Research Priorities for Geriatric Palliative Care: Goals, Values, and Preferences

Older patients and their families desire control over health decisions in serious illness. Experts recommend discussion of prognosis and goals of care prior to decisions about treatment. Having achieved longevity, older persons often prioritize other goals such as function, comfort, or family support—and skilled communication is critical to shift treatment to match these goals

Palliative Care Consultations in Nursing Homes and Reductions in Acute Care Use and Potentially Burdensome End-of-Life Transitions

To evaluate how receipt and timing of nursing home (NH) palliative care consults (primarily by nurse practitioners with palliative care expertise) is associated with end-of-life care transitions and acute care us

Car Cabin Filters as Sampling Devices to Study Bioaerosols Using eDNA and Microbiological Methods

The aim of this study was to examine whether bioaerosols could be isolated and quantified from used car cabin filters. Car cabin filters are widely available and can provide a vast untapped resource for sampling of bioaerosols in areas with enhanced air pollution. We developed a test system where we exposed car cabin filters to birch pollen under compressed air to represent airflow onto the filter. The flow of pollen within the test system was confirmed by microscopy and real-time PCR. Testing of extraction methods was performed on the most prevalent types of filters in UK cars and confirmed it was possible to extract and quantify viable fungi, birch pollen or proteins from car filters. The main challenge of their use is envisaged to be the lack of temporal resolution as car cabin filters are not routinely changed at intervals greater than 1 year; however, the systematic recording of the different routes driven during the sampling interval has been enabled through the common use of GPS, smartphones or similar technologies. Car filters therefore provide substantial possibilities to monitor exposure of harmful bioaerosols in the polluted traffic regions defined by the road network. This method could also be applied to studying allergen exposure associated with bioaerosols and their delivery into the human respiratory system. These findings demonstrate that car cabin filters have the potential to be used to isolate and quantify a range of bioaerosols including pollen and fungi, as well as fractions of bioaerosols, such as proteins

Relationships Between Psychosocial-Spiritual Well-Being and End-of-Life Preferences and Values in African American Dialysis Patients

The purpose of the study was to examine whether psychosocial and spiritual well-being is associated with African-American dialysis patients' end-of-life treatment preferences and acceptance of potential outcomes of life sustaining treatment. Fifty-one African Americans with end stage renal disease (ESRD) completed a socio-demographic questionnaire and interview with measures of symptom distress, health-related quality of life, psychosocial and spiritual well-being, and preferences and values related to life sustaining treatment choices. The subjects were stratified by end-of-life treatment preferences and by acceptance of life sustaining treatment outcomes and compared for psychosocial and spiritual well-being as well as socio-demographic and clinical characteristics. Individuals who desired continued use of life sustaining treatment in terminal illness or advanced dementia had significantly lower spiritual well-being (p = .012). Individuals who valued four potential outcomes of life sustaining treatment as unacceptable showed a more positive, adaptive well-being score in the spiritual dimension compared to the group who valued at least one outcome as acceptable (p = .028). Religious involvement and importance of spirituality were not associated with end-of-life treatment preferences and acceptance of treatment outcomes. African Americans with ESRD expressed varied levels of psychosocial and spiritual well-being, and this characteristic was associated with life sustaining treatment preferences. In future research, the assessment of spirituality should not be limited to its intensity or degree but extended to other dimensions

A Library of Instruments Endorsed by Published Systematic Reviews for Assessing Patients and Their Care Developed by the Palliative Care Research Cooperative

Dear Editor: Palliative care research encompasses a broad array of domains, care settings, and illnesses, and the instrument literature can be difficult and time consuming to navigate. The Palliative Care Research Cooperative (PCRC) has compiled a library of *150 instruments for assessing patients and their care in palliative and end-of-life care research. This library is a resource for investigators wanting to identify relevant and high-quality instruments

Determining Consistency of Surrogate Decisions and End-of-Life Care Received with Patient Goals-of-Care Preferences

Background: Care consistent with preferences is the goal of advance care planning (ACP). However, comparing written preferences to actual end-of-life care may not capture consistency of care with preferences

Transitional care of older adults in skilled nursing facilities: A systematic review

Transitional care may be an effective strategy for preparing older adults for transitions from skilled nursing facilities (SNF) to home. In this systematic review, studies of patients discharged from SNFs to home were reviewed. Study findings were assessed (1) to identify whether transitional care interventions, as compared to usual care, improved clinical outcomes such as mortality, readmission rates, quality of life or functional status; and (2) to describe intervention characteristics, resources needed for implementation, and methodologic challenges. Of 1,082 unique studies identified in a systematic search, the full texts of six studies meeting criteria for inclusion were reviewed. Although the risk for bias was high across studies, the findings suggest that there is promising but limited evidence that transitional care improves clinical outcomes for SNF patients. Evidence in the review identifies needs for further study, such as the need for randomized studies of transitional care in SNFs, and methodological challenges to studying transitional care for SNF patients

Palliative Care Consultations in Nursing Homes and End-of-Life Hospitalizations

While specialty palliative care in hospital and outpatient settings is associated with lower acute care use, its impact in U.S. nursing homes (NHs) is unknown

Is Geriatric Care Associated with Less Emergency Department Use?

Emergency department (ED) use among seniors increased substantially in recent years. This study examined whether community and nursing home (NH) residents treated by a geriatrician were less likely to use the ED than patients treated by other physicians

Does Receipt of Recommended Elements of Palliative Care Precede In-Hospital Death or Hospice Referral?

Context. Palliative care aligns treatments with patients’ values and improves quality of life, yet whether receipt of recommended elements of palliative care is associated with end-of-life outcomes is understudied. Objectives. To assess whether recommended elements of palliative care (pain and symptom management, goals of care, and spiritual care) precede in-hospital death and hospice referral and whether delivery by specialty palliative care affects that relationship. Methods. We conducted structured chart reviews for decedents with late-stage cancer, dementia, and chronic kidney disease with a hospital admission during the six months preceding death. Measures included receipt of recommended elements of palliative care delivered by any clinician and specialty palliative care consult. We assessed associations between recommended elements of palliative care and in-hospital death and hospice referral using multivariable Poisson regression models. Results. Of 402 decedents, 67 (16.7%) died in hospital, and 168 (41.8%) had hospice referral. Among elements of palliative care, only goals-of-care discussion was associated with in-hospital death (incidence rate ratio [IRR] 1.37; 95% CI 1.01e1.84) and hospice referral (IRR 1.85; 95% CI 1.31e2.61). Specialty palliative care consult was associated with a lower likelihood of in-hospital death (IRR 0.57; 95% CI 0.44e0.73) and a higher likelihood of hospice referral (IRR 1.45; 95% CI 1.12e1.89) compared with no consult. Conclusion. Goals-of-care discussions by different types of clinicians commonly precede end-of-life care in hospital or hospice. However, engagement with specialty palliative care reduced in-hospital death and increased hospice referral. Understanding the causal pathways of goals-of-care discussions may help build primary palliative care interventions to support patients near the end of life