Journal of the American Medical Directors Association
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Advance care planning (ACP) is a communicative process of defining preferences for future medical care. Conversation guides support professionals to conduct ACP conversations, yet insight into essential components is limited. ⋯ ACP conversation guides address a diversity of themes regarding illness, EOL issues, and decision making. There is a focus on the exploration of patient's perspectives and preferences. Evidence on the translation of explorative information into specific treatment preferences and consequences for care as provided is limited.
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To examine family caregivers' experiences with end-of-life care for nursing home residents with dementia and associations with the residents dying peacefully. ⋯ Families' reports of unpleasant experiences with end-of-life care may inform practice to improve perceived quality of dying of their loved ones. Humane and compassionate care and attention from physicians and other staff for resident and family may facilitate recollections of a peaceful death.
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A discrepancy in self-reported and performance-based physical functioning levels is often observed among older adults. We investigated the association of discrepancy in self-reported and performance-based physical functioning levels with risk of future falls among community-dwelling older adults. ⋯ Our findings suggest that the discrepancy as high performance-based but low self-reported physical functioning level is associated with an increased risk of future falls in older adults aged 65-89 years. Clinicians should carefully assess older adults whose subjective perception of their physical functioning capacity is lower than those in similar age and sex groups, even if their actual physical functioning appears to be objectively high.
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Readmission after acute care is a significant contributor to health care costs, and has been proposed as a quality indicator. Our earlier studies showed that patients aged ≥55 years who are injured by falls from heights of ≤0.5 m were at increased risk for long-term mortality, compared to patients by high-velocity blunt trauma (higher fall heights, road injuries, and other blunt trauma). We hypothesized that these patients are also at higher risk of readmission, compared to patients injured by high-velocity mechanisms. ⋯ Our study sheds light on the interpretation of trauma data in aging populations. The detailed fall height information in our registry makes it uniquely placed to facilitate understanding of the paradoxical finding that injuries sustained by low-energy falls are higher risk than those sustained by higher-velocity mechanisms. Low-fall patients should be prioritized for rehabilitation and postdischarge support. The proportion of low-fall patients in a trauma registry should be included in the factors considered for benchmarking.
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To determine the prevalence of social frailty and its relation to incident disability and mortality in community-dwelling Japanese older adults. ⋯ Community-dwelling older adults with both social frailty and physical/psychological frailty are at higher risk of death or disability over 6 years than are older adults with only one type of frailty or no frailty. Screening and preventive measures for social frailty are suggested for healthy aging.