Journal of the American Medical Directors Association
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Multicenter Study
Care dependency independently predicts two-year survival in outpatients with advanced chronic organ failure.
Previous studies suggest that care dependency may predict survival in hospitalized patients, but the prognostic value of care dependency in clinically stable outpatients with advanced chronic organ failure remains unknown. The objective of this study was to assess whether and to what extent care dependency predicts 2-year survival in patients with advanced chronic organ failure. ⋯ The level of care dependency independently predicts 2-year survival among clinically stable outpatients with advanced chronic organ failure. Therefore, regular assessment of the level of care dependency should be included in clinical care for patients with advanced chronic organ failure.
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To compare available instruments and investigate which best measure the quality of end-of-life care (QOC) and quality of dying (QOD) in long term care settings, in terms of validity, reliability, and feasibility. ⋯ We recommend the EOLD-SWC to measure QOC, and the EOLD-CAD and MSSE to measure QOD in populations with dementia and in mixed long term care populations of nursing home or residential care home/assisted living residents, because they performed best in both countries. Use of the same instruments allows for comparison of the results between studies.
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Weight loss and poor nutrition have been important considerations in measuring quality of nursing home care since 1987. Our purpose was to examine, synthesize, and provide a systematic review of the current literature on the prevalence and definitions of nutritional problems in nursing home residents. In the fall of 2011, we performed MEDLINE searches of English-language articles published after January 1, 1990. ⋯ Of all the measures, the Minimum Data Set (MDS) weight loss definition of ≥5% in 1 month or ≥10% in 6 months had the narrowest range of prevalence rate: 6% to 15%. Weight loss, as measured by the MDS, may be the most easily replicated indicator of nutritional problems in nursing home residents for medical directors to follow for quality-improvement purposes. Additional studies are needed, reporting the prevalence of the MDS weight loss definition among international nursing home residents.
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Randomized Controlled Trial
Impact of a decision aid on surrogate decision-makers' perceptions of feeding options for patients with dementia.
In advanced dementia, feeding problems are nearly universal, and families face difficult decisions about feeding options. Initial interviews for a randomized trial were used to describe surrogates' perceptions of feeding options, and to determine whether a decision aid on feeding options in advanced dementia would improve knowledge, reduce expectation of benefit from tube feeding, and reduce conflict over treatment choices for persons with advanced dementia. ⋯ A structured decision aid can be used to improve decision making about feeding options in dementia care.