Monday, October 3, 2005
The current issue of The Gerontologist has several articles about end of life care. There's a not-so-shocking article surveying bereaved family members on end of life care in nursing homes finding it globally wanting (not enough staff, physicians inaccessible, hospice referrals late, etc.), a qualitative study interviewing nursing home residents about how they make decisions about advanced directives, and a narrative review on the current research about end of life care preferences amongst different racial & ethnic groups.
Most interesting to me was a nursing home study of people with advanced dementia (average MMSE of 4!) and agitation. The article is based on data from a trial of a psychosocial intervention for agitation & so the data about levels of agitation etc. were carefully & prospectively gathered. The current paper looks at the 32 people who died during the study and compares them to 32 survivors (apparently chosen to be matched for age and level of cognitive impairment). They found that those who died were more verbally agitated, spent less time verbally interacting with nursing staff, and were restrained more; there were no differences in deterioration of cognitive status (although an MMSE of 4 doesn't leave much room), perceived pain, or analgesic use; neuroleptic use was higher in the surviving group. Clearly not a huge amount can be taken from this--I can't quite decide if the comparison group is completely or just mostly bogus. This is a difficult group to prognosticate in so anything that's helpful is of interest; however no one's going to go amending the NHPCO hospice guidelines based on this.