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Advance care planning and end-of-life care for hospitalized nursing home residents.
J Am Geriatr Soc. 2002 May; 50(5):829-35.JA

Abstract

OBJECTIVES

To describe advance care planning (ACP) and end-of-life care for nursing home residents who are hospitalized in the last 6 weeks of life.

DESIGN

Constant comparative analysis of deceased nursing home resident cases.

SETTING

A not-for-profit Jewish nursing home.

PARTICIPANTS

Forty-three deceased residents hospitalized within the last 6 weeks of life at a tertiary medical center.

MEASUREMENTS

Trained nurse reviewers abstracted data from nursing home records and gerontological advanced practice nurse field notes. Clinical and outcome data from the original study were used to describe the sample. Data were analyzed using the constant comparative method and validated in interviews with a gerontological advanced practice nurse and social worker.

RESULTS

The analysis revealed distinct characteristics and identifiable transition points in ACP and end-of-life care with frail nursing home residents. ACP was addressed by social workers as part of the nursing home admission process, focused primarily on cardiopulmonary resuscitation preference, and reviewed only after the crisis of acute illness and hospitalization. Advance directive forms specifying preferences or limitations for life-sustaining treatment contained inconsistent language and vague conditions for implementation. ACP review generally resulted in gradual limitation of life-sustaining treatment. Transition points included nursing home admission, acute illness or hospitalization, and decline toward death. Relatively few nursing home residents received hospice services, with most hospice referrals and palliative care treatment delayed until the week before death. Most residents in this sample died without family present and with little documented evidence of pain or symptom management.

CONCLUSION

Limiting discussion of advance care plans to cardiopulmonary resuscitation falsely dichotomized and oversimplified the choices about medical treatment and care at end-of-life, especially palliative care alternatives, for these older nursing home residents. Formal hospice services were underutilized, and palliative care efforts by nursing home staff were often inconsistent with accepted standards. These results reinforce the need for research and program initiatives in long-term care to improve and facilitate individualized ACP and palliative care at end of life.

Authors+Show Affiliations

School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. mhapp@pitt.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12028168

Citation

Happ, Mary Beth, et al. "Advance Care Planning and End-of-life Care for Hospitalized Nursing Home Residents." Journal of the American Geriatrics Society, vol. 50, no. 5, 2002, pp. 829-35.
Happ MB, Capezuti E, Strumpf NE, et al. Advance care planning and end-of-life care for hospitalized nursing home residents. J Am Geriatr Soc. 2002;50(5):829-35.
Happ, M. B., Capezuti, E., Strumpf, N. E., Wagner, L., Cunningham, S., Evans, L., & Maislin, G. (2002). Advance care planning and end-of-life care for hospitalized nursing home residents. Journal of the American Geriatrics Society, 50(5), 829-35.
Happ MB, et al. Advance Care Planning and End-of-life Care for Hospitalized Nursing Home Residents. J Am Geriatr Soc. 2002;50(5):829-35. PubMed PMID: 12028168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance care planning and end-of-life care for hospitalized nursing home residents. AU - Happ,Mary Beth, AU - Capezuti,Elizabeth, AU - Strumpf,Neville E, AU - Wagner,Laura, AU - Cunningham,Sarah, AU - Evans,Lois, AU - Maislin,Greg, PY - 2002/5/25/pubmed PY - 2002/6/13/medline PY - 2002/5/25/entrez KW - Death and Euthanasia KW - Empirical Approach SP - 829 EP - 35 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 50 IS - 5 N2 - OBJECTIVES: To describe advance care planning (ACP) and end-of-life care for nursing home residents who are hospitalized in the last 6 weeks of life. DESIGN: Constant comparative analysis of deceased nursing home resident cases. SETTING: A not-for-profit Jewish nursing home. PARTICIPANTS: Forty-three deceased residents hospitalized within the last 6 weeks of life at a tertiary medical center. MEASUREMENTS: Trained nurse reviewers abstracted data from nursing home records and gerontological advanced practice nurse field notes. Clinical and outcome data from the original study were used to describe the sample. Data were analyzed using the constant comparative method and validated in interviews with a gerontological advanced practice nurse and social worker. RESULTS: The analysis revealed distinct characteristics and identifiable transition points in ACP and end-of-life care with frail nursing home residents. ACP was addressed by social workers as part of the nursing home admission process, focused primarily on cardiopulmonary resuscitation preference, and reviewed only after the crisis of acute illness and hospitalization. Advance directive forms specifying preferences or limitations for life-sustaining treatment contained inconsistent language and vague conditions for implementation. ACP review generally resulted in gradual limitation of life-sustaining treatment. Transition points included nursing home admission, acute illness or hospitalization, and decline toward death. Relatively few nursing home residents received hospice services, with most hospice referrals and palliative care treatment delayed until the week before death. Most residents in this sample died without family present and with little documented evidence of pain or symptom management. CONCLUSION: Limiting discussion of advance care plans to cardiopulmonary resuscitation falsely dichotomized and oversimplified the choices about medical treatment and care at end-of-life, especially palliative care alternatives, for these older nursing home residents. Formal hospice services were underutilized, and palliative care efforts by nursing home staff were often inconsistent with accepted standards. These results reinforce the need for research and program initiatives in long-term care to improve and facilitate individualized ACP and palliative care at end of life. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/12028168/Advance_care_planning_and_end_of_life_care_for_hospitalized_nursing_home_residents_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2002&volume=50&issue=5&spage=829 DB - PRIME DP - Unbound Medicine ER -