Researchers examined data on 228 residents of three northern
California nursing homes and found that 157 of them, or 69 percent,
were eligible for palliative care based on the types of health
issues they had. But none of them were receiving palliative care,
and only two were getting hospice services.
“We know from several studies that palliative care is often
initiated too late in the disease trajectory and most nursing home
residents die without the benefit of palliative care or with
palliation delayed until the last days of life,” said lead study
author Caroline Stephens of the University of California, San
Francisco School of Nursing.
“We also know that palliative care in nursing homes is associated
with improved quality of care, satisfaction with care, enhanced
symptom management and fewer trips to the emergency room -
especially when such care is initiated earlier in the disease
course,” Stephens added by email.
By 2030, two out of every five deaths in the U.S. will occur in
nursing homes, researchers note in JAMA Internal Medicine. Even
though nursing home care costs an estimated $136 billion a year,
it’s often associated with poor quality and low patient
Palliative care aims to improve quality of life for seriously ill
patients by relieving their symptoms and easing their stress, and it
can be provided in addition to treatment focused on curing disease.
Hospice care, by contrast, doesn’t include active treatment and
focuses instead on providing comfort and pain relief.
In the current study, the nursing home residents eligible for
palliative care were 81 years old on average and 47 percent of them
had Alzheimer’s disease or dementia. Another 24 percent had
congestive heart failure, 17 percent had chronic obstructive
pulmonary disease and 8 percent had cancer.
Nearly all of the patients had completed questionnaires about their
preferences for end-of-life care, and about 25 percent of them
expressed a desire for comfort-focused treatment.
Overall, about 64 percent of family members thought residents
usually or always experienced bothersome symptoms, as did 71 percent
of the residents.
Only about 4 percent of the residents had received assessments at
the nursing home that suggested they had no more than six months to
live. This likely means many residents aren’t getting an accurate
prognosis of their life expectancy, given the severity of their
illnesses, and this may contribute to the scarcity of palliative
care, the authors conclude.
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The study was small and limited to just three facilities, and it
wasn’t a controlled experiment designed to prove whether or how
palliative care might improve the quality of life for nursing home
Even so, the results highlight a need for nursing homes to do a
better job of communicating to patients and families about
palliative care, said Dr. Gary Winzelberg, a geriatrics specialist
at the University of North Carolina School of Medicine in Chapel
“Assessment and treatment of pain and other symptoms is a
fundamental patient right independent of whether an individual
receives palliative or hospice care,” Winzelberg, who wasn’t
involved in the study, said by email.
“Concerns about inadequate symptom management should be addressed
with the nursing staff, and if necessary with a nursing home
ombudsperson or nursing home licensing authority,” Winzelberg added.
Patients and families may be able to improve their odds of receiving
palliative care and adequate services to manage comfort and quality
of life by asking some key questions when they’re shopping for a
nursing home, said Dr. Joan Teno, a geriatrics researcher at the
University of Washington in Seattle who wasn’t involved in the
Among other things, people should ask if the nursing home has a
contract for hospice services and whether they have palliative care
consultation services available, Teno said by email.
“We need improved access to palliative care services in nursing
homes,” Teno said. “Nurse practitioner-led palliative care consult
services are an important means of doing this for nursing home
SOURCE: http://bit.ly/2hRRhmA JAMA Internal Medicine, online
November 20, 2017.
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