Format

Send to

Choose Destination
Palliat Med. 2018 Dec;32(10):1584-1595. doi: 10.1177/0269216318800610. Epub 2018 Oct 1.

Quality of dying and quality of end-of-life care of nursing home residents in six countries: An epidemiological study.

Author information

1
1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels and Ghent, Belgium.
2
2 Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.
3
3 EMGO+ Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
4
4 Radboud University Medical Center, Department of Anesthesiology, Pain and Palliative Medicine, Nijmegen, The Netherlands.
5
5 Unit for Research on Aging Society, Department of Sociology, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.
6
6 National Institute for Health and Welfare, Helsinki, Finland.
7
7 International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK.
8
8 Università Cattolica del Sacro Cuore, Rome, Italy.
9
9 Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Abstract

BACKGROUND:

Nursing homes are among the most common places of death in many countries.

AIM:

To determine the quality of dying and end-of-life care of nursing home residents in six European countries.

DESIGN:

Epidemiological survey in a proportionally stratified random sample of nursing homes. We identified all deaths of residents of the preceding 3-month period. Main outcomes: quality of dying in the last week of life (measured using End-of-Life in Dementia Scales - Comfort Assessment while Dying (EOLD-CAD)); quality of end-of-life care in the last month of life (measured using Quality of Dying in Long-Term Care (QoD-LTC) scale). Higher scores indicate better quality.

SETTING/PARTICIPANTS:

Three hundred and twenty-two nursing homes in Belgium, Finland, Italy, the Netherlands, Poland and England. Participants were staff (nurses or care assistants) most involved in each resident's care.

RESULTS:

Staff returned questionnaires regarding 1384 (81.6%) of 1696 deceased residents. The End-of-Life in Dementia Scales - Comfort Assessment while Dying mean score (95% confidence interval) (theoretical 14-42) ranged from 29.9 (27.6; 32.2) in Italy to 33.9 (31.5; 36.3) in England. The Quality of Dying in Long-Term Care mean score (95% confidence interval) (theoretical 11-55) ranged from 35.0 (31.8; 38.3) in Italy to 44.1 (40.7; 47.4) in England. A higher End-of-Life in Dementia Scales - Comfort Assessment while Dying score was associated with country ( p = 0.027), older age ( p = 0.012), length of stay ⩾1 year ( p = 0.034), higher functional status ( p < 0.001). A higher Quality of Dying in Long-Term Care score was associated with country ( p < 0.001), older age ( p < 0.001), length of stay ⩾1 year ( p < 0.001), higher functional status ( p = 0.002), absence of dementia ( p = 0.001), death in nursing home ( p = 0.033).

CONCLUSION:

The quality of dying and quality of end-of-life care in nursing homes in the countries studied are not optimal. This includes countries with high levels of palliative care development in nursing homes such as Belgium, the Netherlands and England.

KEYWORDS:

Nursing home; epidemiologic research design; palliative care; quality of health care; terminal care

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center