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Care Providers Must Assess Burdensome Symptoms and Care Practices Potentially Deleterious to End-Of-Life Patients

As the older adult population continues to escalate in North America, so does the elderly population residing in nursing homes and assisted living facilities toward the end of life.  Most older adult residents in long-term care are predicted to die in a nursing home (an estimated 80%) or to be discharged or transferred to a hospital right before passing away. The duration an older adult stays in a nursing home is not long: 20 to 25 months on average in Canada and 5 to 33 months on average in the United States. The quality of death these elderly residents experience as a primary component of late-life quality of life is clearly critical. Unfortunately, many long-term care residents near the end of life are victims to burdensome symptoms and potentially deleterious care practices.

End-of-life care is generally unsatisfactory in long-term care facilities, especially for older adult residents with dementia. Far too many residents nearing the end of life experience burdensome yet treatable symptoms, consequently leading to both unnecessary suffering and significantly higher health care expenses. The most commonly experienced symptoms are pain, decreased intake of food and fluids resulting in dehydration and cachexia, respiratory issues, fever, urinary incontinence, and delirium.  Patients with dementia are at higher risk of developing pressure ulcers than those without dementia, and express changes in behavior such as aggressiveness during personal care.

Care providers of these facilities are responsible for providing their residents with the best quality of care in order to maintain their overall well-being. Staff must strive to manage their patients’ burdensome symptoms appropriately and avoid delivering inappropriate care practices as a means of giving consistent, high-quality end-of-life care.

A recent study published in the Journal of the American Medical Directors Association aimed to identify the opinions of long-term care providers about the influence of symptoms and practices for both senior residents and care facilities. The study sought to identify common burdensome symptoms and potentially hazardous practices in regards to end of life care for nursing home residents, as well as create and examine the feasibility of a procedure to have a variety of groups of nursing home care providers to rate influence of symptoms and practices.

Among the participants of the study, three of the most commonly experienced symptoms were urinary incontinence (79.9%), fecal incontinence (66.7%), and responsive behaviors (63%).  The three most commonly used practices were polypharmacy (55.2%), antipsychotic use with no diagnosis of psychosis (29.2%), and physical restraint utilization (18.7%).  The symptoms rated as being the most burdensome were pain, responsive behaviors, and urinary incontinence.  The care practices rates as having the most influence were polypharmacy, hospital and emergency department transitions, and antipsychotic use with no diagnosis of psychosis.

Residents living in nursing homes and assisted living facilities are faced with burdensome symptoms and unethical care practices near the end of life. Addressing those symptoms and practices is crucial to enhance the quality of dying for these older adult residents. The study discussed expresses the importance of care givers in long-term care facilities assessing the influence of symptoms and care procedures on elderly resident experience.