Hospitalization patterns and palliation in the last year of life among residents in long-term care.
OBJECTIVE
This study compared patterns of care, including hospitalization, during the last year of life for a group of residents in institutional long-term care. These subjects were either implicitly or explicitly in palliative care modes versus those who remained in active treatment or blended care.


METHODS
The study used a retrospective chart review and both quantitative and qualitative methods of data collection and analysis to examine indepth the end-of-life experiences of 41 nursing home residents who died in the nursing care unit of one large continuing care retirement community during an 18-month period.


RESULTS
Most residents die in palliative care modes, but their movement into palliation with comfort care and symptom management is often slowed by indecision or inaction on the part of key decision makers, interrupted by aggressive acute care, or delayed until the last few days of life.


CONCLUSIONS
Transitions from active curative care to palliative care are important for residents in permanent long-term care placements. Improved end-of-life care requires more attention to these transitions and to the decisions that residents, their families, and care teams are called upon to make.
Travis
S S
SS
College of Nursing and Health Professions, University of North Carolina at Charlottee, 28223, USA. sstravis@email.uncc.edu
Loving
G
G
McClanahan
L
L
Bernard
M
M
D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006707:Homes for the Aged; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015206:Southwestern United States; D013727:Terminal Care