One-quarter of all cancer deaths in Sweden occur in hospitals. If the place of death affects the quality of end-of-life (EOL) is largely unknown.
This population-based, retrospective study included all adults cancer deaths reported to the Swedish Register of Palliative Care in 2011-2013 (N?=?41,729). Hospital deaths were compared to deaths occurring in general or specialised palliative care, or in nursing homes with respect to care quality indicators in the last week of life. Odds ratios (OR) with 95% confidence intervals (CI) were calculated with specialised palliative home care as reference.
Preferred place of death was unknown for 63% of hospitalised patients and consistent with the actual place of death in 25% compared to 97% in palliative home care. Hospitalised patients were less likely to be informed when death was imminent (OR: 0.3; CI: 0.28-0.33) as were their families (OR: 0.51; CI: 0.46-0.57). Validated screening tools were less often used in hospitals for assessment of pain (OR: 0.32; CI: 0.30-0.34) or other symptoms (OR: 0.31; CI: 0.28-0.34) despite similar levels of EOL symptoms. Prescriptions of as needed drugs against anxiety (OR: 0.27; CI: 0.24-0.30), nausea (OR: 0.19; CI: 0.17-0.21), or pulmonary secretions (OR: 0.29; CI: 0.26-0.32) were less prevalent in hospitals. Bereavement support was offered after 57% of hospital deaths compared to 87-97% in palliative care units and 72% in nursing homes.
Dying in hospital was associated with inferior end-of-life care quality among cancer patients in Sweden.
BACKGROUND AND AIMS: The aim of the one-year follow-up was to evaluate formal care and the situation of informal caregivers from a gender perspective. METHODS: The present study targeted elderly persons (n = 147) living in their own homes 12 months after acute stroke, 94 women and 53 men. The median age of the women was 81 years and the men 80 years. RESULTS: A statistically significant gender difference was seen in living conditions. Eighty percent of the women were living alone compared with 28% of the men (CI 48-56%). The informal care given far exceeded that provided by the community: 65% of these elderly people had some kind of informal care and 44% received formal care from the community. There was a gender difference in daily informal personal care, 24% of men and 16% of women (CI 2-18%), and in daily informal household assistance (CI 15-43%). Formal care was provided by the community significantly more frequently to women (56%) than men (23%) (CI 21-45%). The women more frequently had community-based help with house-cleaning (CI 23-39%) and they also more frequently received help with personal care (CI 1-10%). CONCLUSIONS: This study showed statistically significant gender differences in the use of informal and formal care. Elderly caregivers' situations must be given greater attention, since informal care to stroke survivors represents a far greater burden than the care that is provided by the community. Most of the caregivers were elderly women, and preventive intervention measures should be developed in order to enable them to manage their everyday lives.
OBJECTIVE: Assessment of home aids, adaptations and personal assistance received after traumatic spinal cord injury (SCI). SETTING: Clinic for Spinal Cord Injuries, Denmark. Uptake area, 2.5 million inhabitants. STUDY DESIGN AND METHODS: Cross-sectional follow-up with retrospective data from medical files. MATERIALS: Individuals with traumatic SCI before 1 January 1991, still in regular follow-up and with sufficient medical record. In all, 279 were included, and 236 answered the questionnaire (193 men and 43 women), with a response rate of 84.6%. Mean age at follow-up was 50.5 years, and mean follow-up time, 24.1 years. One hundred and twenty-six were paraplegic and 110, tetraplegic. Responders and non-responders were comparable. RESULTS: Most common aids or adaptations reported were commode/shower chair on wheels or a seat (69%), grab bar by the toilet (41%), electrical bed (44%), special mattress (28%), lift/hoist (20%), computers (39%) and kitchen tools or cutlery with special handles (14%). In all, 7.6% of the participants reported no aids. Eighty-two percent answered 'Yes' to the question 'Have the aids, you currently or previously needed, been available to you?' The majority reported that their source of information about aid had been various journals and magazines. Twenty-one percent had personal helpers, with 60 h per week in median (range 2-168). Thirty-three percent received domestic help with 2.5 h per week in median (range 0.5-37). Eight percent had a home nurse. A total of 98.7% were living in their own homes. CONCLUSIONS: This is the first study of a representative SCI population giving information on home aids. Individuals with SCI in Denmark seem to be sufficiently supplied with aids and personal assistance.
An inventory was made among 210 elderly nursing-home patients to investigate the feasibility of exchanging their permanent stay in the nursing home for another form of care and whether they wanted to. The main alternative was intermittent nursing-home care. The patients were assessed as to physical and mental health and social conditions. The majority (62.7%) were considered too ill for other than nursing-home care. In some patients (24.8%) there were social factors, the main one being that they no longer had a home of their own. However, 26 patients (12.4%) were recommended for intermittent care, but only three were interested. From these results it was concluded that if intermittent home care is to represent a realistic alternative it should be offered to the patients before they move into a nursing home.
Elderly care includes complex interactions between formal services, informal care, morbidity and disabilities. Studies of the incremental effects of formal and informal care are rare and thus the objective was to describe the longitudinal patterns in formal and informal care given to non-demented and demented persons living in a rural area in Sweden.
Transitions in the Kungsholmen-Nordanstig Project (n=919) was followed up 3 years later (n=579), presented as different combinations of informal and formal care, institutionalization and mortality. Number of hours spent on care was examined by the Resource Utilization in Dementia instrument (RUD). Bootstrapped descriptive statistics and regression models were applied.
The overall mortality during follow-up was 34%, and 15% had been institutionalized. Of those who lived at home, those receiving only formal care had been institutionalized to the greatest extent (29%; p
Limited information is available on physical function after septic shock. The aim of the present study was to assess the physical outcome in survivors 1 year after septic shock.
The outcome status of all 174 adult patients admitted to a mixed ICU with the diagnosis septic shock in a 1-year period was registered. Survivors were interviewed about physical function and socioeconomic status using a questionnaire including the Short Form-36 survey. The pre-ICU-admission Functional Comorbidity Index (FCI) was also registered.
Of the 80 survivors, two were still hospitalised; thus, 78 were invited to participate and 70 replied (inclusion-rate 88%). Patients were followed up at median 351 days after hospital discharge. At follow-up the patients had a markedly reduced physical component summary score (PCS) compared with age- and sex-adjusted general population controls (36 vs. 47, P
We evaluated the effectiveness of the Home Care Program of Children's Hospital of Winnipeg for ventilator-dependent children by retrospectively examining morbidity and mortality from February 1, 1979, to July 31, 1992. For the 22 study subjects, the cause of chronic respiratory failure was neurologic disorders for 14 (64%) (group A) and pulmonary disorders for eight (36%) (group B). There were no significant differences between groups A and B in the average number of hospital days, readmission rate, or length of stay per admission. Eleven patients have remained ventilator-dependent at home, four no longer require mechanical ventilation, and seven died. Factors such as diagnosis, type of family, home location, age at initiation of mechanical ventilation, and initial duration of hospital stay did not influence morbidity or mortality in either group. Within the overall mortality rate of 32% is a higher rate among patients whose disorders initially carried a poor prognosis. Ventilator-dependent children can be successfully managed at home, with few nonelective hospital readmissions, through a well-organized home care program.
Repetition after attempted suicide is high with only limited research been put into effect studies. The Baerum-model from Norway offers a practical and affordable intervention. Our aim was to study the acceptability and effectiveness of a Baerum-model like intervention after attempted suicide using a quasi-experimental design. During a period in 2004, attempted suicide patients were offered follow-up care by a rapid-response outreach programme, an intervention lasting 6 months; a control group was established prospectively from a similar period in 2002. The design was an intent-to-treat analysis. The outcome was measured by: 1) participation by acceptance and adherence, 2) repetition of suicide attempt and suicide, and 3) including the number of repetitive acts in 1 year after the attempted suicide episode. Follow-up period was 1 year. Participation was 70%. There was a significant lower repetition rate in the intervention group, where the proportion of repetitive patients fell from 34% to 14%. There were also fewer suicidal acts, in total 37 acts in 58 patients in the control group and 22 acts in 93 patients for the intervention group. We have concluded that the outreach programme has a good feasibility because of high acceptability and adherence, and has an acceptable effectiveness in the follow up period of 1 year. We have therefore initiated a similar study using a randomization design in order to study efficacy.
Service de surveillance, recherche et évaluation, direction de santé publique et d'évaluation, agence de la santé et des services sociaux de Lanaudière, 245, rue du Curé-Majeau, Joliette, QC, J6E 8S8 Canada. email@example.com
Evidence linking home hazards to falls has not been well established. The evidence-based approach to fall-risk assessment in longitudinal studies becomes difficult because of exposures that change during follow-up. We conducted a cohort study to determine the prevalence of hazards and to resolve whether they are linked to the risk of falls among 959 seniors receiving home-care services.
A home hazards assessment was completed at entry and every six months thereafter using a standardized form. The adjusted (for a number of confounding factors) relationship between home hazards and falls was estimated using a survival model taking into account updated time-varying exposures and multiple events. Falls leading to a medical consultation were examined as a secondary outcome, hypothesized as a measure of severity.
Home environmental hazards were found in 91% of homes, with a mean of 3.3 risks per individual. The bathroom was the most common place for hazards. The presence of hazards was significantly associated with all falls and fall-related medical consultations, and showed relatively constant effects from one fall to another.
The current study is innovative in its approach and useful in its contribution to the understanding of the interaction between home environmental hazards and falls. Our results indicate that inattention to changes in exposure masks the statistical association between home hazards and falls. Each environmental hazard identified in the home increases the risk of falling by about 19%. These findings support the positive findings of trials that demonstrate the effectiveness of this home hazard reduction program, particularly for at-risk people.
The identification of risk factors for falls in longitudinal studies becomes difficult because of exposures that change during the follow-up and also because individual subjects may experience an event more than once. These issues have been neglected and improper statistical techniques have been used. The typical approaches have been to report the proportion of fallers or the time to first fall. Both avoid the underlying assumption of independence between events and discard pertinent data. We review the existing methods and propose a Cox hazards extension. We exemplify it in the study of potential risk factors associated with all falls in 959 seniors. Finally, we compare the results of the proposed Wei, Lin, & Weissfeld (WLW) method with those of several other techniques. Stable exposure variables measured at baseline and updated time-varying exposures include socio-demographic characteristics, BMI, nutritional risk, alcohol consumption, home hazards, gait and balance, and medications. Results demonstrate that the usual methods of analyzing risk factors for falling are inappropriate, as they produce considerable biases relative to the WLW model using time-dependent covariates. Results also show that modeling for first events may be inefficient, given that the risk of occurrence varies between falls.