Clinical problems at the end of life in a Swedish population,including the role of advancing age and physical and cognitive function

Abstract

Aims: To improve the understanding of specific clinical problems at the end of life, including the role of advancing age, physical function and cognitive function. Methods: The study is part of an explorative survey of data relevant to end-of-life healthcare services during the last 3 months of life of a randomly selected sample of the population of a Swedish county. Data were selected through retrospective reviews of death certificates and medical records, and comprise information from 12 municipalities and 229 individuals. Results: A range of prevalent concerns was found. Overall deterioration, urinary incontinence, constipation, impaired skin integrity, anxiety and sleep disturbances were significantly associated with dependency on others for activities of daily living; pulmonary rattles and swallowing disturbances were associated with cognitive disorientation; excepting cough, advancing age did not have significant impacts on these prevalent clinical concerns. Conclusions: A range of distressing conditions constitute a common pathway for many individuals at or near the end of life. The incorporation of health promotion as a principle of palliative care will probably benefit individuals at the end of life, and includes a proactive focus and emphasis on enhanced well-being at the time of diagnosis of a life-threatening illness. For individuals with physical and cognitive limitations imparting a state of dependency, it is reasonable to provide assurance of care for individuals' specific needs by professionals with both training for and competence in this special and sometimes unique clinical environment.

Keywords

Clinical problems end of life health promotion palliative care survey symptoms

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References

Ten Have H. , Clark D. Introduction: the work of the Pallium project. In: Ten Have H , Clark D , editors. The ethics in palliative care. European perspective . Milton Keynes: Open University Press; 2002 . p 1—12.

Wilson DM End-of-life care preferences of Canadian senior citizens with caregiving experience . J Adv Nurs 2000;31:1416—21.

Lynn J. , Teno JM , Philips RS , Wu AW , Desbiens N. , Harrold J. , et al. Perceptions by family members of the dying experience of older and seriously ill patients. Ann Intern Med 1997;126:97—106.

Sloane PD , Zimmerman S. , Hanson L. , Mitchell CM , Riedel-Leo C. , Custin-Buie V. End-of-life care in assisted living and related residential care settings: comparison with nursing homes. J Am Geriatr Soc 2003;51:1587—94.

Lloyd L. Dying in old age: promoting well-being at the end-of-life. Mortality 2000;5:171—88.

Reynolds K. , Henderson M. , Schulman A. , Hanson LC Needs of the dying in nursing homes. J Palliat Med 2002;5:895—901.

Porock D. , Parker Oliver D , Zweig SC , Rantz M. , Petroski GF A profile of residents admitted to long-term care facilities for end-of-life care. J Am Med Dir Assoc 2003;4:16—22.

Steel K. , Ljunggren G. , Topinkova E. , Morris JN , Vitale C. , Parzuchowski J. , et al. The RAI-PC: an assessment instrument for palliative care in all settings. Am J Hosp Palliat Care 2003;20:211—19.

Mitchell SL , Morris JN , Park PS , Fries BE Terminal care for persons with advanced dementia in the nursing home and home care settings . J Palliat Med 2004;7:808—16.

10.

Teno JM , Clarridge BR , Casey V. , Welch LC , Wetle T. , Shield R. , Mor V. Family perspective on end-of-life care at the last place of care. JAMA 2004;291:88—93.

11.

Georges JJ , Onwuteaka-Philipsen BD , van der Heide A. , van der Wal G. , van der Maas PJ Symptoms, treatment and ``dying peacefully'' in terminally ill cancer patients: a prospective study. Support Care Cancer 2005;13:160—8.

12.

Chochinov HM , Hack T. , Hassard T. , Kristjanson LJ , McClement S. , Harlos M. Dignity in the terminally ill: a cross-sectional, cohort study. Lancet 2002;360:2026—30.

13.

Chochinov HM , Hack T. , McClement S. , Kristjanson L. , Harlos M. Dignity in the terminally ill: a developing empirical model. Soc Sci Med 2002;54:433—43.

14.

Franklin LL , Ternestedt BM , Nordenfelt L. Views on dignity of elderly nursing home residents . Nurs Ethics 2006;13:130—46.

15.

Kellehear A. Health-promoting palliative care: developing a social model for practice. Mortality 1999 ;4:75—82.

16.

Skilbeck JK , Payne S. End of life care: a discursive analysis of specialist palliative care nursing. J Adv Nurs 2005;51:325—34.

17.

Parker D. , McLeod A. Assessment of need in care homes. In: Hockley J , Clark D , editors. Palliative care for older people in care homes. Milton Keynes: Open University Press; 2002 . p 34—51.

18.

Cartwright J. , Kayser-Jones J. End-of-life care in assisted living facilities . J Hospice Palliat Nurs 2003;5:143—51.

19.

SCB. Befolkningsstatistik [Population Statistics 2003]. Official Statistics of Sweden. Stockholm: Statistiska Centralbyra°n; 2004.

20.

Cochran WG Sampling techniques. 3rd revised edn. New York: Wiley; .

21.

Good P. Permutation tests. New York: Springer Verlag; 2000.

22.

Travis SS , Loving G. , McClanahan L. , Bernard M. Hospitalization patterns and palliation in the last year of life among residents in long term-care . Gerontologist 2001;41: 153—60.

23.

Costello J. Nursing older dying patients: findings from an ethnographic study of death and dying in elderly care wards. J Adv Nurs 2001;35:59—68.

24.

Klinkenberg M. , Willems DL , van der Wal G. , Deeg DJH. Symptom burden in the last week of life. J Pain Symptom Manage 2004;27:5—13.