Satisfaction with End‐of‐Life Care for Nursing Home Residents with Advanced Dementia
- 20 September 2006
- journal article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 54 (10), 1567-1572
- https://doi.org/10.1111/j.1532-5415.2006.00900.x
Abstract
OBJECTIVES: To identify factors associated with satisfaction with care for healthcare proxies (HCPs) of nursing home (NH) residents with advanced dementia. DESIGN: Cross‐sectional study. SETTING: Thirteen NHs in Boston. PARTICIPANTS: One hundred forty‐eight NH residents aged 65 and older with advanced dementia and their formally designated HCPs. MASUREMENTS: The dependent variable was HCPs' score on the Satisfaction With Care at the End of Life in Dementia (SWC‐EOLD) scale (range 10–40; higher scores indicate greater satisfaction). Resident characteristics analyzed as independent variables were demographic information, functional and cognitive status, comfort, tube feeding, and advance care planning. HCP characteristics were demographic information, health status, mood, advance care planning, and communication. Multivariate stepwise linear regression was used to identify factors independently associated with higher SWC‐EOLD score. RESULTS: The mean ages±standard deviation of the 148 residents and HCPs were 85.0±8.1 and 59.1±11.7, respectively. The mean SWC‐EOLD score was 31.0±4.2. After multivariate adjustment, variables independently associated with greater satisfaction were more than 15 minutes discussing advance directives with a care provider at the time of NH admission (parameter estimate=2.39, 95% confidence interval (CI)=1.16–3.61, P<.001), greater resident comfort (parameter estimate=0.10, 95% CI=0.02–0.17, P=.01), care in a specialized dementia unit (parameter estimate=1.48, 95% CI=0.25–2.71, P=.02), and no feeding tube (parameter estimate=2.87, 95% CI=0.46–5.25, P=.02). CONCLUSION: Better communication, greater resident comfort, no tube feeding, and care in a specialized dementia unit are modifiable factors that may improve satisfaction with care in advanced dementia.Keywords
This publication has 30 references indexed in Scilit:
- A National Study of the Location of Death for Older Persons with DementiaJournal of the American Geriatrics Society, 2005
- Terminal Care for Persons with Advanced Dementia in the Nursing Home and Home Care SettingsJournal of Palliative Medicine, 2004
- Barriers to excellent end-of-life care for patients with dementiaJournal of General Internal Medicine, 2004
- Family Perspectives on End-of-Life Care at the Last Place of CareJAMA, 2004
- Barriers to Limiting the Practice of Feeding Tube Placement in Advanced DementiaJournal of Palliative Medicine, 2003
- Clinical and Organizational Factors Associated With Feeding Tube Use Among Nursing Home Residents With Advanced Cognitive ImpairmentJAMA, 2003
- Palliative Excellence in Alzheimer Care Efforts (PEACE): A Program DescriptionJournal of Palliative Medicine, 2003
- Patient-Focused, Family-Centered End-of-Life Medical Care: Views of the Guidelines and Bereaved Family MembersJournal of Pain and Symptom Management, 2001
- Rethinking the Role of Tube Feeding in Patients with Advanced DementiaNew England Journal of Medicine, 2000
- A 12-Item Short-Form Health SurveyMedical Care, 1996