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Does hospice improve quality of care for persons dying from dementia?

ABSTRACT: To examine the effectiveness of hospice services for persons dying from dementia from the perspective of bereaved family members.Mortality follow-back survey.Death certificates were drawn from five states (AL, FL, TX, MA, and MN).Bereaved family members listed as the next of kin on death certificates when dementia was listed as the cause of death.Ratings of the quality of end-of-life care, perceptions of unmet needs, and opportunities to improve end-of-life care. Two questions were also asked about the peacefulness of dying and quality of dying.Of 538 respondents, 260 (48.3%) received hospice services. Family members of decedents who received hospice services reported fewer unmet needs and concerns with quality of care (adjusted odds ratio (AOR)=0.49, 95% confidence interval (CI)=0.33-0.74) and a higher rating of the quality of care (AOR=2.0, 95% CI=1.53-2.72). They also noted better quality of dying than those without hospice services.Bereaved family members of people with dementia who received hospice reported higher perceptions of the quality of care and quality of dying.

SUBMITTER: Teno JM

PROVIDER: S-EPMC3724341 | biostudies-literature | 2011 Aug

REPOSITORIES: biostudies-literature

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Does hospice improve quality of care for persons dying from dementia?

Teno Joan M JM Gozalo Pedro L PL Lee Ian C IC Kuo Sylvia S Spence Carol C Connor Stephen R SR Casarett David J DJ

Journal of the American Geriatrics Society 20110728 8

<h4>Objectives</h4>To examine the effectiveness of hospice services for persons dying from dementia from the perspective of bereaved family members.<h4>Design</h4>Mortality follow-back survey.<h4>Setting</h4>Death certificates were drawn from five states (AL, FL, TX, MA, and MN).<h4>Participants</h4>Bereaved family members listed as the next of kin on death certificates when dementia was listed as the cause of death.<h4>Measurements</h4>Ratings of the quality of end-of-life care, perceptions of ...[more]

PMID: 21797834

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Project description:BackgroundPatients approaching the end of their life do not experience their existential and spiritual needs being sufficiently met by the healthcare professionals responsible for their care. Research suggest that this is partly due to a lack of insight about spiritual care among healthcare professionals. By developing, implementing, and evaluating a research-based educational course on spiritual care targeting hospice staff, we aimed to explore the perceived barriers for providing spiritual care within a hospice setting and to evaluate the post-course impact among staff members.MethodsCourse development and evaluation was based on primary exploratory action research and followed the UK Medical Research Council's framework for complex intervention research. The course was implemented at two Danish hospices and comprised thematic days that included lectures, reflective exercises and improvised participatory theatre. We investigated the course impact using a questionnaire and focus group interviews. The questionnaire data were summarized in bar charts and analysis of the transcribed interviews was performed based on Interpretative Phenomenological Analysis.Results85 staff members participated in the course. Of these, 57 answered the evaluative questionnaire and 15 participated in 5 focus group interviews. The course elements that the participants reported to be the most relevant were improvised theatre unfolding existential themes and reflexive group activities. 98% of participants found the course relevant, answering either "relevant" or "very relevant". 73,1% of participants answered "to a considerable extent" or "to a great extent" when asked to what extent they assessed the content of the course to influence their work in hospice. The focus group data resulted in 3 overall themes regarding perceived barriers for providing spiritual care: 1. Diverse approaches is beneficial for spiritual care, but the lack of a shared and adequate spiritual language is a communicative barrier, 2. Existential conversation is complicated by patients' overlapping physical and existential needs, as well as miscommunication, and 3. Providing spiritual care requires spiritual self-reflection, self-awareness, introspection, and vulnerability.ConclusionsThis study provides insights into the barriers facing spiritual care in a hospice setting. Furthermore, the course evaluations demonstrate the valuable impact of spiritual care training for health care professionals. Further course work development is warranted to enhance the "science" of spiritual care for the dying.

Project description:Nursing home residents with dementia are often dependent on others for mouth care, yet will react with care-resistant behavior when receiving assistance. The oral health of these elders deteriorates in the absence of daily oral hygiene, predisposing them to harmful systemic problems such as pneumonia, hyperglycemia, cardiac disease, and cerebral vascular accidents. The purpose of this study is to determine whether care-resistant behaviors can be reduced, and oral health improved, through the application of an intervention based on the neurobiological principles of threat perception and fear response. The intervention, called Managing Oral Hygiene Using Threat Reduction, combines best mouth care practices with a constellation of behavioral techniques that reduce threat perception and thereby prevent or de-escalate care-resistant behaviors.Using a randomized repeated measures design, 80 elders with dementia from 5 different nursing homes will be randomized at the individual level to the experimental group, which will receive the intervention, or to the control group, which will receive standard mouth care from research team members who receive training in the proper methods for providing mouth care but no training in resistance recognition or prevention/mediation. Oral health assessments and care-resistant behavior measurements will be obtained during a 7-day observation period and a 21-day intervention period. Individual growth models using multilevel analysis will be used to estimate the efficacy of the intervention for reducing care-resistant behaviors in persons with dementia, and to estimate the overall efficacy of the intervention using oral health outcomes. Activity-based costing methods will be used to determine the cost of the proposed intervention.At the conclusion of this study, the research team anticipates having a proven intervention that prevents and reduces care-resistant within the context of mouth care. Long-term objectives include testing the effect of the intervention on systemic illnesses among persons with dementia; examining the transferability of this intervention to other activities of daily living; and disseminating threat reduction interventions to nursing home staff, which may radically change the manner in which care is provided to persons with dementia.ClinicalTrials.gov: NCT01363258.

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Does hospice improve quality of care for persons dying from dementia?

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Does hospice improve quality of care for persons dying from dementia?

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