Needs of the dying in nursing homes.
OBJECTIVE
To describe the palliative care needs of dying nursing home residents during the last 3 months of life.


METHODS
Nurses, aides, and family members completed structured interviews after all deaths of residents in two nursing homes during a 1-year study period. For each resident who died, family and staff caregivers answered parallel questions on the presence of physical and emotional symptoms, unmet needs for treatment of these symptoms, and the quality of the dying experience.


RESULTS
Of 259 eligible respondents 176 completed interviews (68%). Decedents' average age was 82, and 90% died in the nursing home rather than in a hospital. Most deaths were preceded by orders to withhold resuscitation (79%) and other treatments (39%). The most common physical symptoms were pain (86%), problems with personal cleanliness (81%), dyspnea (75%), incontinence (59%), and fatigue (52%). Depressed mood (44%), anxiety (31%), and loneliness (21%) were common emotional symptoms. Respondents believed residents needed more treatment than they received for emotional symptoms (30%), personal cleanliness (23%) and pain (19%). Fifty-eight percent of respondents believed the resident experienced a "good death," as they would have wanted it to be.


CONCLUSIONS
Dying nursing home residents need improved emotional and spiritual care, help with personal cleanliness, and treatment for pain. Efforts to improve end-of-life care in nursing homes should combine traditional palliative care services with increased attention to emotional symptoms and personal care services.
Reynolds
Kimberly
K
Program on Aging, Center for Health Ethics and Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7110, USA.
Henderson
Martha
M
Schulman
Alan
A
Hanson
Laura C
LC
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006301:Health Services Needs and Demand; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009657:North Carolina; D009735:Nursing Homes / Q000592:standards*; D010166:Palliative Care / Q000379:methods*; D011787:Quality of Health Care; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill / Q000523:psychology*