Abstract
Fearnley R, Boland JW: Parental life-limiting illness: What do we tell the children? Healthcare 2019 [E-pub ahead of print]; DOI: 10.3390/healthcare7010047
Being diagnosed with and having a life-limiting illness is a stressful experience that is compounded when the patient has dependent children. An important aspect of the patient's psychosocial care should include recognition that his or her children are also likely to experience severe stress because of the illness. However, children's needs are often overlooked during the illness. These needs include information about the illness. Health care professionals have a significant role in supporting patients to communicate with their children. This study aims to increase our understanding of children's experiences when a parent has a life-limiting illness by exploring bereaved children's experiences of the support they received when their parent had a life-limiting illness, and professionals' perspectives of the support offered to children. Seven children (aged between 9 and 24 years), and 16 health care professionals, were interviewed regarding communication during parental illness. Children reported needing open, clear, and age-appropriate conversations with parents and health care professionals to help them begin to obtain some meaning from the situation. The importance of communication is discussed, with particular reference to the role health care professionals have in supporting these conversations.
Franklin P, Arber A, Reed L, Ream E: Health and social care professionals' experiences of supporting parents and their dependent children during, and following, the death of a parent: A qualitative review and thematic synthesis. Palliat Med 2019;33:49–65.
Children need to be prepared for the death of a parent and supported afterward. Parents seek support from health and social care professionals to prepare their children. Support is not always forthcoming. The aim of this systematically constructed qualitative review and thematic synthesis study was to systematically identify, analyze, and synthesize literature reporting of the experiences of health and social care professionals when supporting parents and children during, and following, the death of a parent. MEDLINE, CINAHL, Embase, PsycINFO, PsycARTICLES, and PROSPERO were searched from January 1996 to July 2018 for qualitative studies in English, containing verbatim reporting of health and social care professionals' experiences of supporting parents and children during, and following, the death of a parent. Qualitative data were appraised using a modified Critical Appraisal Skills Programme qualitative appraisal checklist. Results revealed the authors search yielded 15,758 articles, of which 15 met the inclusion criteria. A total of 13 articles included professionals' experiences of supporting parents and children before parental death. Two articles included experiences of supporting surviving parents and children afterward. Three analytical themes identified as follows: (1) aspiring to deliver family-focused care, (2) health and social care professionals' behaviors and emotions, and (3) improving connections with parents and children. The authors conclude that professionals struggle to connect empathically with parents and their children to prepare and to support children when a parent is dying and afterward, and that awareness of professionals' needs would enable provision of appropriate support for parents and children.
Morin L, Todd A, Barclay S, et al.: Preventive drugs in the last year of life of older adults with cancer: Is there room for deprescribing? Cancer 2019 [E-pub ahead of print]; DOI: 10.1002/cncr.32044
The continuation of preventive drugs among older patients with advanced cancer has come under scrutiny because these drugs are unlikely to achieve clinical benefit during the patients' remaining lifespan. In this study, the authors conducted a nationwide cohort study of older adults in Sweden using routinely collected data with record linkage (those aged ≥65 years) with solid tumors who died between 2007 and 2013. The authors calculated the monthly use and cost of preventive drugs throughout the last year before the patients' death. Results demonstrated that among 151,201 older persons who died with cancer (mean age, 81.3 years [standard deviation {SD}, 8.1 years]), the average number of drugs increased from 6.9 to 10.1 over the course of the last year before death. Preventive drugs frequently were continued until the final month of life, including antihypertensives, platelet aggregation inhibitors, anticoagulants, statins, and oral antidiabetic drugs. Median drug costs amounted to $1482 (interquartile range [IQR], $700–$2896]) per person, including $213 (IQR, $77–$490) for preventive therapies. Compared with older adults who died with lung cancer (median drug cost, $205; IQR, $61–$523), costs for preventive drugs were higher among older adults who died with pancreatic cancer (adjusted median difference, $13; 95% confidence interval [CI], $5–$22) or gynecological cancers (adjusted median difference, $27; 95% CI, $18–$36). There was no decrease noted with regard to the cost of preventive drugs throughout the last year of life. The authors conclude that preventive drugs commonly are prescribed during the last year of life among older adults with cancer, and often are continued until the final weeks before death. They suggest that adequate deprescribing strategies are warranted to reduce the burden of drugs with limited clinical benefit near the end of life.
Bala BS, Chen TF, Nishtala PS: Inappropriate medications in older adults: A way forward. Canadian J Aging 2019 [E-pub ahead of print]; DOI: 10.1017/S0714980819000084
Reducing potentially inappropriate medications (PIMs) in older adults is an area of sustained interest for many clinicians and researchers across the globe, as PIMs contribute to a significant burden of morbidity and mortality in the aging population. The prevalence of PIMs is a pervasive problem despite the presence of several explicit and implicit criteria for reducing PIMs in older adults, the most common being the Beers criteria, the Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START) criteria, and several country-specific criteria. This narrative review discusses the frequently used published criteria for reducing PIMs, and elucidates the role of certain measures, especially deprescribing, to optimize medication prescription in older adults. The numerous available criteria have their specific advantages and drawbacks. Deprescribing, an initiative to reduce the use of PIMs, has gained significant importance in improving appropriate prescribing practices. Deprescribing is a methodical approach to gradually stopping inappropriate medications judiciously for each patient and simultaneously monitoring the patient carefully for the onset of adverse events or rebound symptoms. A combined caregiver–patient-centered approach encourages the collaboration between prescribers and pharmacists to reduce PIMs in older adults.
Roux B, Morin L, Papon A, et al.: Prescription and deprescription of medications for older adults receiving palliative care during the last 3 months of life: A single-center retrospective cohort study. Eur Geriatr Med 2019 [E-pub ahead of print]; DOI: 10.1007/s41999-019-00175-3
The aim of this study was to assess the evolution and quality of drug therapy throughout the last three months of life of older adults in need of palliative care. A single-center retrospective cohort study included older adults (≥65 years) who died in a teaching hospital between January 1, 2014 and June 30, 2014 and identified as patients in need of palliative care in their last three months of life. Drugs were collected from electronic medical records and defined as “unnecessary” or “essential” based on a review of the literature. Results demonstrated that a total of 149 patients were included [age: 82.1 (SD 8.6) years, women: 46.3%]. The mean number of medications varied from 6.7 (SD 3.3) drugs 90 days before death to 7.5 (SD 4.1) 7 days before death to 5.6 (SD 3.6) on the day of death. During the final week of life, one additional prescription of essential drugs was observed for 75.2% of patients, and 79.3% of patients had at least one unnecessary drug deprescribed. The most prescribed and deprescribed drug classes were, respectively, analgesics (56.4%) and antithrombotic agents (38.2%) during the last week of life. The authors conclude that near the end of life, medication therapy is adapted to the goals of palliative care. However, this only occurs during the last week of life. They suggest that earlier transition to palliative care is necessary to avoid exposure to unnecessary drugs.