  
Advance Care

IMPROVING END-OF-LIFE CARE AND ADVANCE CARE PLANNING FOR FRAIL OLDER ADULTS IN CANADA

2018 ◽  
pp. 1-7
Author(s):  
J. Downar ◽  
P. Moorhouse ◽  
R. Goldman ◽  
D. Grossman ◽  
S. Sinha ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Frail Older Adults ◽  
Key Concepts ◽  
Advance Care

We present five Key Concepts that describe priorities for improving end-of-life care for frail older adults in Canada, and recommendations based on each Key Concept. Key Concept #1: Our end-of-life care system is focused on cancer, not frailty. Key Concept #2: We need better strategies to systematically identify frail older adults who would benefit from a palliative approach. Key Concept #3: The majority of palliative and end-of-life care will be, and should be, provided by clinicians who are not palliative care specialists. Key Concept #4: Organizational change and innovative funding models could deliver far better end-of-life care to frail individuals for less than we are currently spending. Key Concept #5: Improving the quality and quantity of advance care planning for frail older adults could reduce unwanted intensive care and costs at the end of life, and improve the experience for individuals and family members alike.

Connecting Personal Experiences of Loss and Professional Practices in Advance Care Planning and End-of-Life Care: A Survey of Providers

2018 ◽  
Vol 35 (11) ◽  
pp. 1369-1376
Author(s):  
Cara L. Wallace ◽  
Dulce M. Cruz-Oliver ◽  
Jennifer E. Ohs ◽  
Leslie Hinyard
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Professional Practices ◽  
Care Planning ◽  
Personal Experiences ◽  
Advance Care ◽  
Hospice And Palliative Care ◽  
Eol Care

Background: Although practitioners overwhelmingly agree on the importance of advance care planning (ACP) and preparing for the end of life (EOL), the process is fraught with barriers. Objective: The goal of this research was to explore potential connections between providers’ own personal experiences and current professional practices in ACP and EOL care. Design: A cross-sectional survey design, gathering voluntary, anonymous responses from participants between August and December 2016. The survey sought information from providers in 3 distinct areas: (1) personal experiences of loss, (2) personal ACP, and (3) professional practices related to ACP and EOL care. Setting/Participants: One hundred and ninety health-care professionals (primarily physicians, nurses, and social workers) participated in the survey across a greater, Metropolitan area in the Midwest. Measurements: Questions for professional practices were subscales from the End-of-Life Professional Caregiver Survey: Patient- and Family-Centered Communication (PFCC) and Effective Care Delivery (ECD). Questions developed by the research team were evaluated by judges chosen for clinical and/or research expertise. Results: Numerous connections were found between professionals’ histories of loss, personal ACP, and professional practices. For example, both clinicians with personal experience caring for someone who is dying and clinicians who had completed their own ACP scored higher in both PFCC and ECD and were more likely to refer patients to hospice and palliative care. Conclusions: Results support educational interventions involving opportunities for reflection and completion and communication about ACP. Additionally, educational opportunities for students in health care should focus on incorporating both ACP and greater exposure to hospice and palliative care.

Awareness and Attitudes Toward Advance Care Planning Among Community-Dwelling Older Adults in China: A Mixed-Methods Study

2020 ◽  
Vol 37 (9) ◽  
pp. 743-749
Author(s):  
Tingting Zhu ◽  
Jing Zhang ◽  
Yan Shi ◽  
Jingna Yi ◽  
Qiushi Zhang ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Advance Care Planning ◽  
Mainland China ◽  
Community Dwelling ◽  
Care Planning ◽  
Validated Questionnaire ◽  
Advance Care ◽  
Specific Implementation ◽  
Community Dwelling Older Adults

Context: Quality of palliative care and death in mainland China is at a low level of the rest of the world, the public is lacked of proper understanding of the relevant information is one of the important reasons. There has been a shift in policy of palliative care in municipalities recently in mainland China. Objectives: To measure the advance care planning-related knowledge and attitudes of Chinese community-dwelling older adults, in the hope of presenting a specific implementation of the strategy. Methods: We conducted a mixed-method sequential explanatory study, composed of a quantitative survey followed by qualitative interviews. The first quantitative phase included 523 community elderly individuals, who completed a validated questionnaire. After statistical analysis, a semistructured qualitative interview has been developed and conducted with 16 of them in order to help explain findings obtained in the first phase. Results: The study was conducted with 523 community-dwelling older adults. The cognition level of advance care planning (ACP) was low, and attitude toward ACP was active. Living alone or living with a spouse (and children), have a religion, poor health condition, and life-sustaining treatment-related experience can affect how they behave with ACP. However, lack of trust in ACP, lack of life education and relevant legislation or policies, and Chinese traditional culture and emotion may impede their take-up. Conclusions: This study indicated that the awareness and participation of ACP of community-dwelling older adults in mainland China are not enough. The influence of national conditions and culture should be fully considered during the process of ACP development.

End-of-life care in nursing home settings: Do race or age matter?

2008 ◽  
Vol 6 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Kimberly S. Reynolds ◽  
Laura C. Hanson ◽  
Martha Henderson ◽  
Karen E. Steinhauser
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Pain Management ◽  
Nursing Homes ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

ABSTRACTObjective:One-quarter of all U.S. chronic-disease deaths occur in nursing homes, yet few studies examine palliative care quality in these settings. This study tests whether racial and/or age-based differences in end-of-life care exist in these institutional settings.Methods:We abstracted residents' charts (N = 1133) in 12 nursing homes. Researchers collected data on indicators of palliative care in two domains of care—advance care planning and pain management—and on residents' demographic and health status variables. Analyses tested for differences by race and age.Results:White residents were more likely than minorities to have DNR orders (69.5% vs. 37.3%), living wills (39% vs. 5%), and health care proxies (36.2% vs. 11.8%; p < .001 for each). Advance directives were highly and positively correlated with age. In-depth advance care planning discussions between residents, families, and health care providers were rare for all residents, irrespective of demographic characteristics. Nursing staff considered older residents to have milder and less frequent pain than younger residents. We found no disparities in pain management based on race.Significance of results:To the extent that advance care planning improves care at the end of life, racial minorities in nursing homes are disadvantaged compared to their white fellow residents. Focusing on in-depth discussions of values and goals of care can improve palliative care for all residents and may help to ameliorate racial disparities in end-of-life care. Staff should consider residents of all ages as appropriate recipients of advance care planning efforts and should be cognizant of the fact that individuals of all ages can experience pain. Nursing homes may do a better job than other health care institutions in eliminating racial disparities in pain management.

scholarly journals Disparities in Video and Telephone Visits Among Older Adults During the COVID-19 Pandemic: Cross-Sectional Analysis

JMIR Aging ◽  
10.2196/23176 ◽  
2020 ◽  
Vol 3 (2) ◽  
pp. e23176 ◽  
Author(s):  
Christopher H Schifeling ◽  
Prajakta Shanbhag ◽  
Angene Johnson ◽  
Riannon C Atwater ◽  
Claire Koljack ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Advance Care Planning ◽  
Patient Characteristics ◽  
Care Planning ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Advance Care ◽  
Sectional Analysis ◽  
White Patients

Background Telephone and video telemedicine appointments have been a crucial service delivery method during the COVID-19 pandemic for maintaining access to health care without increasing the risk of exposure. Although studies conducted prior to the pandemic have suggested that telemedicine is an acceptable format for older adults, there is a paucity of data on the practical implementation of telemedicine visits. Due to prior lack of reimbursement for telemedicine visits involving nonrural patients, no studies have compared telephone visits to video visits in geriatric primary care. Objective This study aimed to determine (1) whether video visits had longer durations, more visit diagnoses, and more advance care planning discussions than telephone visits during the rapid implementation of telemedicine in the COVID-19 pandemic, and (2) whether disparities in visit type existed based on patient characteristics. Methods We conducted a retrospective, cross-sectional analysis of patients seen at two geriatric clinics from April 23 to May 22, 2020. Approximately 25% of patients who had telephone and video appointments during this time underwent chart review. We analyzed patient characteristics, visit characteristics, duration of visits, number of visit diagnoses, and the presence of advance care planning discussion in clinical documentation. Results Of the 190 appointments reviewed, 47.4% (n=90) were video visits. Compared to telephone appointments, videoconferencing was, on average, 7 minutes longer (mean 37.3 minutes, SD 10 minutes; P<.001) and had, on average, 1.2 more visit diagnoses (mean 5.7, SD 3; P=.001). Video and telephone visits had similar rates of advance care planning. Furthermore, hearing, vision, and cognitive impairment did not result in different rates of video or telephone appointments. Non-White patients, patients who needed interpreter services, and patients who received Medicaid were less likely to have video visits than White patients, patients who did not need an interpreter, and patients who did not receive Medicaid, respectively (P=.003, P=.01, P<.001, respectively). Conclusions Although clinicians spent more time on video visits than telephone visits, more than half of this study’s older patients did not use video visits, especially if they were from racial or ethnic minority backgrounds or Medicaid beneficiaries. This potential health care disparity merits greater attention.

scholarly journals Disparities in Video and Telephone Visits Among Older Adults During the COVID-19 Pandemic: Cross-Sectional Analysis (Preprint)

2020 ◽  
Author(s):  
Christopher H Schifeling ◽  
Prajakta Shanbhag ◽  
Angene Johnson ◽  
Riannon C Atwater ◽  
Claire Koljack ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Advance Care Planning ◽  
Patient Characteristics ◽  
Care Planning ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Advance Care ◽  
Sectional Analysis ◽  
White Patients

BACKGROUND Telephone and video telemedicine appointments have been a crucial service delivery method during the COVID-19 pandemic for maintaining access to health care without increasing the risk of exposure. Although studies conducted prior to the pandemic have suggested that telemedicine is an acceptable format for older adults, there is a paucity of data on the practical implementation of telemedicine visits. Due to prior lack of reimbursement for telemedicine visits involving nonrural patients, no studies have compared telephone visits to video visits in geriatric primary care. OBJECTIVE This study aimed to determine (1) whether video visits had longer durations, more visit diagnoses, and more advance care planning discussions than telephone visits during the rapid implementation of telemedicine in the COVID-19 pandemic, and (2) whether disparities in visit type existed based on patient characteristics. METHODS We conducted a retrospective, cross-sectional analysis of patients seen at two geriatric clinics from April 23 to May 22, 2020. Approximately 25% of patients who had telephone and video appointments during this time underwent chart review. We analyzed patient characteristics, visit characteristics, duration of visits, number of visit diagnoses, and the presence of advance care planning discussion in clinical documentation. RESULTS Of the 190 appointments reviewed, 47.4% (n=90) were video visits. Compared to telephone appointments, videoconferencing was, on average, 7 minutes longer (mean 37.3 minutes, SD 10 minutes; <i>P</i>&lt;.001) and had, on average, 1.2 more visit diagnoses (mean 5.7, SD 3; <i>P</i>=.001). Video and telephone visits had similar rates of advance care planning. Furthermore, hearing, vision, and cognitive impairment did not result in different rates of video or telephone appointments. Non-White patients, patients who needed interpreter services, and patients who received Medicaid were less likely to have video visits than White patients, patients who did not need an interpreter, and patients who did not receive Medicaid, respectively (<i>P</i>=.003, <i>P</i>=.01, <i>P</i>&lt;.001, respectively). CONCLUSIONS Although clinicians spent more time on video visits than telephone visits, more than half of this study’s older patients did not use video visits, especially if they were from racial or ethnic minority backgrounds or Medicaid beneficiaries. This potential health care disparity merits greater attention.

Examining Racial Differences in the Informal Discussion of Advance Care Planning Among Older Adults: Application of the Andersen Model of Health Care Utilization

2021 ◽  
pp. 073346482199361
Author(s):  
Zainab Suntai ◽  
Hyunjin Noh ◽  
Cho Rong Won
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Racial Differences ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Utilization ◽  
Care Planning ◽  
Life Care ◽  
Power Of Attorney ◽  
Advance Care

Objectives: The purpose of this study was to examine racial differences in the discussion of advance care planning among older adults using Andersen’s behavioral model of health care utilization. Method: This cross-sectional study utilized data from the 2018 National Health and Aging Trends Study. Weighted multivariable logistic regressions were used to predict advance care planning discussion ( n = 1,326). Results: After accounting for predisposing, enabling, and need factors, Black older adults were less likely to discuss end-of-life care (odds ratio [OR] = .527) and medical power of attorney (OR = .531) compared with Whites. Hispanic older adults were also less likely to discuss end-of-life care (OR = .389) and power of attorney (OR = .384) compared with Whites. Discussion: These results point to significant racial disparities in advance care planning discussions among older adults and call for future examinations of cultural, historical, and systemic factors that could influence the discussion of advance care planning among this population.

Sign in / Sign up

Export Citation Format

Share Document