Journal of the American Medical Directors Association
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Multicenter Study
Advance directives at end-of-life: nursing home resident preferences for artificial nutrition.
Nursing homes are increasingly the place where many Americans die. Thus, advance directives are critical to the preservation of the autonomous wishes at end-of-life. The purpose of this paper is to determine if preferences for artificial nutrition, as stated in the advance directives of nursing home residents, are honored in the last 2 months of life. ⋯ In this nursing home sample, advance directives were significant documents guiding decisions on artificial nutrition, and feeding tubes were in fact uncommon at the end of life. The study suggests that advance care planning, quality palliative care training, and administrative support are necessary for the honoring of preferences. Future research is needed to examine more broadly tube-feeding practices and prevalence in nursing homes.
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Comparative Study
Predictors of rehabilitation outcomes: a comparison of Israeli and Italian geriatric post-acute care (PAC) facilities using the minimum data set (MDS).
To understand the relative contribution of sociodemographic, clinical, and health care features to rehabilitation outcomes in Israel and in Italy in post-acute care (PAC) facilities. ⋯ We found support for the hypothesis that differences in sociodemographic and clinical factors cannot account for all differences in ADL improvement, and that the organization of care and constraints of the health system also influence functional outcomes. Policymakers should examine the policy-amenable features of the Italian and Israeli systems so that optimal ADL recovery can be encouraged. Any reduction in disability will help both patients and the health care system; slightly higher short-term PAC treatment costs may have large long-term future benefits, if they result in the reduction of ADL disability. This study is one of the first to examine outcomes of PAC in 2 countries, and can provide an initial assessment of how rehabilitation can be enhanced or limited by health policies and staffing patterns.