Dying in long-term care facilities in Europe : the PACE epidemiological study of deceased residents in six countries

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

Existing Meditation and Breathing Devices for Stress Reduction and Their Incorporated Stimuli: A Systematic Literature Review and Competition Analysis

To identify, evaluate, and summarize existing meditation and breathing devices for stress reduction and their characteristics (stimuli), we searched PubMed and EMBASE for studies published from January 1, 1980, to December 30, 2021. Full-text articles that presented devices that support meditation and breathing guidance for stress reduction were included. We excluded articles covering study protocols. In addition, a competitor analysis was conducted to identify and evaluate the devices, their name, manufacturer, target group, function, and incorporated stimuli were contracted. The scientific literature identified 367 studies, of which 20 (describing 18 devices and 32 stimuli) were included. The competition analysis identified 66 devices incorporating 126 stimuli. After exclusion of duplicates, this resulted in 46 different types of devices incorporating 24 different types of stimuli. They were organized into 7 device categories (attachable to the head, huggable devices, handheld devices, eye masks, mouth-controlled devices, toys, and wearables) and 14 stimuli categories (perceptible vibrations, imperceptible vibrations, movement, temperature, pressure, texture, light or darkness, abstract visuals, concrete visuals, music, calming sounds, tones, voice guidance, and aromas). This review provides an overview of the different meditation and breathing devices for stress reduction. The current overview will inform a subsequent preference and effectiveness study of breathing devices that aims to gain more knowledge on the topic to increase device uptake and developmental success

Lack of effect of a multicomponent palliative care program for nursing home residents on hospital use in the last month of life and on place of death : a secondary analysis of a multicountry cluster randomized control trial

Objectives: PACE Steps to Success is a 1-year train-the-trainer program aiming to integrate nonspecialist palliative care into nursing homes via staff education and organizational support. In this study, we aimed to explore whether this program resulted in changes in residents' hospital use and place of death. Design: Secondary analysis of the PACE cluster randomized controlled trial (ISRCTN14741671). Data were collected on deaths over the previous 4 months via questionnaires at baseline and postintervention. Setting and Participants: Questionnaires were completed by the nurse/care-assistant most involved from 78 nursing homes in 7 European Union countries. Measures: We measured number of emergency department visits, hospital admissions, length of hospital stay, and place of death. Baseline and postintervention scores between intervention and control groups were compared, and we conducted exploratory mixed-model analyses. We collected 551 out of 610 questionnaires at baseline and 984 out of 1178 at postintervention in 37 intervention and 36 control homes. Results: We found no statistical significant effects of the program on emergency department visits [odds ratio (OR) = 1.38, P =.32], hospital admissions (OR = 0.98, P =.93), length of hospital stay (geometric mean difference = 0.85, P =.44), or place of death (OR = 1.08, P=.80). Conclusions and Implications: We found no effect of the PACE programon either hospital use in the last month of life or place of death. Although thismay be related to implementationproblems in some homes, the program might also require a more specific focus on managing acute end-of-life situations and a closer involvement of general practitioners or specialist palliative care services to influence hospital use or place of death. (C) 2020 AMDA e The Society for Post-Acute and Long-Term Care Medicine

Potentially inappropriate treatments at the end of life in nursing home residents : findings from the PACE cross-sectional study in 6 European countries

Context Certain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area. Objectives To estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries. Methods A cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life. Results We included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%). Conclusion Although the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff

Potentially inappropriate treatments at the end of life in nursing home residents : findings from the PACE cross-sectional study in 6 European countries

Context Certain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area. Objectives To estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries. Methods A cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life. Results We included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%). Conclusion Although the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff

Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries

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 outcome