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Boven C, Dillen L, Van Humbeeck L, Van Den Block L, Piers R, Van Den Noortgate N. Relatives' needs in terms of bereavement care throughout euthanasia processes: A qualitative study. J Clin Nurs 2024. [PMID: 38661114 DOI: 10.1111/jocn.17185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
AIM To explore relatives' needs in terms of bereavement care during euthanasia processes, how healthcare providers respond to these needs, and the degree of commonality between relatives' and healthcare providers' reports. DESIGN A phenomenological design was employed, utilising reflexive thematic analysis to examine interviews conducted with relatives (N = 19) and healthcare providers (N = 47). RESULTS Relatives' needs throughout euthanasia processes are presented in five main themes and several subthemes, with similar findings between both sets of participants. Although relatives infrequently communicated their needs explicitly to healthcare providers, they appreciated it when staff proactively met their needs. Healthcare providers aimed to assist with the relatives' grief process by tending to their specific needs. However, aftercare was not consistently offered, but relatives did not have high expectations for professional follow-up care. CONCLUSION Our research offers important directions for healthcare professionals, empowering them to provide needs-based bereavement care during euthanasia processes. Moreover, it emphasises the importance of recognising the unique needs of relatives and proactively addressing them in the period before the loss to positively contribute to relatives' grief process. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Insights into relatives' needs in the context of euthanasia. Good practices on how healthcare providers can attend to relatives' needs before, during and after the loss IMPACT: Current literature and guidelines on needs-based bereavement care in the context of euthanasia and, more generally, assisted dying, are limited. These findings provide concrete directions for practice in supporting (nearly) bereaved relatives in the context of euthanasia, potentially mitigating adverse health outcomes. REPORTING METHOD Standards for Reporting Qualitative Research (SRQR checklist). PATIENT OR PUBLIC CONTRIBUTION Relatives of deceased cancer patients were involved in the conduct of the study.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | | | - Lieve Van Den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels Health Campus, Brussels, Belgium
- End-of-Life Care Research Group, Ghent University, Campus Ghent University Hospital, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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2
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Jennes DAD, Biesbrouck T, De Roo ML, Smets T, Van Den Noortgate N. Pharmacological Treatment for Terminal Agitation, Delirium and Anxiety in Frail Older Patients. Geriatrics (Basel) 2024; 9:51. [PMID: 38667518 PMCID: PMC11050185 DOI: 10.3390/geriatrics9020051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
CONTEXT Psychological distress symptoms in the last days of life often contribute to the overall symptom burden in frail older patients. Good symptom management practices are crucial to ensure high-quality end-of-life care in an aging population, though the best pharmacological approach to treat these psychological symptoms has yet to be established. OBJECTIVES To identify current evidence-based and practice-based knowledge of pharmacological interventions for the treatment of agitation, delirium, and anxiety during the last days of life in frail older patients. METHODS A systematic, mixed methods review was performed through MEDLINE via PubMed and EMBASE from inception until February 2022 and updated through March 2023. National and international guideline databases and grey literature were searched for additional studies and guidelines. RESULTS Four quantitative studies, two non-randomized and two descriptive, were identified. No randomized controlled trials met inclusion criteria. No qualitative studies were withheld. The three consensus-based protocols that were found through citation searching and screening of grey literature did not meet the standards for inclusion. Haloperidol is recommended in consensus-based guidelines for delirium and is widely used, but high-quality evidence about its efficacy is missing. Better control of agitation or refractory delirium might be achieved with the addition of a benzodiazepine. There is no evidence available about the treatment of anxiety in the last days of life in frail older patients. CONCLUSIONS This mixed methods review demonstrates the lack of good quality evidence that is needed to help clinicians with pharmacological treatment decisions when confronted with psychological symptoms in the last days of life in frail older patients. Population aging will only emphasize the need for further research in this specific population.
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Affiliation(s)
- Dine A. D. Jennes
- Department of Geriatric Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Tim Biesbrouck
- Department of Geriatric Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, 3000 Leuven, Belgium
| | - Maaike L. De Roo
- Department of Geriatric Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, 3000 Leuven, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel [VUB] and Ghent University, 1090 Brussels, Belgium
| | - Nele Van Den Noortgate
- End-of-Life Care Research Group, Vrije Universiteit Brussel [VUB] and Ghent University, 1090 Brussels, Belgium
- Department of Geriatric Medicine, Ghent University Hospital, 9000 Ghent, Belgium
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3
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De Spiegeleer A, Descamps A, Wynendaele E, Naumovski P, Crombez L, Planas M, Feliu L, Knappe D, Mouly V, Bigot A, Bielza R, Hoffmann R, Van Den Noortgate N, Elewaut D, De Spiegeleer B. Streptococcal quorum sensing peptide CSP-7 contributes to muscle inflammation and wasting. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167094. [PMID: 38428683 DOI: 10.1016/j.bbadis.2024.167094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/04/2024] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
Muscle wasting diseases, such as cancer cachexia and age-associated sarcopenia, have a profound and detrimental impact on functional independence, quality of life, and survival. Our understanding of the underlying mechanisms is currently limited, which has significantly hindered the development of targeted therapies. In this study, we explored the possibility that the streptococcal quorum sensing peptide Competence Stimulating Peptide 7 (CSP-7) might be a previously unidentified contributor to clinical muscle wasting. We found that CSP-7 selectively triggers muscle cell inflammation in vitro, specifically the release of IL-6. Furthermore, we demonstrated that CSP-7 can traverse the gastrointestinal barrier in vitro and is present in the systemic circulation in humans in vivo. Importantly, CSP-7 was associated with a muscle wasting phenotype in mice in vivo. Overall, our findings provide new mechanistic insights into the pathophysiology of muscle inflammation and wasting.
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Affiliation(s)
- Anton De Spiegeleer
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) Group, Ghent University Hospital, Ghent, Belgium; Department of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Amélie Descamps
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) Group, Ghent University Hospital, Ghent, Belgium; Drug Quality and Registration (DruQuaR) Group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Evelien Wynendaele
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) Group, Ghent University Hospital, Ghent, Belgium; Drug Quality and Registration (DruQuaR) Group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Petar Naumovski
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) Group, Ghent University Hospital, Ghent, Belgium; Drug Quality and Registration (DruQuaR) Group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Liesbeth Crombez
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) Group, Ghent University Hospital, Ghent, Belgium; Department of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Marta Planas
- LIPPSO, Department of Chemistry, Universitat de Girona, Maria Aurèlia Capmany 69, Girona, Spain
| | - Lidia Feliu
- LIPPSO, Department of Chemistry, Universitat de Girona, Maria Aurèlia Capmany 69, Girona, Spain
| | - Daniel Knappe
- Center for Biotechnology and Biomedicine, University of Leipzig, Leipzig, Germany; Institute of Bioanalytical Chemistry, Faculty of Chemistry and Mineralogy, University of Leipzig, Leipzig, Germany
| | - Vincent Mouly
- Centre de Recherche en Myologie, Sorbonne Université, Paris, France
| | - Anne Bigot
- Centre de Recherche en Myologie, Sorbonne Université, Paris, France
| | - Rafael Bielza
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Ralf Hoffmann
- Center for Biotechnology and Biomedicine, University of Leipzig, Leipzig, Germany; Institute of Bioanalytical Chemistry, Faculty of Chemistry and Mineralogy, University of Leipzig, Leipzig, Germany
| | - Nele Van Den Noortgate
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) Group, Ghent University Hospital, Ghent, Belgium; Department of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Dirk Elewaut
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) Group, Ghent University Hospital, Ghent, Belgium; VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University, Ghent, Belgium; Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Bart De Spiegeleer
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) Group, Ghent University Hospital, Ghent, Belgium; Drug Quality and Registration (DruQuaR) Group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
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De Raedt S, De Groote M, Martens H, Velghe A, Van Den Noortgate N, Piers R. Will-to-Live and Self-Rated Health in Older Hospitalized Patients Are Not Predictive for Short-Term Mortality. J Palliat Med 2024; 27:376-382. [PMID: 37948556 DOI: 10.1089/jpm.2023.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background: Self-assessed will-to-live and self-rated health are associated with long-term survival in community-dwelling older persons but have not been examined in frailer older patients in relation to short-term prognosis. The aim was to explore whether will-to-live and self-rated health are predictive for six-month mortality and can guide ceiling of treatment decisions in hospitalized patients in an acute geriatric ward. We included the Surprise Question as reference, being a well-established clinical tool for short-term prognostication. Methods: This multicentric prospective study included patients of 75 years and older admitted at acute geriatric wards of two Belgian hospitals. Will-to-live and self-rated health were scored on a Likert scale (0-5, 0-4) and assessed by junior geriatricians. The senior geriatricians answered the Surprise Question for clinical judgment of prognosis. Receiver-operator characteristic (ROC) curves were constructed to determine diagnostic accuracy. For time-dependent analysis, Cox regression was performed with adjustment for age and gender. Results: Of 93 included patients in the study, 69 were still alive after six months and 24 died, resulting in a six-month mortality of 26%. The mean age was 86 years (range 75-100), 67% of the patients were women. Median will-to-live and self-rated health were 3 (moderate and good). Both will-to-live and self-rated health were not predictive for six-month mortality (area under the ROC curve [AUC] 0.496, p = 0.951 for will-to-live; 0.447, p = 0.442 for self-rated health) as opposed to Surprise Question (AUC 0.793, p < 0.001). After correction for sex and age, the hazard ratio of six-month mortality was 0.92 for will-to-live (p = 0.667), 0.86 for self-rated health (p = 0.548), and 10.28 for Surprise Question (p < 0.001). Conclusion: Will-to-live and self-rated health are not predictive for six-month mortality in patients admitted to the acute geriatric ward, unlike prognostic tools such as Surprise Question. Clinical Trial Registration Number: B670202100792.
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Affiliation(s)
- Soetkin De Raedt
- Department of Geriatrics, University Hospital Gent, Ghent, Belgium
| | - Marie De Groote
- Department of Geriatrics, University Hospital Gent, Ghent, Belgium
| | - Han Martens
- Department of Geriatrics, General Hospital Sint-Lucas, Ghent, Belgium
| | - Anja Velghe
- Department of Geriatrics, University Hospital Gent, Ghent, Belgium
| | | | - Ruth Piers
- Department of Geriatrics, University Hospital Gent, Ghent, Belgium
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5
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De Groote M, De Raedt S, Van Humbeeck L, Van Hoeyweghen R, Nobels A, Van Den Noortgate N, Piers R. How strong is the will-to-live in frail older persons? A survey study in acute geriatric wards and nursing homes in Belgium. Aging Ment Health 2024; 28:302-306. [PMID: 37534457 DOI: 10.1080/13607863.2023.2242302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Will-to-live is defined as the psychological expression of one's commitment to life and the desire to continue living. It is an important indicator of subjective wellbeing. This study aimed to assess the will-to-live in frail older hospitalized patients and nursing home residents as well as to evaluate its association with physical frailty, tiredness of life, depression and wish-to-die. METHODS Between March and September 2021, we interviewed 186 older adults in six nursing homes and two acute geriatric wards across Belgium. Will-to-live was assessed using a single-item numeric rating scale from 0 to 5. A linear regression analysis was performed to assess the association between will-to-live and frailty (Clinical Frailty Scale) with adjustment for age, gender and setting. Mann-Whitney U test was used to evaluate the association between will-to-live and depression, tiredness of life and wish-to-die. RESULTS Mean age was 85 (± 6.2) years. Mean score on the Clinical Frailty Scale was five (± 1.5) and four on the will-to-live (± 1.3). No statistical significant association was found between will-to-live and age (p = 0.991), gender (p = 0.272), setting (p = 0.627) and frailty (p = 0.629). Multiple linear regression showed no significant association with Clinical Frailty Scale (p = 0.660), after adjustment for age, gender and setting. Will-to-live was negatively associated with tiredness of life (p = 0.020) and wish-to-die (p < 0.001), but not with depression (p = 0.186). DISCUSSION Both nursing home residents and older hospitalized patients expressed a strong or very strong will-to-live. Will-to-live was not associated with physical frailty as measured by the Clinical Frailty Scale. Nursing home residents with a weak will-to-live were more likely to have depressive symptoms. Most nursing home residents with a wish-to-die had also a low will-to-live, although some residents had both a high will-to-live and wish-to-die.
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Affiliation(s)
- Marie De Groote
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Soetkin De Raedt
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | | | | | - Anne Nobels
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
| | | | - Ruth Piers
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
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6
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Boven C, Dillen L, Dierickx S, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. Relatives' Experiences of Being Involved in Assisted Dying: A Qualitative Study. Qual Health Res 2023; 33:1154-1164. [PMID: 37791685 PMCID: PMC10626978 DOI: 10.1177/10497323231196827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Recent literature demonstrates an interdependence between relatives and healthcare providers throughout euthanasia processes. Yet, current guidelines and literature scarcely specify the interactions between healthcare providers and bereaved relatives. The aim of this work consisted of providing an insight into bereaved relatives' experiences (1) of being involved in euthanasia processes and (2) of their interactions with healthcare providers before, during, and after the euthanasia. The research process was guided by the principles of constructivist grounded theory. Nineteen Dutch-speaking bereaved relatives of oncological patients, who received euthanasia at home or in a hospital less than 24 months ago, participated via semi-structured interviews. These interviews were conducted between May 2021 and June 2022. Due to the intensity of euthanasia processes, relatives wanted to be involved as early as possible, in order to receive time, space, and access to professionals' support whilst preparing themselves for the upcoming loss of a family member with cancer. Being at peace with the euthanasia request facilitated taking a supportive attitude, subsequently aiding in achieving a serene atmosphere. A serene atmosphere facilitated relatives' grief process because it helped them in creating and preserving good memories. Relatives appreciated support from healthcare providers, as long as overinvolvement on their part was not occurring. This study advocates for a relational approach in the context of euthanasia and provides useful complements to the existing euthanasia guidelines.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Sigrid Dierickx
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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De Brauwer I, Henrard S, Baeyens H, Van Den Noortgate N, De Saint-Hubert M, Piers R. Palliative profile, one-year mortality and quality of life in older inpatients according to Be-PICT: a multicenter prospective cohort study. Acta Clin Belg 2023; 78:16-24. [PMID: 35293853 DOI: 10.1080/17843286.2022.2053812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND A palliative care approach (PCA), including advanced care planning (ACP), should be considered for patients with limited life expectancy. The Belgian Palliative Care Indicators Tool (Be-PICT) has been released to help identify patients who may benefit from such approach. This study aimed at measuring 1-year mortality and describe the quality of life in older inpatients, according to baseline Be-PICT results. METHODS Prospective multicentre cohort study in older patients (≥ 75 years) admitted at geriatrics and cardiology wards of four Belgian hospitals. The palliative profile was defined as a positive Be-PICT.1, defined by the presence of its three criteria, i.e. a negative physician's answer to the surprise question 'would you be surprised if this patient dies in the 6-12 next months?', ≥ 1 poor health indicator and ≥ 1 life-limiting condition. RESULTS Of the 379 patients (50% aged ≥85 years; 51% female), 52 (14%) presented a palliative profile and 83 (23%) died within 1 year. Be-PICT.1 showed the following characteristics to predict 1-year mortality: sensitivity 0.54, specificity 0.83, positive and negative predictive values 0.48 and 0.86, positive and negative likelihood ratios 3.22 and 0.55. The patients with a palliative profile were at higher mortality risk (hazard ratio 4.79 p < 0.001) and 1-year mortality rate (45%). Not using the SQ allowed to improve sensitivity to include a larger number of patients who may benefit from ACP and PCA. CONCLUSIONS Be-PICT.1 is a simple case-finding tool to identify older inpatients being at high mortality risk and candidates for ACP and PCA.
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Affiliation(s)
- Isabelle De Brauwer
- Department of Geriatric Medicine, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.,Institute of Health and Society, UCLouvain, Bruxelles, Belgium
| | - Séverine Henrard
- Institute of Health and Society, UCLouvain, Bruxelles, Belgium.,Louvain Drug Research Institute, UCLouvain, Bruxelles, Belgium
| | - Hilde Baeyens
- Department of Geriatric Medicine, AZ Alma Campus Eeklo, Eeklo, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Marie De Saint-Hubert
- Institute of Health and Society, UCLouvain, Bruxelles, Belgium.,Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Namur, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
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8
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Boven C, Van Humbeeck L, Van den Block L, Piers R, Van Den Noortgate N, Dillen L. Bereavement care and the interaction with relatives in the context of euthanasia: A qualitative study with healthcare providers. Int J Nurs Stud 2023; 140:104450. [PMID: 36796117 DOI: 10.1016/j.ijnurstu.2023.104450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND A recent review shows an interdependence between healthcare providers and relatives in the context of euthanasia. Belgian guidelines do focus on the role of certain healthcare providers (physicians, nurses, and psychologists), yet they hardly specify bereavement care services before, during and after the euthanasia. PURPOSE A conceptual model showing underlying mechanisms of healthcare providers' experiences regarding the interaction with and the provision of bereavement care to relatives of cancer patients throughout a euthanasia process. METHODS 47 semi-structured interviews with Flemish physicians, nurses and psychologists working in hospitals and/or homecare, conducted from September 2020 to April 2022. Transcripts were analyzed using the Constructivist Grounded Theory Approach. RESULTS Participants experienced the interaction with relatives as very diverse, which can be visualized as a continuum ranging from negative to positive, depending on each unique case. The achieved degree of serenity was the main contributor in determining their position on the aforementioned continuum. To create this serene atmosphere, healthcare providers undertook actions underpinned by two attitudes (wariness and meticulousness), which are guided by different considerations. These considerations can be categorized into three groups: 1) ideas about a good death and its importance, 2) having the situation well under control and 3) self-reassurance. CONCLUSIONS If relatives were not at peace, most participants said that they deny a request or formulate additional requirements. Moreover, they wanted to ensure relatives can cope with the loss, which was often experienced as intense and time-consuming. Our insights shape needs-based care from healthcare providers' perspective in the context of euthanasia. Future research should explore the relatives' perspective regarding this interaction and the provision of bereavement care. TWEETABLE ABSTRACT Professionals strive for a serene atmosphere throughout a euthanasia process to ensure relatives can cope with the loss, and the way in which the patient died.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium.
| | - Liesbeth Van Humbeeck
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels Health Campus, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
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Vella Azzopardi R, Beyer I, De Raedemaeker K, Foulon I, Vermeiren S, Petrovic M, Van Den Noortgate N, Bautmans I, Gorus E. Hearing aid use and gender differences in the auditory-cognitive cascade in the oldest old. Aging Ment Health 2023; 27:184-192. [PMID: 34937465 DOI: 10.1080/13607863.2021.2007355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study analyzed cognitive differences between hearing-aid (HA) and non-HA users. We hypothesized that HA-use attenuates the auditory-cognitive cascade, thereby, the latter is more conspicuous in non-HA users. Since hearing impairment (HI) shows male predominance, we hypothesized gender differences within the auditory-cognitive relationship. METHODS Non-frail community-dwellers ≥ 80 years were assessed for HI (pure tone audiogram-PTA; speech reception threshold-SRT) and global and domain-specific cognitive impairments (Mini-Mental State Examination-MMSE; Montreal Cognitive Assessment-MOCA; Reaction Time Test-RT1-4). Pearson and partial correlations (correcting for age and PTA) assessed auditory-cognitive associations within gender and HA subgroups. Fisher's z test compared correlations between HA and non-HA users. RESULTS 126 participants (age range 80-91 years) were included. HA-use prevalence was 21%. HA-users were older with worse HI (mean PTA 49.5dBHL). HA-users exhibited no significant auditory (PTA, SRT) and cognitive (MMSE, MOCA, RT1- RT4) correlations. Male non-HA users, displayed a significant association between HI and global cognition, processing speed, selective and alternating attention. Significant differences were noted between MMSE and PTA and SRT (z-score 2.28, 3.33, p = 0.02, <0.01, respectively) between HA and non-HA users. CONCLUSION Male non-HA users displayed an association between HI and global and domain-specific (processing speed; selective and alternating attention) cognitive decline. Associations between global cognition and HI were significantly different between HA and non-HA users. This may be partially attributable to underlying subgroups sample sizes and statistical power disparity. If larger scale longitudinal or interventional studies confirm these findings, timely HI assessment and management may be the cornerstone for delaying cognitive decline.
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Affiliation(s)
- Roberta Vella Azzopardi
- Gerontology Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ingo Beyer
- Gerontology Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Geriatrics Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Kaat De Raedemaeker
- Department of Otolaryngology - Head and Neck Surgery, UZ Brussel, Brussels, Belgium
| | - Ina Foulon
- Department of Otolaryngology - Head and Neck Surgery, UZ Brussel, Brussels, Belgium
| | - Sofie Vermeiren
- Gerontology Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Mirko Petrovic
- Geriatrics Department, Ghent University Hospital (UZ Gent), Ghent, Belgium
| | | | - Ivan Bautmans
- Gerontology Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Geriatrics Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Ellen Gorus
- Gerontology Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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- Members of the Gerontopole Brussels Study group: Ivan Bautmans (FRIA, VUB), Dominque Verté (Belgian Ageing Studies BAST, VUB), Ingo Beyer (Geriatrics Department, UZ Brussel), Mirko Petrovic (ReFrail, UGhent), Liesbeth De Donder (Belgian Ageing Studies BAST, VUB), Tinie Kardol (Leerstoel Bevordering Active Ageing, VUB), Gina Rossi (Clinical and Lifespan Psychology KLEP, VUB), Peter Clarys (Physical Activity and Nutrition PANU, VUB), Aldo Scafoglieri (Experimental Anatomy EXAN, VUB), Erik Cattrysse (Experimental Anatomy EXAN, VUB), Eugenio Mantovani (Fundamental Rights and Constitutionalism Research group FRC, VUB), Bart Jansen (Department of Electronics and Informatics ETRO, VUB)
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10
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de Nooijer K, Van Den Noortgate N, Pype P, Van den Block L, Pivodic L. Correction: Palliative care symptoms, concerns and well-being of older people with frailty and complex care needs upon hospital discharge: a cross-sectional study. Palliat Care 2022; 21:208. [DOI: 10.1186/s12904-022-01081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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11
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De Spiegeleer A, Wynendaele E, Descamps A, Debunne N, Braeckman BP, De Mey M, Coudenys J, Crombez L, Verbeke F, Janssens Y, Janky R, Goossens E, Vlaeminck C, Duchi D, Andries V, Dumas E, Petrovic M, Van de Wiele T, Knappe D, Hoffmann R, Mouly V, Bigot A, Vereecke L, Van Immerseel F, Van Den Noortgate N, De Spiegeleer B, Elewaut D. The bacterial quorum sensing peptide iAM373 is a novel inducer of sarcopenia. Clin Transl Med 2022; 12:e1053. [PMID: 36229976 PMCID: PMC9561422 DOI: 10.1002/ctm2.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/08/2022] [Accepted: 08/25/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Anton De Spiegeleer
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) groupGhent University HospitalGhentBelgium,Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical SciencesGhent UniversityGhentBelgium,VIB Center for Inflammation Research (IRC), Unit for Molecular Immunology and InflammationGhent UniversityGhentBelgium,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health SciencesGhent University HospitalGhentBelgium
| | - Evelien Wynendaele
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) groupGhent University HospitalGhentBelgium,Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical SciencesGhent UniversityGhentBelgium
| | - Amélie Descamps
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) groupGhent University HospitalGhentBelgium,Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical SciencesGhent UniversityGhentBelgium
| | - Nathan Debunne
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical SciencesGhent UniversityGhentBelgium
| | - Bart P. Braeckman
- Laboratory for Aging Physiology and Molecular Evolution, Faculty of SciencesGhent UniversityGhentBelgium
| | - Marjan De Mey
- Center for Synthetic Biology, Department of Biotechnology, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | - Julie Coudenys
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) groupGhent University HospitalGhentBelgium,VIB Center for Inflammation Research (IRC), Unit for Molecular Immunology and InflammationGhent UniversityGhentBelgium,Laboratory for Aging Physiology and Molecular Evolution, Faculty of SciencesGhent UniversityGhentBelgium
| | - Liesbeth Crombez
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) groupGhent University HospitalGhentBelgium,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health SciencesGhent University HospitalGhentBelgium
| | - Frederick Verbeke
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical SciencesGhent UniversityGhentBelgium
| | - Yorick Janssens
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical SciencesGhent UniversityGhentBelgium
| | | | - Evy Goossens
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Caroline Vlaeminck
- Laboratory for Aging Physiology and Molecular Evolution, Faculty of SciencesGhent UniversityGhentBelgium
| | - Dries Duchi
- Center for Synthetic Biology, Department of Biotechnology, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | - Vanessa Andries
- VIB Center for Inflammation Research (IRC), Unit for Molecular Immunology and InflammationGhent UniversityGhentBelgium,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health SciencesGhent University HospitalGhentBelgium,Host‐Microbiota‐Interaction labVIB Center for Inflammation ResearchGhentBelgium,Ghent Gut Inflammation Group (GGIG)Ghent UniversityGhentBelgium
| | - Emilie Dumas
- VIB Center for Inflammation Research (IRC), Unit for Molecular Immunology and InflammationGhent UniversityGhentBelgium,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health SciencesGhent University HospitalGhentBelgium
| | - Mirko Petrovic
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health SciencesGhent University HospitalGhentBelgium
| | - Tom Van de Wiele
- Center for Microbial Ecology and Technology, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | - Daniel Knappe
- Center of Biotechnology and Biomedicine, Faculty of Chemistry and MineralogyUniversity of LeipzigLeipzigGermany
| | - Ralf Hoffmann
- Center of Biotechnology and Biomedicine, Faculty of Chemistry and MineralogyUniversity of LeipzigLeipzigGermany
| | - Vincent Mouly
- Institut de Myologie, Centre de Recherche en MyologieInserm, Sorbonne UniversitéParisFrance
| | - Anne Bigot
- Institut de Myologie, Centre de Recherche en MyologieInserm, Sorbonne UniversitéParisFrance
| | - Lars Vereecke
- VIB Center for Inflammation Research (IRC), Unit for Molecular Immunology and InflammationGhent UniversityGhentBelgium,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health SciencesGhent University HospitalGhentBelgium,Host‐Microbiota‐Interaction labVIB Center for Inflammation ResearchGhentBelgium,Ghent Gut Inflammation Group (GGIG)Ghent UniversityGhentBelgium
| | - Filip Van Immerseel
- Host‐Microbiota‐Interaction labVIB Center for Inflammation ResearchGhentBelgium
| | - Nele Van Den Noortgate
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) groupGhent University HospitalGhentBelgium,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health SciencesGhent University HospitalGhentBelgium
| | - Bart De Spiegeleer
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical SciencesGhent UniversityGhentBelgium
| | - Dirk Elewaut
- Translational Research in Immunosenescence, Gerontology and Geriatrics (TRIGG) groupGhent University HospitalGhentBelgium,VIB Center for Inflammation Research (IRC), Unit for Molecular Immunology and InflammationGhent UniversityGhentBelgium,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health SciencesGhent University HospitalGhentBelgium
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12
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de Nooijer K, Van Den Noortgate N, Pype P, Van den Block L, Pivodic L. Palliative care symptoms, concerns and well-being of older people with frailty and complex care needs upon hospital discharge: a cross-sectional study. Palliat Care 2022; 21:173. [PMID: 36203161 PMCID: PMC9540036 DOI: 10.1186/s12904-022-01065-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about the nature and intensity of palliative care needs of hospitalised older people. We aimed to describe the palliative care symptoms, concerns, and well-being of older people with frailty and complex care needs upon discharge from hospital to home, and to examine the relationship between palliative care symptoms and concerns, and well-being. Methods Cross-sectional study using baseline survey data of a pilot randomised controlled trial. Hospital staff identified patients (≥ 70 years) about to be discharged home, with a clinical frailty score of 5 to 7 and complex needs based on physician-assessment. Patients completed structured interviews, using the Integrated Palliative Care Outcome Scale (IPOS), ICEpop CAPability measure for supportive care (ICECAP-SCM) and IPOS Views on Care quality of life item. We calculated descriptive statistics. Results We assessed 37 older people with complex needs (49% women, mean age 84, standard deviation 6.1). Symptoms rated as causing severe problems were weakness (46%) and poor mobility (40%); 75% reported that their family felt anxious at least occasionally. Of the 17 IPOS items, 41% of patients rated five or more symptoms as causing severe problems, while 14% reported that they were not severely affected by any symptom. 87% expressed feeling supported. There was a negative correlation between symptoms (IPOS) and well-being (ICECAP); r = -0.41. Conclusion We identified a large variety of symptoms experienced by older people identified as having frailty and complex needs upon hospital discharge. Many were severely affected by multiple needs. This population should be considered for palliative care follow-up at home.
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Affiliation(s)
- Kim de Nooijer
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, Belgium.
| | - Nele Van Den Noortgate
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Peter Pype
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Lara Pivodic
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
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13
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Bentin F, Van Den Noortgate N, Piers R. In-hospital end-of-life care in the old: a retrospective study of intensive care unit use and do-not-resuscitate forms in patients deceased in a Belgian university hospital. Acta Clin Belg 2022; 78:185-191. [PMID: 35816019 DOI: 10.1080/17843286.2022.2097408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To explore the quality of in-hospital end-of-life care in adult patients with special attention to those 75 years and older and to make a comparison with the situation 10 years ago. METHODS Data were retrospectively collected on adult patients who deceased at Ghent University Hospital between September 2018 and December 2019. The main outcome measures were 'ICU use' and 'presence of DNR forms on non-ICU units' in the final hospitalization. In order to identify possible risk factors for ICU use, logistic regression was performed. RESULTS In total, 762 people died, of whom 35% were 75 or older. Just as 10 years ago, one-third (31%) died in the ICU versus 49% of those younger than 75 years (p < 0.001). Of people ≥75 years, 38%, compared to 42% 10 years ago, received an ICU treatment during their final hospitalization. The median length of an ICU stay was 4 versus 3 days 10 years ago. After adjusting for gender, comorbidities and the Charlson Comorbidity Index, factors associated with less ICU use were higher age, active malignancy and dementia (OR 0.838, 0.116 and 0.098 respectively). Seventy-nine percent of older patients on non-ICU wards died with a DNR form (versus 87% 10 years ago). CONCLUSION Although there was an increase in the presence of DNR forms in the final hospitalization, no significant differences were seen in actual ICU use compared to 10 years ago. Factors associated with less ICU use were higher age, active malignancy and dementia.
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Affiliation(s)
- Felicia Bentin
- Department of Geriatrics, University Hospital Ghent, Ghent, Belgium
| | | | - Ruth Piers
- Department of Geriatrics, University Hospital Ghent, Ghent, Belgium
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14
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Maes H, Van Den Noortgate N, De Brauwer I, Velghe A, Desmedt M, De Saint-Hubert M, Piers R. Prognostic value of the Surprise Question for one-year mortality in older patients: a prospective multicenter study in acute geriatric and cardiology units. Acta Clin Belg 2022; 77:286-294. [PMID: 33044915 DOI: 10.1080/17843286.2020.1829869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To determine the prognostic value of the Surprise Question (SQ) in older persons. METHODS A multicenter prospective study, including patients aged 75 years or older admitted to acute geriatric (AGU) or cardiology unit (CU). The SQ was answered by the treating physician. Patients or relatives were contacted after 1 year to determine 1-year survival. Logistic regression was used to explore parameters associated with SQ. Summary ROC curves were constructed to obtain the pooled values of sensitivity and specificity based on a bivariate model. RESULTS The SQ was positive (death within 1 year is no surprise) in 34.7% AGU and 33.3% CU patients (p = 0.773). Parameters associated with a positive SQ were more severe comorbidity, worse functionality, significant weight loss, refractory symptoms and the request for palliative care by patient or family. One-year mortality was, respectively, 24.9% and 20.2% for patients hospitalized on AGU and CU (p = 0.319). There was no difference in sensitivity or specificity, respectively, 64% and 77% (AUC 0.635) for AGU versus 63% and 76% (AUC 0.758) for CU (p = 0.870). A positive SQ is associated with a significant shorter time until death (HR 5.425 (95% CI 3.332-8.834), p < 0.001) independently from the ward. CONCLUSION The Surprise Question is moderately accurate to predict 1-year mortality in older persons hospitalized on acute geriatric and cardiologic units.
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Affiliation(s)
- Hanne Maes
- Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Isabelle De Brauwer
- Geriatric Medicine, Saint Luc UCLouvain, Bruxelles, Belgium
- Geriatric Medicine, CHU-UCL Namur, Belgium
| | - Anja Velghe
- Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | | | | | - Ruth Piers
- Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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15
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Boven C, Dillen L, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. In-Hospital Bereavement Services as an Act of Care and a Challenge: An Integrative Review. J Pain Symptom Manage 2022; 63:e295-e316. [PMID: 34695567 DOI: 10.1016/j.jpainsymman.2021.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Globally, people most often die within hospitals. As such, healthcare providers in hospitals are frequently confronted with dying persons and their bereaved relatives. OBJECTIVES To provide an overview of the current role hospitals take in providing bereavement care. Furthermore, we want to present an operational definition of bereavement care, the way it is currently implemented, relatives' satisfaction of receiving these services, and finally barriers and facilitators regarding the provision of bereavement care. METHODS An integrative review was conducted by searching four electronic databases, from January 2011 to December 2020, resulting in 47 studies. Different study designs were included and results were reported in accordance with the theoretical framework of Whittemore and Knafl (2005). RESULTS Only four articles defined bereavement care: two as services offered solely post loss and the other two as services offered pre and post loss. Although different bereavement services were delivered the time surrounding the death, the follow-up of bereaved relatives was less routinely offered. Relatives appreciated all bereavement services, which were rather informally and ad-hoc provided to them. Healthcare providers perceived bereavement care as important, but the provision was challenged by numerous factors (such as insufficient education and time). CONCLUSION Current in-hospital bereavement care can be seen as an act of care that is provided ad-hoc, resulting from the good-will of individual staff members. A tiered or stepped approach based on needs is preferred, as it allocates funds towards individuals-at-risk. Effective partnerships between hospitals and the community can be a useful, sustainable and cost-effective strategy.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium.
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit (L.D.), Ghent University Hospital, Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group (L.V.D.B.), Vrije Universiteit Brussel (VUB) & Ghent University, Brussels Health Campus (Building C), Laarbeeklaan 103, 1090 Brussels, Belgium & Campus Ghent University Hospital (Entrance 42 K3), Ghent, Belgium; Department of Family Medicine and Chronic Care (L.V.D.B.), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
| | - Liesbeth Van Humbeeck
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
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Abstract
OBJECTIVES To explore the legal understanding and attitudes of nurses and physicians in both acute and chronic geriatric care (Flanders, Belgium) regarding euthanasia in the context of tiredness of life in older people. METHOD Healthcare providers employed in acute care (59 geriatricians and 75 nurses of acute geriatric wards), as well as chronic care (135 general practitioners (GPs) and 76 nurses employed in nursing homes and home care services) were sent a survey with four case vignettes. For each case vignette, respondents were asked the following questions: (1) 'Does this case fit the due-care criteria of the euthanasia law?', (2) 'Do you consider this person to be tired of life?', (3) 'Can you comprehend this person's euthanasia request?'. RESULTS In cases of severe and life-limiting physical suffering, where the patient meets the legal criteria for euthanasia in Belgium, only 50% of physicians and nurses are aware of this legal basis. In case of tiredness of life without underlying pathology, nurses showed more comprehension for the euthanasia request compared to physicians (43.0% vs. 10.8%, p < 0.001). Physicians tend to assess the legal base of an euthanasia-request depending on the severity of physical morbidity, whereas nurses show a greater comprehension towards euthanasia-requests even in absence of severe illness. Geriatricians are more reserved regarding performing euthanasia themselves as compared to GPs, regardless of underlying pathology or reason for the euthanasia-request (p < 0.001). CONCLUSION The legal understanding and attitude of Flemish physicians and nurses towards tiredness of life and euthanasia in older patients differed to a great extent. This study showed (1) a lack of awareness of the legal basis for euthanasia in the context of ToL among all HCPs, (2) differences in the extent of comprehension between nurses and physicians and (3) differences in willingness to actually perform euthanasia between geriatricians and GPs. So even with the formulation of strict due-care criteria there is still room for interpretation. This creates a gray area and a discussion point between healthcare providers.
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Affiliation(s)
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Reine De Bock
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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de Nooijer K, Pivodic L, Van Den Noortgate N, Pype P, Evans C, Van den Block L. Timely short-term specialized palliative care service intervention for older people with frailty and their family carers in primary care: Development and modelling of the frailty+ intervention using theory of change. Palliat Med 2021; 35:1961-1974. [PMID: 34423701 PMCID: PMC8649418 DOI: 10.1177/02692163211040187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care is advocated for older people with frailty and multimorbidity in the community. However, how to best deliver it is unclear. AIM To develop and model an intervention of short-term specialized palliative care that is initiated timely based on complex care needs and integrated with primary care for older people with frailty and their family, detailing the intervention components, outcomes and preconditions needed for implementation, using a novel theoretical approach. DESIGN Observational study informed by the UK MRC guidance for complex interventions integrated with a Theory of Change (i.e. hypothetical causal pathway to impact) approach. We synthesized evidence from a systematic review, semi-structured interviews, group discussions and Theory of Change workshops. SETTING Primary care in Flanders, Belgium. RESULTS We identified patient and family carer-related long-term outcomes and preconditions to achieve them for example, service providers are willing and able to deliver the intervention. The intervention components included implementation components, for example, training for service providers, and a core component, that is, provision of timely short-term specialized palliative care by a specialized palliative home care nurse. The latter includes: short-term service delivery; collaborative and integrative working within primary care; delivery of holistic needs- and capacity-based care; person-centred and family-focussed; and goal-oriented pro-active care. CONCLUSIONS The Theory of Change approach allowed us to identify multiple intervention components targeting different stakeholders to achieve the desired outcomes. It also facilitated a detailed description of the intervention which aims to increase replicability and effective comparisons with other interventions.
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Affiliation(s)
- Kim de Nooijer
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Lara Pivodic
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Nele Van Den Noortgate
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Peter Pype
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Catherine Evans
- King's College London, Cicely Saunders Institute, London, UK.,Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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18
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De Spiegeleer A, Kahya H, Sanchez-Rodriguez D, Piotrowicz K, Surquin M, Marco E, Detremerie C, Hussein D, Hope S, Dallmeier D, Decker G, Hrnciarikova D, Czesak J, Toscano-Rico M, Meza-Valderrama D, Bahat G, Descamps A, Wynendaele E, Elewaut D, Vankova H, Landi F, Benoit F, Gasowski J, Van Den Noortgate N. Acute sarcopenia changes following hospitalization: influence of pre-admission care dependency level. Age Ageing 2021; 50:2140-2146. [PMID: 34379741 DOI: 10.1093/ageing/afab163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/02/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Hospitalization is associated with acute changes in sarcopenia status in older people, but the influencing factors are not fully understood. Pre-admission care dependency level as a risk factor has not yet been investigated. OBJECTIVE Evaluate if pre-admission care dependency level is an independent predictor of sarcopenia changes following hospitalization. SETTING AND SUBJECTS Data came from the Sarcopenia 9+ EAMA Project, a European prospective multi-centre study. For this study, 227 hospitalised older people were included from four different hospitals in Belgium, Spain and Poland, between 18 February 2019 and 5 September 2020. METHODS Sarcopenia status at admission and discharge were calculated using a combined score (desirability value) based on muscle mass (calf circumference), strength (grip) and function (walking speed). Ratio of admission to discharge status was the outcome (desirability ratio; 1.00 meaning no difference). Predictor variable was the pre-admission care dependency level, classified into three groups: independent older people living at home, dependent older people living at home and older people living in a care home. Linear regression models were applied, considering potential confounders. RESULTS Mean desirability ratio for dependent older people living at home ('middle dependent group') was lower (0.89) compared to independent older people (0.98; regression coefficient -0.09 [95% CI -0.16, -0.02]) and care home patients (1.05; -0.16 [95% CI -0.01, -0.31]). Adjusting for potential confounders or using another statistical approach did not affect the main results. CONCLUSION Dependent older people living at home were at higher risk of deterioration in sarcopenia status following hospitalization. In-depth studies investigating causes and potential interventions of these findings are needed.
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Affiliation(s)
- Anton De Spiegeleer
- Department of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
- Drug Quality and Registration group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Unit for Molecular Immunology and Inflammation, VIB-Center for Inflammation Research, Ghent, Belgium
| | - Hasan Kahya
- Department of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Dolores Sanchez-Rodriguez
- Clinical Research Unit, Brugmann University Hospital, Brussels, Belgium
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology, and Health Economics, University of Liège, Liège, Belgium
- Geriatrics Department, Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Murielle Surquin
- Clinical Research Unit, Brugmann University Hospital, Brussels, Belgium
| | - Ester Marco
- Physical Medicine and Rehabilitation Department, Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Celine Detremerie
- Department of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Dhurgham Hussein
- Department of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Suzy Hope
- Department of Healthcare for Older People, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- University of Exeter Medical School, Exeter, UK
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- Geriatric Center Ulm/Alb-Donau, Ulm University, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Genia Decker
- Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- Geriatric Center Ulm/Alb-Donau, Ulm University, Ulm, Germany
| | - Dana Hrnciarikova
- Faculty of Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Joanna Czesak
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
- Institute of Clinical Rehabilitation, University School of Physical Education, Kraków, Poland
| | | | - Delky Meza-Valderrama
- Physical Medicine and Rehabilitation Department, Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation (INMFER), Panama city, Panama
| | - Gülistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Amélie Descamps
- Drug Quality and Registration group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Evelien Wynendaele
- Drug Quality and Registration group, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Unit for Molecular Immunology and Inflammation, VIB-Center for Inflammation Research, Ghent, Belgium
| | - Hana Vankova
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Florence Benoit
- Clinical Research Unit, Brugmann University Hospital, Brussels, Belgium
| | - Jerzy Gasowski
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Nele Van Den Noortgate
- Department of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
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19
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Nobels A, Keygnaert I, Robert E, Vandeviver C, Haekens A, Lemey L, Strobbe M, Van Den Noortgate N, Lemmens GMD. 'Breaking the silence': Sexual victimisation in an old age psychiatry patient population in Flanders. Int J Geriatr Psychiatry 2021; 36:1550-1558. [PMID: 33969546 DOI: 10.1002/gps.5565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/06/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sexual violence (SV) is linked to mental health problems in adulthood and old age. However, the extent of sexual victimisation in old age psychiatry patients is unknown. Due to insufficient communication skills in both patients and healthcare workers, assessing SV in old age psychiatry patients is challenging. AIMS To assess lifetime and sexual victimisation in the past 12-months, correlates and SV disclosure in an old age psychiatry population. METHODS Between July 2019 and March 2020, 100 patients at three old age psychiatry wards across Flanders participated in a face-to-face structured interview receiving inpatient treatment. The participation rate was 58%. We applied the WHO definition of SV, encompassing sexual harassment, sexual abuse with physical contact without penetration, and (attempted) rape. RESULTS In 57% of patients (65% F, 42% M) SV occurred during their lifetime and 7% (6% F, 9% M) experienced SV in the past 12-months. Half of the victims disclosed their SV experience for the first time during the interview. Only two victims had disclosed SV to a mental health care professional before. CONCLUSIONS Sexual victimisation appears to be common in old age psychiatry patients, yet it remains largely undetected. Although victims did reveal SV during a face-to-face interview to a trained interviewer, they do not seem to spontaneously disclose their experiences to mental health care professionals. In order to provide tailored care for older SV victims, professionals urgently need capacity building through training, screening tools and care procedures.
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Affiliation(s)
- Anne Nobels
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Ines Keygnaert
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Egon Robert
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Christophe Vandeviver
- Department of Criminology, Criminal Law and Social Law, Ghent University, Ghent, Belgium.,Research Foundation-Flanders (FWO), Brussels, Belgium
| | - An Haekens
- Psychiatric Hospital Alexianen Zorggroep Tienen, Tienen, Belgium
| | - Lieve Lemey
- Department of Psychiatry and Psychosomatic Medicine, AZ Sint-Jan Bruges-Ostend AV, Bruges, Belgium
| | | | | | - Gilbert M D Lemmens
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium.,Department of Head and Skin - Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
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20
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Miranda R, Smets T, De Schreye R, Faes K, Van Den Noortgate N, Cohen J, Van den Block L. Improved quality of care and reduced healthcare costs at the end-of-life among older people with dementia who received palliative home care: A nationwide propensity score-matched decedent cohort study. Palliat Med 2021; 35:1701-1712. [PMID: 34109861 DOI: 10.1177/02692163211019321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While palliative home care is advocated for people with dementia, evidence of its effectiveness is lacking. AIM To evaluate the effects of palliative home care on quality and costs of end-of-life care for older people with dementia. DESIGN Decedent cohort study using linked nationwide administrative databases and propensity score matching. SETTING/PARTICIPANTS All home-dwelling older people who died with dementia between 2010 and 2015 in Belgium (N = 23,670). EXPOSURE Receiving palliative home care support for the first time between 360 and 15 days before death. RESULTS Five thousand six hundred and thirty-seven (23.8%) received palliative home care support in the last 2 years of life, of whom 2918 received it for the first time between 360 and 15 days before death. Two thousand eight hundred and thirty-nine people who received support were matched to 2839 people who received usual care. After matching, those using palliative home care support, in the last 14 days of life, had lower risk of hospital admission (17.5% vs 50.5%; relative risk (RR) = 0.21), undergoing diagnostic testing (17.0% vs 53.6%; RR = 0.20) and receiving inappropriate medications, but were more likely to die at home (75.7% vs 32.6%; RR = 6.45) and to have primary care professional contacts (mean 11.7 vs mean 5.2), compared with those who did not. Further, they had lower mean total costs of care in the last 30 days of life (incremental cost:-€2129). CONCLUSIONS Palliative home care use by home-dwelling older people with dementia is associated with improved quality and reduced costs of end-of-life care. Access remains low and should be increased.
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Affiliation(s)
- Rose Miranda
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Robrecht De Schreye
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kristof Faes
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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21
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Abstract
BACKGROUND In particular older people are at risk of mortality due to corona virus disease 2019 (COVID-19). Advance care planning is essential to assist patient autonomy and prevent non-beneficial medical interventions. AIM To describe early (taken within 72 h after hospital admission) resuscitation orders in oldest-old hospitalized with COVID-19. SETTING/PARTICIPANTS A cohort of patients aged 80 years and older admitted to the acute hospital in March and April 2020 with COVID-19 were retrospectively recruited from 10 acute hospitals in Belgium. Recruitment was done through a network of geriatricians. RESULTS Overall, 766 octogenarians were admitted of whom 49 were excluded because no therapeutic relationship with the geriatrician and six because of incomplete case report form. Early decisions not to consider intensive care admission were taken in 474/711 (66.7%) patients. This subgroup was characterized by significantly higher age, higher number of comorbidities and higher frailty level. There was a significant association between the degree of the treatment limitation and the degree of premorbid frailty (p < 0.001). Overall in-hospital mortality was 41.6% in patients with an early decision not to consider intensive care admission (67.1% in persons who developed respiratory failure vs 16.7% in patients without respiratory failure (p < 0.001)). Of 104 patients without early decision not to consider intensive care admission but who developed respiratory failure, 59 were eventually not transferred to intensive care unit with in-hospital mortality of 25.4%; 45 were transferred to the intensive care unit with mortality of 64.4%. CONCLUSIONS Geriatricians applied all levels of treatment in oldest-old hospitalized with COVID-19. Early decisions not to consider intensive care admission were taken in two thirds of the cohort of whom more than 50% survived to hospital discharge by means of conservative treatment.
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Affiliation(s)
- Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Eva Van Braeckel
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique Benoit
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.,Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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22
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De Spiegeleer A, Van Migerode J, Bronselaer A, Wynendaele E, Peelman M, Vandaele F, Byttebier G, De Tré G, Belmans L, Van De Wiele C, Sathekge M, Van Dijck D, Saxberg B, Alexander M, Fedson D, Elewaut D, Van Den Noortgate N, De Spiegeleer B. Statin Intake and All-Cause Mortality among Older Nursing Home Residents. Gerontology 2021; 68:407-411. [PMID: 34134106 DOI: 10.1159/000516862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Statins are progressively accepted as being associated with reduced mortality. However, few real-world statin studies have been conducted on statin use in older people and especially the most frail, that is, the nursing home residents. OBJECTIVE The aim of this study was to evaluate the impact of statin intake in nursing home residents on all-cause mortality. METHOD This is a cross-sectional study of 1,094 older people residing in 6 nursing homes in Flanders (Belgium) between March 1, 2020 and May 30, 2020. We considered all residents who were taking statins for at least 5 days as statin users. All-cause mortality during the 3 months of data collection was the primary outcome. Propensity score overlap-weighted logistic regression models were applied with age, sex, functional status, diabetes, and cardiac failure/ischemia as potential confounders. RESULTS 185 out of 1,094 residents were on statin therapy (17%). The statin intake was associated with decreased all-cause mortality: 4% absolute risk reduction; adjusted odds ratio 0.50; CI 0.31-0.81, p = 0.005. CONCLUSIONS The statin intake was associated with decreased all-cause mortality in older people residing in nursing homes. More in-depth studies investigating the potential geroprotector effect of statins in this population are needed.
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Affiliation(s)
- Anton De Spiegeleer
- Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium, .,Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium, .,VIB-Center for Inflammation Research, Ghent, Belgium,
| | | | - Antoon Bronselaer
- Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | | | - Milan Peelman
- Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | | | | | - Guy De Tré
- Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | - Luc Belmans
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | | | - Mike Sathekge
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Bo Saxberg
- DDO Strategic Services, Oro Valley, Arizona, USA
| | | | | | - Dirk Elewaut
- VIB-Center for Inflammation Research, Ghent, Belgium
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23
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Piers R, De Brauwer I, Baeyens H, Velghe A, Hens L, Deschepper E, Henrard S, De Pauw M, Van Den Noortgate N, De Saint-Hubert M. Supportive and Palliative Care Indicators Tool prognostic value in older hospitalised patients: a prospective multicentre study. BMJ Support Palliat Care 2021:bmjspcare-2021-003042. [PMID: 34059507 DOI: 10.1136/bmjspcare-2021-003042] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND An increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population. AIM To validate SPICT as a prognostic tool for risk of dying within one year in older hospitalised patients. DESIGN Prospective multicentre study. Premorbid SPICT and 1-year survival and survival time were assessed. SETTING/PARTICIPANTS Patients 75 years and older admitted at acute geriatric (n=209) and cardiology units (CUs) (n=249) of four hospitals. RESULTS In total, 59.3% (124/209) was SPICT identified on acute geriatric vs 40.6% (101/249) on CUs (p<0.001). SPICT-identified patients in CUs reported more functional needs and more symptoms compared to SPICT non-identified patients. On acute geriatric units, SPICT-identified patients reported more functional needs only.The HR of dying was 2.9 (95% CI 1.1 to 8.7) in SPICT-identified versus non-identified after adjustment for hospital strata, age, gender and did not differ between units. One-year mortality was 24% and 22%, respectively, on acute geriatric versus CUs (p=0.488). Pooled average sensitivity, specificity and partial area under the curve differed significantly between acute geriatric and CUs (p<0.001), respectively, 0.82 (95%CI 0.66 to 0.91), 0.49 (95%CI 0.40 to 0.58) and 0.82 in geriatric vs 0.69 (95% CI 0.42 to 0.87), 0.66 (95% CI 0.55 to 0.77) and 0.65 in CUs. CONCLUSIONS SPICT may be used as a tool to identify older hospitalised patients at risk of dying within 1 year and who may benefit from a palliative care approach including advance care planning. The prognostic accuracy of SPICT is better in older patients admitted at the acute geriatric versus the CU.
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Affiliation(s)
- Ruth Piers
- Department of Geriatric Medicine, University Hospital Ghent, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Isabelle De Brauwer
- Department of Geriatric Medicine, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
- UCL Institute of Health and Society, Bruxelles, Belgium
| | - Hilde Baeyens
- Department of Geriatric Medicine, AZ Alma campus Eeklo, Eeklo, Belgium
| | - Anja Velghe
- Department of Geriatric Medicine, University Hospital Ghent, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Lineke Hens
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Séverine Henrard
- UCL Institute of Health and Society, Bruxelles, Belgium
- UCLouvain Louvain Drug Research Institute, Bruxelles, Belgium
| | - Michel De Pauw
- Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
- Department of Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, University Hospital Ghent, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
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24
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Zanders R, Druwé P, Van Den Noortgate N, Piers R. The outcome of in- and out-hospital cardiopulmonary arrest in the older population: a scoping review. Eur Geriatr Med 2021; 12:695-723. [PMID: 33683679 PMCID: PMC7938035 DOI: 10.1007/s41999-021-00454-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
Aim We aimed to collect the available evidence on outcome regarding survival and quality of life after CPR following both IHCA and OHCA in the older population. Findings Hospital survival rates following IHCA and OHCA in the older population improved in the recent decade, though do not exceed 28.5% and 11.1%, respectively. The effect of age on outcome remains controversial and age should not be used as the sole decision criterium whether to initiate CPR. Message Future research should study frailty and resilience as an independent predictor regardless of age, and add broader, extensive QoL measures as outcome variables. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00454-y. Purpose We aimed to collect the available evidence on outcome regarding survival and quality of life after cardiopulmonary resuscitation (CPR) following both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) in the older population. Methods A scoping review was performed studying published reviews after 2008, focusing on outcome of CPR in patients aged ≥ 70 years following IHCA and OHCA. In addition, 11 (IHCA) and 19 (OHCA) eligible studies published after the 2 included reviews were analyzed regarding: return of spontaneous circulation, survival until hospital discharge, long-term survival, neurological outcome, discharge location or other measurements for quality of life (QoL). Results The survival until hospital discharge ranged between 11.6 and 28.5% for IHCA and 0–11.1% for OHCA, and declined with increasing age. The same trend was seen regarding 1-year survival rates with 5.7–25.0% and 0–10% following IHCA and OHCA, respectively. A good neurological outcome defined as a Cerebral Performance Category (CPC) 1–2 was found in 11.5–23.6% (IHCA) and up to 10.5% (OHCA) of all patients. However, the proportion of CPC 1–2 among patients surviving until hospital discharge was 82–93% (IHCA) and 77–91.6% (OHCA). Few studies included other QoL measures as an outcome variable. Other risk factors aside from age were identified, including nursing home residency, comorbidity, non-shockable rhythm, non-witnessed arrest. The level of frailty was not studied as a predictor of arrest outcome in the included studies. Conclusions Hospital survival rates following IHCA and OHCA in the older population improved in the recent decade, though do not exceed 28.5% and 11.1%, respectively. The effect of age on outcome remains controversial and age should not be used as the sole decision criterium whether to initiate CPR. Future research should study frailty and resilience as an independent predictor regardless of age, and add broader, extensive QoL measures as outcome variables. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00454-y.
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Affiliation(s)
- Rina Zanders
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium.
| | - Patrick Druwé
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Ruth Piers
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
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25
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Miranda R, Smets T, Van Den Noortgate N, van der Steen JT, Deliens L, Payne S, Szczerbińska K, Pautex S, Van Humbeeck L, Gambassi G, Kylänen M, Van den Block L. No difference in effects of 'PACE steps to success' palliative care program for nursing home residents with and without dementia: a pre-planned subgroup analysis of the seven-country PACE trial. BMC Palliat Care 2021; 20:39. [PMID: 33678179 PMCID: PMC7937240 DOI: 10.1186/s12904-021-00734-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background ‘PACE Steps to Success’ is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents’ comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia. Methods Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying–End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome). Results At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (− 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (− 0.6; p = 0.741), non-advanced and without dementia (− 1.5; p = 0.428), and advanced and non-advanced dementia (0.9; p = 0.632). Conclusions The lack of subgroup difference suggests that while the program did not improve comfort in dying residents with or without dementia, it appeared to equally improve quality of care and dying in the last month of life for residents with dementia (regardless of the stage) and those without dementia. A generalist and non-disease-specific palliative care program, such as PACE Steps to Success, is a useful starting point for future palliative care improvement in nursing homes, but to effectively improve residents’ comfort, this program needs further development. Trial registration ISRCTN, ISRCTN14741671. Registered 8 July 2015 – Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00734-1.
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Affiliation(s)
- Rose Miranda
- Vrije Universiteit Brussel & Ghent University, End-of-Life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Vrije Universiteit Brussel, Department of Family Medicine and Chronic Care, Brussels, Belgium.
| | - Tinne Smets
- Vrije Universiteit Brussel & Ghent University, End-of-Life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium.,Vrije Universiteit Brussel, Department of Family Medicine and Chronic Care, Brussels, Belgium
| | | | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC-VU University Medical Center, Amsterdam, The Netherlands
| | - Luc Deliens
- Vrije Universiteit Brussel & Ghent University, End-of-Life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium.,Vrije Universiteit Brussel, Department of Family Medicine and Chronic Care, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sheila Payne
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK
| | - Katarzyna Szczerbińska
- Laboratory for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Sophie Pautex
- Hôpitaux Universitaires de Genève, University of Geneva, Geneva, Switzerland
| | | | - Giovanni Gambassi
- Department of Internal Medicine, Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marika Kylänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Lieve Van den Block
- Vrije Universiteit Brussel & Ghent University, End-of-Life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium.,Vrije Universiteit Brussel, Department of Family Medicine and Chronic Care, Brussels, Belgium
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26
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Miranda R, Smets T, Van Den Noortgate N, Deliens L, Van den Block L. Higher Prevalence of Dementia but No Change in Total Comfort While Dying among Nursing Home Residents with Dementia between 2010 and 2015: Results from Two Retrospective Epidemiological Studies. Int J Environ Res Public Health 2021; 18:ijerph18042160. [PMID: 33672123 PMCID: PMC7926426 DOI: 10.3390/ijerph18042160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
Important policy developments in dementia and palliative care in nursing homes between 2010 and 2015 in Flanders, Belgium might have influenced which people die in nursing homes and how they die. We aimed to examine differences between 2010 and 2015 in the prevalence and characteristics of residents with dementia in nursing homes in Flanders, and their palliative care service use and comfort in the last week of life. We used two retrospective epidemiological studies, including 198 residents in 2010 and 183 in 2015, who died with dementia in representative samples of nursing homes in Flanders. We found a 15%-point increase in dementia prevalence (p-value < 0.01), with a total of 11%-point decrease in severe to very severe cognitive impairment (p = 0.04). Controlling for residents’ characteristics, in the last week of life, there was an increase in the use of pain assessment (+20%-point; p < 0.03) but no change in total comfort. The higher prevalence of dementia in nursing homes with no change in residents’ total comfort while dying emphasizes an urgent need to better support nursing homes in improving their capacities to provide timely and high-quality palliative care services to more residents dying with dementia.
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Affiliation(s)
- Rose Miranda
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, 1090 Brussels, Belgium; (T.S.); (L.D.); (L.V.d.B.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Correspondence:
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, 1090 Brussels, Belgium; (T.S.); (L.D.); (L.V.d.B.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | | | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, 1090 Brussels, Belgium; (T.S.); (L.D.); (L.V.d.B.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University Hospital, 9000 Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, 1090 Brussels, Belgium; (T.S.); (L.D.); (L.V.d.B.)
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
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de Nooijer K, Pivodic L, Van Den Noortgate N, Pype P, Van den Block L. Timely short-term specialised palliative care service intervention for frail older people and their family carers in primary care: study protocol for a pilot randomised controlled trial. BMJ Open 2021; 11:e043663. [PMID: 33472789 PMCID: PMC8483035 DOI: 10.1136/bmjopen-2020-043663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There is limited evidence regarding the effectiveness of timely integration of short-term specialised palliative care services for older people in primary care. Using a Theory of Change approach, we developed such an intervention, the Frailty+ intervention. We present the protocol of a pilot randomised controlled trial (RCT) with a process evaluation that aims to assess the feasibility and preliminary effectiveness of the Frailty+ intervention. METHODS AND ANALYSIS We will conduct a pilot RCT in Flanders, Belgium. Frail older people who are discharged to home from hospital will be identified and recruited. Seventy-six will be randomly assigned either to the control group (standard care) or the intervention group (Frailty+ intervention alongside standard care). Data will be collected from patients and family carers. At the core of the Frailty+ intervention is the provision of timely short-term specialised palliative care facilitated by a nurse from the specialised palliative home care service over a period of 8 weeks. We will assess feasibility in terms of recruitment, randomisation, acceptability of the intervention, retention in the programme and data completion. The primary outcome for assessing preliminary effectiveness is a mean score across five key symptoms that are amenable to change (ie, breathlessness, pain, anxiety, constipation, fatigue), measured at baseline and 8 weeks post-baseline. The process evaluation will be conducted in the intervention group only, with measurements at 8-11 weeks post-baseline to evaluate implementation, mechanisms of change and contextual factors. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of University Hospital Ghent. Results will be used to inform the design of a full-scale RCT and will be published in a peer-reviewed, open access journal. TRIAL REGISTRATION NUMBER ISRCTN39282347; Pre-results.
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Affiliation(s)
- Kim de Nooijer
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lara Pivodic
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Van Den Noortgate
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Geriatric Medicine, University Hospital Ghent, Ghent, Belgium
| | - Peter Pype
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Clinical Sciences, Vrije Universiteit Brussel, Brussels, Belgium
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Van Den Noortgate N, Van Humbeeck L. Medical assistance in dying and older persons in Belgium: trends, emerging issues and challenges. Age Ageing 2021; 50:68-71. [PMID: 32574355 DOI: 10.1093/ageing/afaa116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
In 2002, the Belgian Act on euthanasia came into effect, regulating the intentional ending of life by a physician at the patient's explicit request. Subsequently, the number of reported euthanasia deaths increased every year. Specifically, the proportion of euthanasia deaths in older persons has risen significantly in the last few years. Since the conception of the Euthanasia Act, Belgian physicians have been confronted with challenges concerning euthanasia requests in older persons with polypathology, tiredness of life or dementia. By exploring these issues, this commentary highlights the importance of a meticulous and team-based assessment of the (i) seriousness of the underlying condition, (ii) voluntariness of the request and (iii) decisional capacity of the older person requesting euthanasia.
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Van de Vyver C, Velghe A, Baeyens H, Baeyens JP, Dekoninck J, Van Den Noortgate N, Piers R. Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards. BMC Geriatr 2020; 20:499. [PMID: 33234124 PMCID: PMC7687723 DOI: 10.1186/s12877-020-01898-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background Timely palliative care in frail older persons remains challenging. Scales to identify older patients at risk of functional decline already exist. However, factors to predict short term mortality in older hospitalized patients are scarce. Methods In this prospective study, we recruited patients of 75 years and older at the department of cardiology and geriatrics. The usual gait speed measurement closest to discharge was chosen. We used the risk of dying within 1 year as parameter for starting palliative care. ROC curves were used to determine the best cut-off value of usual gait speed to predict one-year mortality. Time to event analyses were assessed by COX regression. Results On the acute geriatric ward (n = 60), patients were older and more frail (assessed by Katz and iADL) in comparison to patients on the cardiology ward (n = 82); one-year mortality was respectively 27 and 15% (p = 0.069). AUC on the acute geriatric ward was 0.748 (p = 0.006). The best cut-off value was 0.42 m/s with a sensitivity and specificity of 0.857 and 0.643. Slow walkers died earlier than faster walkers (HR 7.456, p = 0.011), after correction for age and sex. On the cardiology ward, AUC was 0.560 (p = 0.563); no significant association was found between usual gait speed and survival time. Conclusions Usual gait speed may be a valuable prognostic factor to identify patients at risk for one-year mortality on the acute geriatric ward but not on the cardiology ward. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-020-01898-w.
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Affiliation(s)
- Celine Van de Vyver
- Department of Geriatric Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Anja Velghe
- Department of Geriatric Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Hilde Baeyens
- Department of Geriatric Medicine, AZ Alma Eeklo, Eeklo, Belgium
| | | | - Julien Dekoninck
- Department of Geriatric Medicine, AZ Alma Eeklo, Eeklo, Belgium.,Department of Geriatric Medicine, Sint-Andriesziekenhuis, Tielt, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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Froggatt KA, Moore DC, Van den Block L, Ling J, Payne SA, Van den Block L, Arrue B, Baranska I, Moore DC, Deliens L, Engels Y, Finne-Soveri H, Froggatt K, Gambassi G, Honincx E, Kijowska V, Koppel MT, Kylanen M, Mammarella F, Miranda R, Smets T, Onwuteaka-Philipsen B, Oosterveld-Vlug M, Pasman R, Payne S, Piers R, Pivodic L, van der Steen J, Szczerbińska K, Van Den Noortgate N, van Hout H, Wichmann A, Vernooij-Dassen M. Palliative Care Implementation in Long-Term Care Facilities: European Association for Palliative Care White Paper. J Am Med Dir Assoc 2020; 21:1051-1057. [DOI: 10.1016/j.jamda.2020.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/17/2019] [Accepted: 01/08/2020] [Indexed: 10/24/2022]
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Tanghe M, Van Den Noortgate N, Deliens L, Smets T, Onwuteaka-Philipsen B, Finne-Soveri H, Van den Block L, Piers R. Comparing Symptom Ratings by Staff and Family Carers in Residents Dying in Long-Term Care Facilities in Three European Countries, Results From a PACE Survey. J Pain Symptom Manage 2020; 60:362-371.e2. [PMID: 32169540 DOI: 10.1016/j.jpainsymman.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 11/24/2022]
Abstract
CONTEXT Symptom management is essential in the end-of-life care of long-term care facility residents. OBJECTIVES To study discrepancies and possible associated factors in staff and family carers' symptom assessment scores for residents in the last week of life. METHODS A postmortem survey in Belgium, The Netherlands, and Finland: staff and family carers completed the End-of-Life in Dementia-Comfort Assessment in Dying scale, rating 14 symptoms on a one-point to three-point scale. Higher scores reflect better comfort. We calculated mean paired differences in symptom, subscale, and total scores at a group level and inter-rater agreement and percentage of perfect agreement at a resident level. RESULTS Mean staff scores significantly reflected better comfort than those of family carers for the total End-of-Life in Dementia-Comfort Assessment in Dying (31.61 vs. 29.81; P < 0.001) and the physical distress (8.64 vs. 7.62; P < 0.001) and dying symptoms (8.95 vs. 8.25; P < 0.001) subscales. No significant differences were found for emotional distress and well-being. The largest discrepancies were found for gurgling, discomfort, restlessness, and choking for which staff answered not at all, whereas the family carer answered a lot, in respectively, 9.5%, 7.3%, 6.7%, and 6.1% of cases. Inter-rater agreement κ ranged from 0.106 to 0.204, the extent of perfect agreement from 40.8 for lack of serenity to 68.7% for crying. CONCLUSION There is a need for improved communication between staff and family and discussion about symptom burden in the dying phase in long-term care facilities.
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Affiliation(s)
- Marc Tanghe
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent University, Ghent, Belgium.
| | - Nele Van Den Noortgate
- Department of Geriatrics, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Bregje Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | | | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Ruth Piers
- Department of Geriatrics, Ghent University and Ghent University Hospital, Ghent, Belgium
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Nobels A, Vandeviver C, Beaulieu M, Cismaru Inescu A, Nisen L, Van Den Noortgate N, Vander Beken T, Lemmens G, Keygnaert I. "Too Grey To Be True?" Sexual Violence in Older Adults: A Critical Interpretive Synthesis of Evidence. Int J Environ Res Public Health 2020; 17:ijerph17114117. [PMID: 32526986 PMCID: PMC7312038 DOI: 10.3390/ijerph17114117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 01/18/2023]
Abstract
Sexual violence (SV) is an important public health issue with a major impact on victims and their peers, offspring and community. However, SV in older adults is under-researched. This paper aims to establish the prevalence and nature of SV in older adults in Europe, link this with existing policies and health care workers’ response to sexual health needs in older age, and critically revise the currently used frameworks in public health research. To fill this gap in the literature, we applied a Critical Interpretative Synthesis (CIS) approach. The CIS approach uses techniques from grounded theory and processes from systematic review. It allows to critically interpret key findings from both academic as well as grey literature, engendering theory refining. In the first phase of purposive sampling, we conducted a systematic review of academic sources and included 14 references. The cut-off age used to define old age varied between 60 and 70 years old among the included studies. Subsequently we added another 14 references in the second phase of theoretical sampling. We ultimately included 16 peer-reviewed articles and 12 documents from the grey literature. The CIS results demonstrate that knowledge of SV in older adults is still limited. The current research suggests that SV in older adults rarely occurs, however, prevalence rates are likely to be underestimated because of methodological shortcomings. The complexity of SV in older adults is not acknowledged in ongoing research due to the conflation of SV with other types of violence. Information on specific risk factors and about assailants committing SV in old age is absent. Policy documents dealing with sexual and reproductive health, rights and ageing make no mention of SV in older adults. In clinical practice, the sexual health needs of older adults often remain unmet. In conclusion, our findings suggest that older adults are forgotten in prevention and response to SV. Greater awareness about this topic could contribute to a revision of current policies and health care practices, leading to more tailored care for older victims of SV.
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Affiliation(s)
- Anne Nobels
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health (ICRH), Ghent University, C. Heymanslaan 10, ICRH, 9000 Ghent, Belgium;
- Correspondence: ; Tel.: +32-9-332-35-64
| | - Christophe Vandeviver
- Department of Criminology, Criminal Law and Social Law, Ghent University, Universiteitstraat 4, 9000 Ghent, Belgium; (C.V.); (T.V.B.)
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
| | - Marie Beaulieu
- School of Social Work and Research Centre on Aging, University of Sherbooke, Sherbrooke, QC J1H 5N4, Canada;
| | - Adina Cismaru Inescu
- ESPRIst, Études et évaluations, University of Liège, 4000 Liège, Belgium; (A.C.I.); (L.N.)
| | - Laurent Nisen
- ESPRIst, Études et évaluations, University of Liège, 4000 Liège, Belgium; (A.C.I.); (L.N.)
| | - Nele Van Den Noortgate
- Department of Geriatrics, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium;
| | - Tom Vander Beken
- Department of Criminology, Criminal Law and Social Law, Ghent University, Universiteitstraat 4, 9000 Ghent, Belgium; (C.V.); (T.V.B.)
| | - Gilbert Lemmens
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium;
| | - Ines Keygnaert
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health (ICRH), Ghent University, C. Heymanslaan 10, ICRH, 9000 Ghent, Belgium;
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Vandepitte S, Putman K, Van Den Noortgate N, Verhaeghe N, Annemans L. Cost-effectiveness of an in-home respite care program to support informal caregivers of persons with dementia: A model-based analysis. Int J Geriatr Psychiatry 2020; 35:601-609. [PMID: 32011773 DOI: 10.1002/gps.5276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/20/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate cost-effectiveness of an in-home respite care program in addition to standard community-based dementia care to support informal caregivers of persons with dementia compared with standard community-based dementia care. METHODS An age-dependent decision-analytic Markov model was applied from a third-party payer and a societal perspective projecting results of a quasi-experimental study over a time horizon of 5 years assuming a repetition of the program every 6 months. Additionally, to deal with uncertainty and to test robustness of the model scenario, one-way and probabilistic sensitivity analyses were conducted. RESULTS Implementing the program resulted in a quality-adjusted life year (QALY) gain of 0.14 in favor of the invention group compared with controls and an incremental cost of 1270€ from the third-party payer perspective and of 1220€ from the societal perspective. Next, an incremental cost-effectiveness ratio of 9042€/QALY and of 8690€/QALY was found in the base case, from the third-party payer perspective and the societal perspective, respectively. The scenario, one-way sensitivity, and probabilistic analyses demonstrated robustness of the base-case results. CONCLUSION This cost-effectiveness analysis suggests that an in-home respite care program in addition to standard community-based dementia care is a cost-effective approach compared with standard community-based dementia care only. These findings provide more insight into the value of such services for the patient, the caregiver, and for society.
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Affiliation(s)
- Sophie Vandepitte
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Koen Putman
- Faculty of Medicine and Pharmacy, Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Van Den Noortgate
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Nick Verhaeghe
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
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Tanghe M, Van Den Noortgate N, Deliens L, Smets T, Onwuteaka-Philipsen B, Szczerbińska K, Finne-Soveri H, Payne S, Gambassi G, Van den Block L, Piers R. Opioid underuse in terminal care of long-term care facility residents with pain and/or dyspnoea: A cross-sectional PACE-survey in six European countries. Palliat Med 2020; 34:784-794. [PMID: 32286149 DOI: 10.1177/0269216320910332] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVES Opioids relieve symptoms in terminal care. We studied opioid underuse in long-term care facilities, defined as residents without opioid prescription despite pain and/or dyspnoea, 3 days prior to death. DESIGN AND SETTING In a proportionally stratified randomly selected sample of long-term care facilities in six European Union countries, nurses and long-term care facility management completed structured after-death questionnaires within 3 months of residents' death. MEASUREMENTS Nurses assessed pain/dyspnoea with Comfort Assessment in Dying with Dementia scale and checked opioid prescription by chart review. We estimated opioid underuse per country and per symptom and calculated associations of opioid underuse by multilevel, multivariable analysis. RESULTS Nurses' response rate was 81.6%, 95.7% for managers. Of 901 deceased residents with pain/dyspnoea reported in the last week, 10.6% had dyspnoea, 34.4% had pain and 55.0% had both symptoms. Opioid underuse per country was 19.2% (95% confidence interval: 12.9-27.2) in the Netherlands, 25.2% (18.3-33.6) in Belgium, 29.3% (16.9-45.8) in England, 33.7% (26.2-42.2) in Finland, 64.6% (52.0-75.4) in Italy and 79.1% (71.2-85.3) in Poland (p < 0.001). Opioid underuse was 57.2% (33.0-78.4) for dyspnoea, 41.2% (95% confidence interval: 21.9-63.8) for pain and 37.4% (19.4-59.6) for both symptoms (p = 0.013). Odds of opioid underuse were lower (odds ratio: 0.33; 95% confidence interval: 0.20-0.54) when pain was assessed. CONCLUSION Opioid underuse differs between countries. Pain and dyspnoea should be formally assessed at the end-of-life and taken into account in physicians orders.
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Affiliation(s)
- Marc Tanghe
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Bregje Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Giovanni Gambassi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University and Ghent University Hospital, Ghent, Belgium
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Van Humbeeck L, Malfait S, Holvoet E, Vogelaers D, De Pauw M, Van Den Noortgate N, Van Biesen W. Value discrepancies between nurses and patients: A survey study. Nurs Ethics 2020; 27:1044-1055. [DOI: 10.1177/0969733020906595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Patient-centeredness, respect for patient autonomy, and shared decision-making have now made it to center stage in discussions on quality of care. Knowing what actually counts in care and how it should be accomplished from the patients’ and nurses’ perspective seems crucial. Aim To explore how patients and their nurses perceive the importance and enactment of values in their healthcare. Research design An observational, cross-sectional study using a self-developed questionnaire, consisting of 15 items related to seven values (e.g. uniqueness, autonomy, professionalism, compassion, responsiveness, partnership, and empowerment) as described in the taxonomy of Bastemeijer et al. Participants and research context The survey was completed by 384 patients and 81 nurses. Participants were recruited on eight internal medicine wards of a 1000-bed university hospital in Belgium. Ethical considerations This study was approved by the ethical committee of the Ghent University Hospital (B670201836799). Findings (1) Patients and nurses prioritize values of care differently; (2) nurses report not being able to enact the values they prioritize in actual practice as much as one would like to; and (3) there is a gap in experienced delivery of a comprehensible explanation of all treatment options, a conversation based on equality, making shared decisions, and being non-judgmental between nurses and patients. Discussion Our findings challenge nurses’ overemphasis on professional compassion and uniqueness while arguing for increased attention on authentic shared decision-making and empowerment. The first step to a patient-centered culture truly involving patients in their healthcare is communication and information provision, rather than focusing on tangible and normative constructs. Conclusion Our findings revealed differences in prioritization and actual enactment of values in care between patients and nurses. This was especially so for values related to communication, provision of complete unbiased information, and shared decision-making. Nurses should prioritize providing comprehensible information and using conversations based on equality to make decision together with patients.
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De Spiegeleer A, Elewaut D, Van Den Noortgate N, Janssens Y, Debunne N, Van Langenhove S, Govindarajan S, De Spiegeleer B, Wynendaele E. Quorum sensing molecules as a novel microbial factor impacting muscle cells. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165646. [DOI: 10.1016/j.bbadis.2019.165646] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/15/2019] [Indexed: 02/07/2023]
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Sanchez-Rodriguez D, Annweiler C, Marco E, Hope S, Piotrowicz K, Surquin M, Ranhoff A, Van Den Noortgate N, Andersen-Ranberg K, Bonin-Guillaume S, Conroy S, Gordon A, Grodziki T, Landi F, Martínez-Velilla N, Münzer T, Ranhoff AH, Roller-Wirnsberger R, Singler K, Van Den Noortgate N, Al Hamad HK, Annweiler C, Beuscart JB, Blanc F, Ciurea A, Cobbaert K, Dallmeier D, Dinan P, Engvig A, Højmann AH, Hosia H, Hope S, Kerminen HM, Knapskog AB, Koutsouri A, Laurent M, Lilamand M, Marien S, Mellingsaeter M, Mendes A, Nguyen S, Ogugua C, Ommundsen N, Périvier S, Piotrowicz K, Rapo-Pylkkö S, Roitto HM, Roubaud-Baudron C, Saka B, Sanchez-Rodriguez D, Surquin M, Tarazona F, Toscano-Rico M, Tschurr G, Vande Walle N, Vetrano D, Yavuz BB. European Academy for medicine of ageing session participants' report on malnutrition assessment and diagnostic methods; an international survey. Clin Nutr ESPEN 2020; 35:75-80. [DOI: 10.1016/j.clnesp.2019.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022]
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Van den Block L, Honinx E, Pivodic L, Miranda R, Onwuteaka-Philipsen BD, van Hout H, Pasman HRW, Oosterveld-Vlug M, Ten Koppel M, Piers R, Van Den Noortgate N, Engels Y, Vernooij-Dassen M, Hockley J, Froggatt K, Payne S, Szczerbinska K, Kylänen M, Gambassi G, Pautex S, Bassal C, De Buysser S, Deliens L, Smets T. Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries: The PACE Cluster-Randomized Clinical Trial. JAMA Intern Med 2020; 180:233-242. [PMID: 31710345 PMCID: PMC6865772 DOI: 10.1001/jamainternmed.2019.5349] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE High-quality evidence on how to improve palliative care in nursing homes is lacking. OBJECTIVE To investigate the effect of the Palliative Care for Older People (PACE) Steps to Success Program on resident and staff outcomes. DESIGN, SETTING, AND PARTICIPANTS A cluster-randomized clinical trial (2015-2017) in 78 nursing homes in 7 countries comparing PACE Steps to Success Program (intervention) with usual care (control). Randomization was stratified by country and median number of beds in each country in a 1:1 ratio. INTERVENTIONS The PACE Steps to Success Program is a multicomponent intervention to integrate basic nonspecialist palliative care in nursing homes. Using a train-the-trainer approach, an external trainer supports staff in nursing homes to introduce a palliative care approach over the course of 1 year following a 6-steps program. The steps are (1) advance care planning with residents and family, (2) assessment, care planning, and review of needs and problems, (3) coordination of care via monthly multidisciplinary review meetings, (4) delivery of high-quality care focusing on pain and depression, (5) care in the last days of life, and (6) care after death. MAIN OUTCOMES AND MEASURES The primary resident outcome was comfort in the last week of life measured after death by staff using the End-of-Life in Dementia Scale Comfort Assessment While Dying (EOLD-CAD; range, 14-42). The primary staff outcome was knowledge of palliative care reported by staff using the Palliative Care Survey (PCS; range, 0-1). RESULTS Concerning deceased residents, we collected 551 of 610 questionnaires from staff at baseline and 984 of 1178 postintervention in 37 intervention and 36 control homes. Mean (SD) age at time of death ranged between 85.22 (9.13) and 85.91 (8.57) years, and between 60.6% (160/264) and 70.6% (190/269) of residents were women across the different groups. Residents' comfort in the last week of life did not differ between intervention and control groups (baseline-adjusted mean difference, -0.55; 95% CI, -1.71 to 0.61; P = .35). Concerning staff, we collected 2680 of 3638 questionnaires at baseline and 2437 of 3510 postintervention in 37 intervention and 38 control homes. Mean (SD) age of staff ranged between 42.3 (12.1) and 44.1 (11.7) years, and between 87.2% (1092/1253) and 89% (1224/1375) of staff were women across the different groups. Staff in the intervention group had statistically significantly better knowledge of palliative care than staff in the control group, but the clinical difference was minimal (baseline-adjusted mean difference, 0.04; 95% CI, 0.02-0.05; P < .001). Data analyses began on April 20, 2018. CONCLUSIONS AND RELEVANCE Residents' comfort in the last week of life did not improve after introducing the PACE Steps to Success Program. Improvements in staff knowledge of palliative care were clinically not important. TRIAL REGISTRATION ISRCTN Identifier: ISRCTN14741671.
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Affiliation(s)
- Lieve Van den Block
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Elisabeth Honinx
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Lara Pivodic
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Rose Miranda
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hein van Hout
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mariska Oosterveld-Vlug
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maud Ten Koppel
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruth Piers
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Nele Van Den Noortgate
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jo Hockley
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
| | - Katherine Froggatt
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
| | - Sheila Payne
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
| | - Katarzyna Szczerbinska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marika Kylänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Giovanni Gambassi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sophie Pautex
- Hôpitaux Universitaires de Genève, University of Geneva, Geneva, Switzerland
| | - Catherine Bassal
- Center for the Interdisciplinary Study of Gerontology and Vulnerability (CIGEV), University of Geneva, Geneva, Switzerland
| | - Stefanie De Buysser
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Luc Deliens
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Public Health and Primary Care, Ghent University, Belgium
| | - Tinne Smets
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
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Sanchez-Rodriguez D, Hope S, Piotrowicz K, Benoit F, Czesak J, Dallmeier D, Decker G, De Spiegeleer A, Højmann AH, Hrnciarikova D, Marco E, Mendes D, Meza D, Nascimento P, Rodrigues A, Surquin M, Toscano-Rico M, Vankova H, Vetrano DL, Gąsowski J, Van Den Noortgate N, Landi F. Sarcopenia in Acute Care Patients: Protocol for the European Collaboration of Geriatric Surveys: Sarcopenia 9+ EAMA Project. J Am Med Dir Assoc 2019; 20:e1-e3. [DOI: 10.1016/j.jamda.2019.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/27/2019] [Indexed: 01/08/2023]
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De Spiegeleer A, Elewaut D, Van Den Noortgate N, Janssens Y, Debunne N, Van Langenhove S, Govindarajan S, De Spiegeleer B, Wynendaele E. WITHDRAWN: This article has been withdrawn. Biochim Biophys Acta Mol Basis Dis 2019:165585. [PMID: 31678164 DOI: 10.1016/j.bbadis.2019.165585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/11/2019] [Accepted: 09/22/2019] [Indexed: 11/21/2022]
Abstract
This article has been withdrawn at the request of the author for administrative reasons. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Anton De Spiegeleer
- Department of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB-Center for Inflammation Research, Technologiepark 71, 9052, Zwijnaarde, Ghent, Belgium
| | - Dirk Elewaut
- Unit for Molecular Immunology and Inflammation, VIB-Center for Inflammation Research, Technologiepark 71, 9052, Zwijnaarde, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Yorick Janssens
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Nathan Debunne
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Selien Van Langenhove
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Srinath Govindarajan
- Unit for Molecular Immunology and Inflammation, VIB-Center for Inflammation Research, Technologiepark 71, 9052, Zwijnaarde, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Bart De Spiegeleer
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Evelien Wynendaele
- Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium.
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Vandepitte S, Putman K, Van Den Noortgate N, Verhaeghe S, Annemans L. Effectiveness of an in-home respite care program to support informal dementia caregivers: A comparative study. Int J Geriatr Psychiatry 2019; 34:1534-1544. [PMID: 31243801 DOI: 10.1002/gps.5164] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/15/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Dementia is a major public health problem with important physical, psychosocial, emotional, and financial consequences for patients, their caregivers, and society. Since patients prefer to be managed at home, extensive research has been conducted into effectiveness of psychosocial interventions to support informal caregivers. The aim of this study was to assess the effectiveness of an in-home respite care program. METHODS In a prospective quasi-experimental study, 99 dyads who received an in-home respite care program were compared at 6 months post-baseline, with 99 matched dyads receiving standard dementia care. Additionally, the short-term effect of the program was evaluated 14 to 15 days post-intervention. The primary outcome was caregiver burden. The secondary outcomes were: desire to institutionalize the patient, caregiver quality of life, and frequency and impact of behavioral problems. Mixed model analyses were performed to evaluate the impact of the intervention. RESULTS After 6 months, no significant difference on caregiver burden was observed, but intervention group caregivers had a significant lower desire to institutionalize the patient compared with control group caregivers (adj.diff = -0.51; p = .02). Shortly after the program, intervention group caregivers also had a significant lower role strain (adj.diff = 0.75; p = .05), and a lower burden on social and family life (adj.diff = 0.55; p = .05) compared with baseline. CONCLUSIONS This study was the first comparative study to investigate effectiveness of an in-home respite care program to support informal caregivers of persons with dementia. The results partly confirm earlier positive findings from explorative studies.
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Affiliation(s)
- Sophie Vandepitte
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Koen Putman
- Faculty of Medicine and Pharmacy, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Van Den Noortgate
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Ten Koppel M, Onwuteaka-Philipsen BD, Van den Block L, Deliens L, Gambassi G, Heymans MW, Kylänen M, Oosterveld-Vlug MG, Pasman HRW, Payne S, Smets T, Szczerbińska K, Twisk JW, van der Steen JT, Mammarella F, Mercuri M, Pivodic L, Pac A, Rossi P, Segat I, Sowerby E, Stodolska A, van Hout H, Wichmann A, Adang E, Andreasen P, Finne-Soveri H, Collingridge Moore D, Froggatt K, Kijowska V, Van Den Noortgate N, Vernooij-Dassen M. Palliative care provision in long-term care facilities differs across Europe: Results of a cross-sectional study in six European countries (PACE). Palliat Med 2019; 33:1176-1188. [PMID: 31258004 DOI: 10.1177/0269216319861229] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While the need for palliative care in long-term care facilities is growing, it is unknown whether palliative care in this setting is sufficiently developed. AIM To describe and compare in six European countries palliative care provision in long-term care facilities and to assess associations between patient, facility and advance care planning factors and receipt and timing of palliative care. DESIGN Cross-sectional after-death survey regarding care provided to long-term care residents in Belgium, England, Finland, Italy, the Netherlands and Poland. Generalized estimating equations were used for analyses. SETTING/PARTICIPANTS Nurses or care assistants who are most involved in care for the resident. RESULTS We included 1298 residents in 300 facilities, of whom a majority received palliative care in most countries (England: 72.6%-Belgium: 77.9%), except in Poland (14.0%) and Italy (32.1%). Palliative care typically started within 2 weeks before death and was often provided by the treating physician (England: 75%-the Netherlands: 98.8%). A palliative care specialist was frequently involved in Belgium and Poland (57.1% and 86.7%). Residents with cancer, dementia or a contact person in their record more often received palliative care, and it started earlier for residents with whom the nurse had spoken about treatments or the preferred course of care at the end of life. CONCLUSION The late initiation of palliative care (especially when advance care planning is lacking) and palliative care for residents without cancer, dementia or closely involved relatives deserve attention in all countries. Diversity in palliative care organization might be related to different levels of its development.
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Affiliation(s)
- Maud Ten Koppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Giovanni Gambassi
- Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Marika Kylänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Mariska G Oosterveld-Vlug
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Sheila Payne
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Katarzyna Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jos Wr Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Barańska I, Kijowska V, Engels Y, Finne-Soveri H, Froggatt K, Gambassi G, Hammar T, Oosterveld-Vlug M, Payne S, Van Den Noortgate N, Smets T, Deliens L, Van den Block L, Szczerbińska K. Factors Associated with Perception of the Quality of Physicians' End-of-life Communication in Long-Term Care Facilities: PACE Cross-Sectional Study. J Am Med Dir Assoc 2019; 21:439.e1-439.e8. [PMID: 31521539 DOI: 10.1016/j.jamda.2019.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/17/2019] [Accepted: 07/20/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine factors associated with perceived quality of communication with physicians by relatives of dying residents of long-term care facilities (LTCFs). DESIGN A cross-sectional retrospective study in a representative sample of LTCFs conducted in 2015. In each LTCF, deaths of residents during the 3 months before the researcher's visit were reported. Structured questionnaires were sent to the identified relatives of deceased residents. SETTINGS AND PARTICIPANTS A total of 736 relatives of deceased residents in 210 LTCFs (in Belgium, Finland, Italy, the Netherlands, and Poland). METHODS The Family Perception of Physician-Family Communication scale (FPPFC) was used to assess the quality of end-of-life (EOL) communication with physicians as perceived by relatives. We applied multilevel linear regression models to find factors associated with the FPPFC score. RESULTS The quality of EOL communication with physicians was perceived by relatives as higher when the relative spent more than 14 hours with the resident in the last week of the resident's life (b = 0.205; P = .044), and when the treating physician visited the resident at least 3 times in the last week of the resident's life (b = 0.286; P = .002) or provided the resident with palliative care (b = 0.223; P = .003). Relatives with higher emotional burden perceived the quality of EOL communication with physicians as lower (b = -0.060; P < .001). These results had been adjusted to countries and LTCF types with physicians employed on-site or off-site of the facility. CONCLUSION The quality of EOL communication with physicians, as perceived by relatives of dying LTCF residents, is associated with the number of physician visits and amount of time spent by the relative with the resident in the last week of the resident's life, and relatives' emotional burden. IMPLICATIONS LTCF managers should organize care for dying residents in a way that enables frequent interactions between physicians and relatives, and emotional support to relatives to improve their satisfaction with EOL communication.
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Affiliation(s)
- Ilona Barańska
- Unit for Research on Aging Society, Department of Sociology, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Violetta Kijowska
- Unit for Research on Aging Society, Department of Sociology, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Giovanni Gambassi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Teija Hammar
- National Institute for Health and Welfare, Helsinki, Finland
| | - Mariska Oosterveld-Vlug
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Sheila Payne
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Tinne Smets
- Department of Family Medicine and Chronic Care, End-of- Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- Department of Family Medicine and Chronic Care, End-of- Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, End-of- Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Katarzyna Szczerbińska
- Unit for Research on Aging Society, Department of Sociology, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
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Van Deun B, Hobbelen JSM, Cagnie B, Van Eetvelde B, Van Den Noortgate N, Cambier D. Reproducible Measurements of Muscle Characteristics Using the MyotonPRO Device: Comparison Between Individuals With and Without Paratonia. J Geriatr Phys Ther 2019; 41:194-203. [PMID: 28005829 DOI: 10.1519/jpt.0000000000000119] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The MyotonPRO is a portable device that measures muscle tone and biomechanical muscle properties objectively. MyotonPRO has already proven to be effective in measuring muscle properties in healthy and diseased populations. However, to the best of our knowledge, it has never been tested in individuals suffering from paratonia, a form of hypertonia frequently accompanying dementia. The aims of the present study were to (1) compare muscle tone, elasticity, and stiffness between 3 different subpopulations of young and old healthy adults and individuals with paratonia, and (2) investigate the intra- and interrater reproducibility of MyotonPRO measurements of the biceps brachii (BB) muscle in each subpopulation. METHODS MyotonPRO measurements of muscle tone, elasticity, and dynamic stiffness were carried out by 2 investigators on 2 different days over the BB muscles of 54 participants (18 healthy young adults, 20 healthy older adults, and 16 older individuals with paratonia). Muscle properties were compared between subpopulations using ANOVA/Welch and post hoc tests. Reliability (intraclass correlation coefficient) and agreement parameters (standard error of measurement and the minimal detectable change) were calculated. RESULTS Statistically significant differences between subpopulations were found in all parameters, except for stiffness between healthy elderly and individuals with paratonia. In the healthy subpopulations, (a) intrarater reliability was very high and intrarater agreement was good between 2 consecutive series, (b) between days intrarater reliability was low to high and intrarater agreement was variable, (c) interrater reliability was high to very high and interrater agreement was good. In individuals with paratonia, (a) intrarater reliability was moderate to high and agreement was variable between series, (b) between days intrarater reliability was poor to moderate and agreement was poor, (c) interrater reliability ranged from low to high with poor agreement. CONCLUSIONS MyotonPRO measurements of the BB muscle showed good reproducibility in both healthy subpopulations, particularly for measurements performed within the same day. In individuals with paratonia, reliability and agreement were substantially lower. MyotonPRO can be used in clinical assessment and research. However, in individuals with paratonia, careful interpretation of results is required. Research in a larger sample of persons with paratonia at different stages of disease severity is recommended.
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Affiliation(s)
- Bieke Van Deun
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Johannes S M Hobbelen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Birgit Van Eetvelde
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | | | - Dirk Cambier
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Honinx E, van Dop N, Smets T, Deliens L, Van Den Noortgate N, Froggatt K, Gambassi G, Kylänen M, Onwuteaka-Philipsen B, Szczerbińska K, Van den Block L. Dying in long-term care facilities in Europe: the PACE epidemiological study of deceased residents in six countries. BMC Public Health 2019; 19:1199. [PMID: 31470875 PMCID: PMC6717349 DOI: 10.1186/s12889-019-7532-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022] Open
Abstract
Background By 2030, 30% of the European population will be aged 60 or over and those aged 80 and above will be the fastest growing cohort. An increasing number of people will die at an advanced age with multiple chronic diseases. In Europe at present, between 12 and 38% of the oldest people die in a long-term care facility. The lack of nationally representative empirical data, either demographic or clinical, about people who die in long-term care facilities makes appropriate policy responses more difficult. Additionally, there is a lack of comparable cross-country data; the opportunity to compare and contrast data internationally would allow for a better understanding of both common issues and country-specific challenges and could help generate hypotheses about different options regarding policy, health care organization and provision. The objectives of this study are to describe the demographic, facility stay and clinical characteristics of residents dying in long-term care facilities and the differences between countries. Methods Epidemiological study (2015) in a proportionally stratified random sample of 322 facilities in Belgium, Finland, Italy, the Netherlands, Poland and England. The final sample included 1384 deceased residents. The sampled facilities received a letter introducing the project and asking for voluntary participation. Facility manager, nursing staff member and treating physician completed structured questionnaires for all deaths in the preceding 3 months. Results Of 1384 residents the average age at death ranged from 81 (Poland) to 87 (Belgium, England) (p < 0.001) and length of stay from 6 months (Poland, Italy) to 2 years (Belgium) (p < 0.05); 47% (the Netherlands) to 74% (Italy) had more than two morbidities and 60% (England) to 83% (Finland) dementia, with a significant difference between countries (p < 0.001). Italy and Poland had the highest percentages with poor functional and cognitive status 1 month before death (BANS-S score of 21.8 and 21.9 respectively). Clinical complications occurred often during the final month (51.9% England, 66.4% Finland and Poland). Conclusions The population dying in long-term care facilities is complex, displaying multiple diseases with cognitive and functional impairment and high levels of dementia. We recommend future policy should include integration of high-quality palliative and dementia care.
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Affiliation(s)
- Elisabeth Honinx
- Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Nanja van Dop
- Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Tinne Smets
- Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Luc Deliens
- Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Katherine Froggatt
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YW, UK
| | - Giovanni Gambassi
- Department of Internal Medicine, Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, 00135, Rome, Italy
| | - Marika Kylänen
- National Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Bregje Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorstraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Katarzyna Szczerbińska
- Department of Sociology of Medicine, Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, ul. Kopernika 7a, 31-034, Kraków, Poland
| | - Lieve Van den Block
- Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
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Tanghe M, Van Den Noortgate N, Pivodic L, Deliens L, Onwuteaka-Philipsen B, Szczerbinska K, Finne-Soveri H, Collingridge-Moore D, Gambassi G, Van den Block L, Piers R. Opioid, antipsychotic and hypnotic use in end of life in long-term care facilities in six European countries: results of PACE. Eur J Public Health 2019; 29:74-79. [PMID: 30285189 PMCID: PMC6345144 DOI: 10.1093/eurpub/cky196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Opioids, antipsychotics and hypnotics are recommended for comfort care in dying. We studied their prescription during the last 3 days in residents deceased in the long-term care facility (LTCF). Methods In a retrospective, cross-sectional survey in Belgium, England, Finland, Italy, the Netherlands and Poland, LTCFs, selected by proportional stratified random sampling, reported all deaths over the previous 3 months. The nurse most involved in the residents’ care reviewed the chart for opioid, antipsychotic and hypnotic prescription, cause of death and comorbidities. Multivariable logistic regression was performed to adjust for resident characteristics. Results Response rate was 81.6%. We included 1079 deceased residents in 322 LCTFs. Opioid prescription ranged from 18.5% (95% CI: 13.0–25.8) of residents in Poland to 77.9% (95% CI: 69.5–84.5) in the Netherlands, antipsychotic prescription from 4.8% (95% CI: 2.4–9.1) in Finland to 22.4% (95% CI: 14.7–32.4) in Italy, hypnotic prescription from 7.8% (95% CI: 4.6–12.8) in Finland to 47.9% (95% CI: 38.5–57.3) in the Netherlands. Differences in opioid, antipsychotic and hypnotic prescription between countries remained significant (P < 0.001) when controlling for age, gender, length of stay, cognitive status, cause of death in multilevel, multivariable analyses. Dying from cancer showed higher odds for receiving opioids (OR 3.51; P < 0.001) and hypnotics (OR 2.10; P = 0.010). Conclusions Opioid, antipsychotic and hypnotic prescription in the dying phase differed significantly between six European countries. Further research should determine the appropriateness of their prescription and refine guidelines especially for LTCF residents dying of non-cancer diseases.
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Affiliation(s)
- Marc Tanghe
- End-of-Life Care Research Group, Ghent University, Ghent, Belgium
| | | | - Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | | | | | - Giovanni Gambassi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Roma, Italy
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ruth Piers
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
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Van Deun B, Van Den Noortgate N, Van Bladel A, De Weerdt K, Cambier D. Managing Paratonia in Persons With Dementia: Short-term Effects of Supporting Cushions and Harmonic Techniques. J Am Med Dir Assoc 2019; 20:1521-1528. [PMID: 31227470 DOI: 10.1016/j.jamda.2019.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/29/2019] [Accepted: 04/30/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Paratonia, a form of hypertonia typically seen in dementia, is often associated with difficulties in positioning and daily care. No evidence-based therapy or clinical guideline for management is available. In this study, the short-term effect of harmonic techniques (HT) and supporting cushions (SC) on paratonia was explored. DESIGN This was a multicenter interventional clinical trial with AB/BA crossover design. Each intervention (SC or HT) was subsequently implemented over 1 week in each of the participants. SETTING AND PARTICIPANTS The study included 22 participants with moderate to severe paratonia from 9 different nursing homes in Flanders, Belgium. METHODS Measurements of biceps brachii and rectus femoris muscle tone (MyotonPRO), maximal elbow and knee extension (goniometer), and pain (Pain Assessment Checklist for Seniors With Limited Ability to Communicate) were performed on 3 different days within 1 week. The effect of HT on nursing care was evaluated with the Pain Assessment Checklist for Seniors With Limited Ability to Communicate and visual analog scale ratings of discomfort items. RESULTS After 30 minutes of positioning with SC, participants had lower biceps brachii muscle tone (P = .041) and higher maximal elbow extension (P = .006) than without SC. After a 30-minute session of HT, a significant increase in biceps brachii muscle tone (P = .032) and maximal extension of elbow (P < .001) and knee (P = .028) was found. Pain (P = .003) and discomfort (P = .001 to P = .019) during morning care were significantly lower when care was preceded by 30 minutes of HT. CONCLUSIONS/IMPLICATIONS This explorative study revealed beneficial short-term effects on range of motion for both SC and HT and a positive effect of SC on upper limb muscle tone. Beneficial effects of HT were found on resident's pain and caregiver's discomfort during care. The results of the present study are encouraging and can contribute to the development of evidence-based interventions for paratonia.
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Affiliation(s)
- Bieke Van Deun
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | | | - Anke Van Bladel
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Koen De Weerdt
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Dirk Cambier
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Vandepitte S, Putman K, Van Den Noortgate N, Verhaeghe S, Mormont E, Van Wilder L, De Smedt D, Annemans L. Factors Associated with the Caregivers' Desire to Institutionalize Persons with Dementia: A Cross-Sectional Study. Dement Geriatr Cogn Disord 2019; 46:298-309. [PMID: 30453298 DOI: 10.1159/000494023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Dementia is one of the main reasons for institutionalization among the elderly. Few studies have explored factors associated with the caregivers' (CG) desire to institutionalize (DTI) a person with dementia (PWD). The objective of this study is to identify modifiable and non-modifiable psychosocial and sociodemographic factors associated with a caregiver's DTI. METHODS Cross-sectional data of 355 informal CG of community-dwelling PWD were analyzed. Several characteristics were identified in CG and PWD to be included in a multivariable regression model based on the purposeful selection method. RESULTS Positively modifiable associated factors were: higher CG burden, being affected by behavioral problems, and respite care use. Positively associated non-modifiable factors were: CG older age, being professionally active, and CG higher educational level. Cohabitation and change of professional situation were negatively associated. CONCLUSION Although no causality can be assumed, several practical recommendations can be suggested. First of all, these results reconfirm the importance of multicomponent strategies, especially support aimed at decreasing burden and in learning coping strategies. Also, CG might benefit from information about support options, such as respite care services. Finally, special attention should be given to older and working CG. In the latter, flexible and adaptive working conditions might alleviate burden and therefore reduce the DTI of the PWD.
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Affiliation(s)
- Sophie Vandepitte
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium,
| | - Koen Putman
- Department of Medical Sociology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Van Den Noortgate
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Eric Mormont
- CHU UCL Namur, Service de Neurologie, Yvoir, Belgium.,Université Catholique de Louvain, Institute of NeuroScience, Louvain-la-Neuve, Belgium
| | - Lisa Van Wilder
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Roller-Wirnsberger R, Masud T, Vassallo M, Zöbl M, Reiter R, Van Den Noortgate N, Petermans J, Petrov I, Topinkova E, Andersen-Ranberg K, Saks K, Nuotio M, Bonin-Guillaume S, Lüttje D, Mestheneos E, Szekacs B, Jonsdottir AB, O’Neill D, Cherubini A, Macijauskiene J, Leners JC, Fiorini A, van Iersel M, Ranhoff AH, Kostka T, Duque S, Prada GI, Davidovic M, Krajcik S, Kolsek M, del Nozal JM, Ekdahl AW, Münzer T, Savas S, Knight P, Gordon A, Singler K. European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique. Age Ageing 2019; 48:291-299. [PMID: 30423032 PMCID: PMC6424375 DOI: 10.1093/ageing/afy173] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/14/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations. METHODS under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators. RESULTS the final recommendations include four different domains: 'General Considerations' on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), 'Knowledge in patient care' (36 sub-items), 'Additional Skills and Attitude required for a Geriatrician' (9 sub-items) and a domain on 'Assessment of postgraduate education: which items are important for the transnational comparison process' (1 item). CONCLUSION the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.
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Affiliation(s)
| | - Tahir Masud
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK
| | - Michael Vassallo
- Royal Bournemouth and Christchurch NHS Hospitals Foundation Trust, Castle Lane East, Bournemouth, UK
| | - Martina Zöbl
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Raphael Reiter
- Department of Geriatric Medicine, Paracelsus Medical University Strubergasse 22, Salzburg, Austria
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital Corneel Heymanslaan 10, Gent, Belgium
| | - Jean Petermans
- Geriatric Department, CHU Rue de Gaillarmont 600, Liège, Belgium
| | - Ignat Petrov
- Clinical Centre of Endocrinology and Gerontology, Medical University of SofiaBoulevard “Akademik Ivan Evstratiev Geshov” 15, Sofia Center, Sofia, Bulgaria
| | - Eva Topinkova
- Department of Gerontology and Geriatrics, 1st Faculty of Medicine, Charles University and General Faculty HospitalOvocný trh 3-5, Staré Město, Czechia
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 4, Odense, Denmark
| | - Kai Saks
- Department of Internal Medicine, University of Tartu, Ülikooli 18, Tartu, Estonia
| | - Maria Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, Finland
- Department of Geriatrics, University of Turku, Turku, Finland
| | - Sylvie Bonin-Guillaume
- Department of Geriatric Medicine, Hopital de la Timone, 264 Rue Saint Pierre, 13005 Marseille 05, Provence-Alpes-Côte d'Azur, France
| | - Dieter Lüttje
- Medizinische Klinik IV, Geriatrie und Palliativmedizin, Klinikum Osnabrück, Germany
| | - Elizabeth Mestheneos
- Hellenic Association of Gerontology and Geriatrics, Past President Age Platform Europe, Greece
| | - Bela Szekacs
- Hungarian Association of Gerontology and Geriatrics (HAGG)
| | - Anna Björg Jonsdottir
- Department of Geriatric Medicine, The National University Hospital of Iceland Landakoti, 101, Reykjavík Iceland
| | - Desmond O’Neill
- Department of Clinical Gerontology, College Green, Dublin 2, Ireland
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italia
| | - Jurate Macijauskiene
- Department of Geriatrics, The Faculty of Nursing, Medical Academy Lithuanian, University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, Lithuania
| | - Jean-Claude Leners
- House Omega & LTCF Alzheimer, University of Luxembourg, 2, avenue de l'Université, Esch-sur-Alzette, Luxembourg
| | - Anthony Fiorini
- The Geriatric Medicine Society of Malta, Karin Grech Hospital, Telghat Gwardamangia, Pieta' Malta PTA, Malta
| | - Marianne van Iersel
- Department of Geriatric Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, Netherlands
| | | | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, plac Hallera 1, Łódź, Poland
| | - Sofia Duque
- Internal Medicine Specialist with Geriatrics Competence, Orthogeriatric Unit Coordinator, Internal Medicine Department, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa, Ocidental, Invited Lecturer of Geriatrics, Faculdade de Medicina, Universidade de Lisboa, Estr. Forte do Alto Duque, Lisboa, Portugal
| | - Gabriel Ioan Prada
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Ana Aslan National Institute of Gerontology and Geriatrics, Romania
| | - Mladen Davidovic
- Serbian Association of Geriatricians and Gerontologist, Udruženje gerijatara i gerontologa Srbije, Preševska 31, Beograd, Serbia
| | - Stefan Krajcik
- Geriatric Department, Slovak Medical University, 831 01 Bratislava, Slovakia
| | - Marko Kolsek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana Korytkova ulica 2, Ljubljana, Slovenia
| | | | - Anne W Ekdahl
- Department of Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Svartbrödragränden 3-5, Helsingborg, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical geriatrics, Solnavägen 1, Solna, Sweden
| | - Thomas Münzer
- Department of Geriatrics, Geriatrische Klinik St. Gallen and University of Zürich, Zürich, Switzerland
| | - Sumru Savas
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Ege University Erzene Mahallesi, Bornova/İzmir, Turkey
| | - Paul Knight
- Department Geriatric Medicine, Royal Infirmary, Glasgow, UK
| | - Adam Gordon
- CLAHRC-East Midlands ‘Caring for Older People and Stroke Survivors’ (COPSS), Nottingham Biomedical Research Centre (BRC)
| | - Katrin Singler
- Institute of Biomedicine of Ageing, Friedrich Alexander University Erlangen, Schloßplatz 4, Erlangen, Germany
- Department of Geriatrics, Klinikum Nürnberg, Paracelsus Private Medical University, Prof.-Ernst-Nathan-Straße 1, Nürnberg, Germany
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Van Humbeeck L, Dillen L, Piers R, Grypdonck M, Verhaeghe S, Van Den Noortgate N. Cancer patients' experiences of communicating and dealing with their older parents: A qualitative study. Eur J Oncol Nurs 2019; 38:98-103. [DOI: 10.1016/j.ejon.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 02/04/2023]
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