• Aluem Tark, Leah V Estrada, Mary E Tresgallo, Denise D Quigley, Patricia W Stone, and Mansi Agarwal.
• School of Nursing, Columbia University, New York, NY, USA.
• Palliat Med. 2020 May 1; 34 (5): 580-588.

BackgroundInfections are common occurrences at end of life that are associated with high rates of morbidity and mortality among frail elderly individuals. The problem of infections in nursing homes has led to a subsequent overuse and misuse of antibiotics in this already-frail population. Improving palliative care in nursing homes has been proposed as a key strategy to reduce the use of antibiotics.AimThe aim of this study was to describe the current status of how nursing homes integrates palliative care and infection management at end of life across the nation.DesignThis is a cross-sectional survey of nationally representative US nursing homes.Setting/ParticipantsBetween November 2017 and October 2018, a survey was conducted with a nationally representative random sample of nursing homes and 892 surveys were completed (49% response rate). The weighted study sample represented 15,381 nursing homes across the nation.ResultsMost nursing homes engaged in care plan documentation on what is important to residents (90.43%) and discussed spiritual needs of terminally ill residents (89.50%). In the event of aspiration pneumonia in terminally ill residents, 59.43% of nursing homes responded that resident would be transferred to the hospital. In suspected urinary tract infection among terminally ill residents, 66.62% of nursing homes responded that the resident will be treated with antibiotics.ConclusionThe study found wide variations in nursing home palliative care practices, particularly for timing of end-of-life care discussions, and suboptimal care reported for antibiotic usage. Further education for nursing home staff on appropriate antibiotic usage and best practices to integrate infection management in palliative care at the end of life is needed.

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