Symptom Burden and Activity of Daily Living (ADL) Dependency Among Home Health care Patients Discharged to Home Hospice

Background: We sought to examine sociodemographic and clinical characteristics present on admission to HHC associated with discharge to hospice. Methods: We used a 5% random sample of 2017 national Outcome and Assessment Information Set (OASIS) data. A Cox proportional hazards regression model was estimated for the primary outcome (discharge to hospice) to examine the associations with sociodemographic and clinical characteristics of HHC patients. Results: Among 489, 230 HHC patients, 4268 were discharged to hospice. The median (interquartile range) length of HHC stay for patients discharged to hospice care was 33 (14-78) days. Compared to White patients, Black, Hispanic, and other race, (hazard ratio [HR] = .50 [95% confidence interval, CI = .44–.57]), (HR = .53 [95% CI = .46–.62]), and (HR = .49 [95% CI = .40–.61], respectively) was associated with shorter time to discharge to hospice care. Clinical characteristics including severe dependence in activities of daily (ADL) (HR = 1.68 [95% CI = 1.01–2.78]), cognitive impairment (HR = 1.10 [95% CI = 1.01–1.20]), disruptive behavior daily (HR = 1.11 [95% CI = 1.02–1.22]), and inability to feed oneself (HR = 4.78, 95% CI = 4.30, 5.31) was associated with shorter time to discharge to hospice. Symptoms of anxiety daily (HR = 1.55 [95% CI = 1.43–1.68]), and pain daily or all the time (HR = 1.54 [95% CI = 1.43–1.64]) were associated with shorter time to discharge to hospice. Conclusions: High symptom burden, ADL dependency, and cognitive impairment on admission to HHC services was associated with greater likelihood of discharge to hospice.

Gerontological aspects of improving the quality of medical and social assistance to older displaced persons in the context of the COVID-19 pandemic in Ukraine

Исследование посвящено вопросам организации медицинского и социального обслуживания переселенцев пожилого возраста на уровне первичной медико-санитарной помощи (ПМСП) на Украине, определению основных задач и особенностей организации и предоставления им паллиативной и хосписной помощи (ПХП) в условиях пандемии COVID-19. По результатам социологического исследования с использованием методов опроса, экспертных оценок были проанализированы социально-психологические характеристики переселенцев пожилого возраста, особенностей их социальной адаптации, финансирования и медико-социального обслуживания. Были определены пути улучшения организации амбулаторной помощи переселенцам старшего возраста на уровне ПМСП, включающие структурную модернизацию и оптимизацию организационного обеспечения. Внедрение доступных и экономически обоснованных подходов позволяет усилить взаимодействие специалистов учреждений здравоохранения и социальной защиты, оптимизировать соблюдение стандартов и принципов медицинской помощи. В рамках организации ПХП базовыми являются европейские подходы формирования стратегии непрерывности предоставления паллиативной помощи в условиях пандемии COVID-19. Внедрение предлагаемых подходов в организации медицинской и социальной помощи на уровне амбулаторий ПМСП и обеспечение доступной ПХП являются актуальными для переселенцев пожилого возраста, находящихся в группе повышенного риска при пандемии COVID-19. This work aimed to study the organization of medical-social services for the elderly internally displaced persons at the level of primary medico-sanitary aid (PMSA) in Ukraine, assessment of the main tasks and specifics of organization and provision of palliative and hospice care (PHC) under COVID-19 conditions. As a result of the sociological investigation, using the questionnaire methods and experts’ evaluations, we have analyzed the socio-psychological characteristics of the elderly internally displaced persons, the specifics of their social adaptation, financing and medico-social servicing at the level PMSA, including structural modernization and optimization of organizational provision. The introduction of an affordable and economically viable system allows for the interaction of specialists from health care and social protection institutions, and optimizes compliance with the standards and principles of medical care. Within the framework of the PНC, we use the European approaches of formation of the strategy of palliative care expansion under COVID-19 pandemic. One of the main tasks is the provision of constant PHC. Introduction of the organization-structural system of the medical-social care at the PMSA level and provision of accessible and highly qualitative constant PHC are actual for the elderly displaced people, who are in the group of high risk COVID-19 death group.

全人照護及其教育訓練與評值

<p>目的：全人照護是對病人身體、心理、社會層面及靈性全面照護的態度與行為，需要醫療院所投注多專 業、跨領域且有效率又有品質的整合服務，才能滿足病人「一站式服務、一次購足」的需求。本文之目的在於詮釋全人照護之真諦、內涵、教育訓練與評值。</p> <p>方法：藉由闡釋全人照護的素養與能力，強調推廣全人照護需要多面向的教育訓練加以養成，並發展以能力為基礎的評值方法。</p> <p>結果：醫療人員需要終身持續學習有關全人照護的核心知識與技能、醫療專業照護、同理心與心理支持、就醫行為和家庭照護，以及生命關懷及和臨終照護，並佐以適合及一致性的評值標準，方能系統性的推廣全人照護。</p> <p>結論：本文探討全人照護的真諦、如何推動全人照護及如何實施全人照護之教育訓練與評值，作為醫療院所推動全人照護之參考。</p> <p>&nbsp;</p><p>Objective: Holistic care is an approach that involves consideration of the physical, emotional, social, and spiritual wellbeing of a patient. It involves multidisciplinary, interprofessional integrated teams with members who educate, cooperate with, and respect each other to offer one-stop fulfillment of patient needs. This article explains the core values and intentions of holistic care and the relevant education, training, and assessments.</p> <p>Methods: By explaining the competencies of holistic care, this article argues that the promotion of holistic care necessitates multidimensional education, training, and competency-based assessments.</p> <p>Results: To systematically promote holistic care, accompanied by appropriate and consistent assessment standards, health care providers must continue to learn about the main components of holistic care, including its required knowledge and competencies, professional medical care empathy and psychological support, the praxeology of healthcare seeking, family care, and end-of-life and hospice care.</p> <p>Conclusion: This article discusses the core values of holistic care; how to promote holistic care; and how to implement education, training, and assessments in the field of holistic care and may therefore serve as a reference for holistic care training in medical settings.</p> <p>&nbsp;</p>

Probing into the Dilemma of Hospice Care for the Elderly in China

With the aging of the population gradually become a worldwide trend, China has entered into the aging society in 2000, the phenomenon of “getting old before getting rich” has caused a severe challenge. As a part of the pension system, hospice should be paid attention and promoted. However, due to the influence of China’s traditional view of death and the fact that hospice is not included in the medical insurance system, the idea of hospice has not been widely publicized. Based on Maslow’s hierarchy of needs theory, this paper analyzes the current situation of hospice care for the elderly in China and explores the specific difficulties encountered in its development, then we hope people re-understand the saying “a good death is better than a lazy life” and choose hospice care services rationally.

The Healthcare Journey of Women With Advanced Gynecological Cancer From Diagnosis Through Terminal Illness: Qualitative Analysis of Progress Note Data

Objective To examine women’s journeys with gynecologic cancer from before diagnosis through death and identify elements of their healthcare experience that warrant improvement. Methods This exploratory study used longitudinal progress notes data from a multispecialty practice in Northern California. The sample included women with stage IV gynecological cancer diagnosed after 2011 and who died before 2018. Available progress notes from prior to diagnosis to death were qualitatively analyzed. Results We identified 32 women, (median age 61 years) with mostly uterine (n=17) and ovarian (n=9) cancers and median survival of 9.2 months (min:2.9 and max:47.5). Sixteen (50%) received outpatient palliative care and 18 (56%) received hospice care. The analysis found wide variation in documentation about communication about diagnosis, prognosis, goals of care, stopping treatment, and starting hospice care. Challenges included escalating/severe symptoms, repeated urgent care/emergency department/hospital encounters, and lack of or late access to palliative and hospice care. Notes also illustrated how patient background and goals influenced care trajectory and communication. Documentation styles varied substantially, with palliative care notes more consistently documenting conversations about goals of care and psychosocial needs. Conclusion This analysis of longitudinal illness experience of women with advanced gynecological cancer suggests that clinicians may want to (1) prioritize earlier discussion about goals of care; (2) provide supplemental support to patients with higher needs, possibly through palliative care or navigation; and (3) write notes to enhance patient understanding now that patients may access all notes.

Predictors and Assessment of Hospice Use for End-Stage Renal Disease Patients in Taiwan

Objectives: Hospice and early palliative care are generally considered as an alternative and supportive care to offer symptoms relief and optimize the quality of life among end-stage renal disease (ESRD) patients, but hospice care remains underutilized. This study aimed to examine patient and health system characteristics and develop a patient assessment scale to evaluate ESRD patients for hospice care after the implementation of non-cancer hospice care reimbursement policy in 2009 in Taiwan. Method: We conducted a retrospective cohort study using nationwide population-based datasets. Adult long-term dialysis patients between 2009 and 2012 were included. Multivariable logistic regression and the Firth penalized likelihood estimation were used to estimate the likelihood of receiving hospice care. A receiver operating characteristic curve (ROC) analysis and C-statistic were calculated to determine the optimal models for a patient assessment of hospice use. Results: Patients who were older, comorbid with anemia (odds ratio [OR] 3.53, 95% CI 1.43-8.70) or sepsis (OR 1.62, 95% CI 1.08–2.44), with longer dialysis durations, more hospitalizations (OR 4.68, 95% CI 2.56–8.55), or primary provider care with hospice (OR 5.15, 95% CI 2.80–9.45) were more likely to receive hospice care. The total score of the patient assessment scale of hospice care was 0–28 with a cut-off value of 19 based on the results of the receiver operating characteristic curve. Conclusion: Given the “Patient Right to Autonomy Act” implemented in Taiwan in 2019 to promote the concept of a “good quality of death”, this patient assessment scale may help health professionals target ESRD patients for hospice care and engage in shared decision making and the advance care planning process.

Hospices in the infrastructure of the cities of the RF

The author analyzes the current state of hospices and palliative centers in the Russian Federation, as well as the problems and opportunities they face. The presence of world-class hospices along with the regions of zero palliative care for the population is revealed in the infrastructure of the RF. The article studies the basic forms of care organization and reveals the necessity of taking into account territorial and regional peculiarities of a particular region. It also outlines the necessary components of hospice care and highlights the ethical sense of its provision.