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Symptom Experience of Dying Long‐Term Care Residents
Author(s) -
Hanson Laura C.,
Eckert J. Kevin,
Dobbs Debra,
Williams Christianna S.,
Caprio Anthony J.,
Sloane Philip D.,
Zimmerman Sheryl
Publication year - 2008
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01388.x
Subject(s) - medicine , staffing , long term care , palliative care , family medicine , end of life care , nursing homes , stratified sampling , gerontology , physical therapy , nursing , pathology
OBJECTIVES: To describe the end‐of‐life symptoms of nursing home (NH) and residential care/assisted living (RC/AL) residents, compare staff and family symptom ratings, and compare how staff assess pain and dyspnea for cognitively impaired and cognitively intact residents. DESIGN: After‐death interviews. SETTING: Stratified random sample of 230 long‐term care facilities in four states. PARTICIPANTS: Staff (n=674) and family (n=446) caregivers for dying residents. MEASUREMENTS: Interview items measured frequency and severity of physical symptoms, effectiveness of treatment, recommendations to improve care, and staff report of assessment. RESULTS: Decedents' median age was 85, 89% were white, and 77% were cognitively impaired. In their last month of life, 47% had pain, 48% dyspnea, 90% problems with cleanliness, and 72% symptoms affecting intake. Problems with cleanliness, intake, and overall symptom burden were worse for decedents in NHs than for those in RC/AL. Treatment for pain and dyspnea was rated very effective for only half of decedents. For a subset of residents with both staff and family interviews (n=331), overall ratings of care were similar, although agreement in paired analyses was modest (kappa=−0.043–0.425). Staff relied on nonverbal expressions to assess dyspnea but not pain. Both groups of caregivers recommended improved application of treatment and increased staffing to improve care. CONCLUSION: In NHs and RC/AL, dying residents have high rates of physical symptoms and need for more‐effective palliation of symptoms near the end of life.