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

(2018) PALLIATIVE MEDICINE. 32(10). p.1584-1595
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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, terminal care, palliative care, quality of health care, epidemiologic research design, ADVANCED DEMENTIA, PLACE, DEATH, FLANDERS, BELGIUM

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Chicago
Pivodic, Lara, Tinne Smets, Nele Van Den Noortgate, Bregje D Onwuteaka-Philipsen, Yvonne Engels, Katarzyna Szczerbińska, Harriet Finne-Soveri, et al. 2018. “Quality of Dying and Quality of End-of-life Care of Nursing Home Residents in Six Countries : an Epidemiological Study.” Palliative Medicine 32 (10): 1584–1595.
APA
Pivodic, L., Smets, T., Van Den Noortgate, N., Onwuteaka-Philipsen, B. D., Engels, Y., Szczerbińska, K., Finne-Soveri, H., et al. (2018). Quality of dying and quality of end-of-life care of nursing home residents in six countries : an epidemiological study. PALLIATIVE MEDICINE, 32(10), 1584–1595.
Vancouver
1.
Pivodic L, Smets T, Van Den Noortgate N, Onwuteaka-Philipsen BD, Engels Y, Szczerbińska K, et al. Quality of dying and quality of end-of-life care of nursing home residents in six countries : an epidemiological study. PALLIATIVE MEDICINE. 2018;32(10):1584–95.
MLA
Pivodic, Lara, Tinne Smets, Nele Van Den Noortgate, et al. “Quality of Dying and Quality of End-of-life Care of Nursing Home Residents in Six Countries : an Epidemiological Study.” PALLIATIVE MEDICINE 32.10 (2018): 1584–1595. Print.
@article{8575900,
  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 {\textrangle} 1 year (p = 0.034), higher functional status (p {\textlangle} 0.001). A higher Quality of Dying in Long-Term Care score was associated with country (p {\textlangle} 0.001), older age (p {\textlangle} 0.001), length of stay {\textrangle} 1 year (p {\textlangle} 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.},
  author       = {Pivodic, Lara and Smets, Tinne and Van Den Noortgate, Nele and Onwuteaka-Philipsen, Bregje D and Engels, Yvonne and Szczerbi\'{n}ska, Katarzyna and Finne-Soveri, Harriet and Froggatt, Katherine and Gambassi, Giovanni and Deliens, Luc and Van den Block, Lieve},
  issn         = {0269-2163},
  journal      = {PALLIATIVE MEDICINE},
  language     = {eng},
  number       = {10},
  pages        = {1584--1595},
  title        = {Quality of dying and quality of end-of-life care of nursing home residents in six countries : an epidemiological study},
  url          = {http://dx.doi.org/10.1177/0269216318800610},
  volume       = {32},
  year         = {2018},
}

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