Most nursing home residents eligible for palliative care but lack access

November 21, 2017 by Scott Maier, University of California, San Francisco

Nearly 70 percent of nursing home residents are eligible for palliative care, but do not receive any corresponding support to provide relief from their symptoms and improve their quality of life, according to a study by researchers at UC San Francisco.

In a survey of 228 residents of three northern California nursing homes between January and May 2015, UCSF researchers found that 157 patients (68.8 percent) were eligible for specialized medical care that focuses on improving quality of life for patients with serious illness, known as palliative care. Of those, 47 percent had been diagnosed with Alzheimer's or dementia, and almost half had a hospital readmission in the past year. None were receiving palliative care, and only two were receiving hospice care.

"To our knowledge, this is the first prospective evaluation of nursing home residents' palliative care needs," said lead author Caroline Stephens, PhD, RN, GNP-BC, associate professor in the UCSF School of Nursing. "We found a high symptom burden among nursing home residents, with no residents routinely receiving specialty palliative care services in their facilities."

In the research letter, which appears online Nov. 20, 2017, in JAMA Internal Medicine, the researchers write that earlier identification of palliative care-eligible nursing home residents is crucial. Novel strategies such as telemedicine also are needed, they say, to facilitate access to in nursing homes, due to the low supply of palliative care professionals available to care for residents.

By 2030, 40 percent of all U.S. deaths are projected to occur in . Despite an estimated $136 billion spent each year on , it remains associated with poor symptom control, low family satisfaction, and burdensome and unnecessary care transitions in the final months of life.

In the JAMA Internal Medicine study, researchers found that almost all of the 157 residents (98.7 percent) had a Physician Order for Life-Sustaining Treatment (POLST), with 47.7 percent preferring full treatment, 27.5 percent requesting selective or limited treatment, and 24.8 percent preferring comfort-focused treatment. A POLST is a legal directive for emergency responders, paramedics and other medical personnel to follow in honoring a patient's wishes for care when the patient is not legally able to do so.

A sub-study of 17 -eligible nursing home residents found nearly 53 percent rated their overall quality of life as fair to very poor. This group also reported a higher symptom burden than that perceived by their families.

Explore further: Palliative care may mean fewer difficult transitions for older adults nearing end of life

More information: Caroline E. Stephens et al. Palliative Care Eligibility, Symptom Burden, and Quality-of-Life Ratings in Nursing Home Residents, JAMA Internal Medicine (2017). DOI: 10.1001/jamainternmed.2017.6299

Related Stories

Palliative care may mean fewer difficult transitions for older adults nearing end of life

November 18, 2016
Palliative care is treatment—such as medication, nutritional support, or massage—that helps you feel better when you have a serious illness. Palliative care can help ease pain, insomnia, shortness of breath, nausea, and ...

Less futile end-of-life care observed where palliative care knowledge is greater

March 20, 2015
When a nursing home patient is dying, aggressive interventions such as inserting a feeding tube or sending the patient to the emergency room can futilely exacerbate, rather than relieve, their distress. Palliative care focuses ...

Research examines benefits of palliative care in heart failure treatment

October 18, 2017
Patients living with heart failure receive palliative care significantly less often than patients with other illnesses, including cancer, despite evidence that such care improves symptom management and quality of life.

People with dementia fail to get specialist care despite great need

September 19, 2017
People suffering in the late stages of dementia receive most of their healthcare from GPs or emergency services rather than from specialist health care professionals, despite them having complex needs, researchers at UCL ...

Serious pain afflicts a third of nursing home residents in last six months of life

June 29, 2017
Many nursing home residents have a fairly pain-free experience until the end of life, but at least a third suffer persistent, significant pain during their last six months, according to a new study from the University of ...

Florida to require nursing home generators after Irma deaths

September 22, 2017
Florida's top health care regulator, in the aftermath of the nursing home deaths that followed Hurricane Irma, says the state will "aggressively" enforce new rules that require nursing homes and assisted living facilities ...

Recommended for you

Like shark attack and the lottery, unconscious bias influences cancer screening

August 17, 2018
What do shark attack, the lottery and ovarian cancer screening having in common? It turns out our judgments about these things are all influenced by unconscious bias.

Moderate carbohydrate intake may be best for health

August 17, 2018
Eating carbohydrates in moderation seems to be optimal for health and longevity, suggests new research published in The Lancet Public Health journal.

Phantom odors: One American in 15 smells odors that aren't there, study finds

August 16, 2018
Imagine the foul smell of an ash tray or burning hair. Now imagine if these kinds of smells were present in your life, but without a source. A new study finds that 1 in 15 Americans (or 6.5 percent) over the age of 40 experiences ...

US drug overdose deaths surge amid fentanyl scourge

August 16, 2018
US drug overdose deaths surged to nearly 72,000 last year, as addicts increasingly turn to extremely powerful synthetic opioid fentanyl as the supply of prescription painkillers has tightened.

Parental life span predicts daughters living to 90 without chronic disease or disability

August 15, 2018
Researchers at the University of California San Diego School of Medicine report that women whose mothers lived to at least age 90 were more likely to also live to 90, free of serious diseases and disabilities.

Widespread declines in life expectancy across high income countries coincide with rising young adult, midlife mortality

August 15, 2018
The ongoing opioid epidemic in the United States is a key contributor to the most recent declines in life expectancy, suggests a study published by The BMJ today.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.