Symptoms, Signs, Problems, and Diseases of Terminally Ill Nursing Home Patients: A Nationwide Observational Study in the Netherlands | Geriatrics | JAMA Internal Medicine | JAMA Network
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1.
World Health Organization, Palliative Care: The Solid Facts. Copenhagen, Denmark World Health Organization2004;
2.
Zerzan  JStearns  SHanson  L Access to palliative care and hospice in nursing homes.  JAMA 2000;2842489- 2494PubMedGoogle ScholarCrossref
3.
Happ  MBCapezuti  EStrumpf  NE  et al.  Advance care planning and end-of-life care for hospitalized nursing home residents.  J Am Geriatr Soc 2002;50829- 835PubMedGoogle ScholarCrossref
4.
Zimmerman  SSloane  PDHanson  LMitchell  CMShy  A Staff perceptions of end-of-life care in long-term care.  J Am Med Dir Assoc 2003;423- 26PubMedGoogle ScholarCrossref
5.
Froggatt  KA Palliative care and nursing homes: where next?  Palliat Med 2001;1542- 48PubMedGoogle ScholarCrossref
6.
Hanson  LCHenderson  MMenon  MMenon  M As individual as death itself: a focus group study of terminal care in nursing homes.  J Palliat Med 2002;5117- 125PubMedGoogle ScholarCrossref
7.
Ersek  MWilson  SA The challenges and opportunities in providing end-of-life care in nursing homes.  J Palliat Med 2003;645- 57PubMedGoogle ScholarCrossref
8.
Christakis  NALamont  EB Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study.  BMJ 2000;320469- 472PubMedGoogle ScholarCrossref
9.
Ribbe  MWLjunggren  GSteel  K  et al.  Nursing homes in 10 nations: a comparison between countries and settings.  Age Ageing 1997;26 ((suppl 2)) 3- 12PubMedGoogle ScholarCrossref
10.
Ribbe  MW Care for the elderly: the role of the nursing home in the Dutch health care system.  Int Psychogeriatr 1993;5213- 222PubMedGoogle ScholarCrossref
11.
Van der Steen  JTOoms  MEAdér  HJRibbe  MWvan der Wal  G Withholding antibiotic treatment in pneumonia patients with dementia: a quantitative observational study.  Arch Intern Med 2002;1621753- 1760PubMedGoogle ScholarCrossref
12.
Prismant/Arcares., Verpleeghuizen in Cijfers 2000 [Statistical Data on Dutch Nursing Homes 2000] Utrecht, the Netherlands Prismant/Arcares2002;Google Scholar
13.
Statistics Netherlands (CBS), Vademecum Health Statistics Netherlands.  Voorburg/Heerlen, the Netherlands Statistics Netherlands (CBS)2001;
14.
Stichting Informatiecentrum voor de Gezondheidszorg (SIG), Jaarboek Verpleeghuizen 1997.  [SIG Nursing Home Information System Annual Report Nursing Homes 1997]. Utrecht, the Netherlands Stichting Informatiecentrum voor de Gezondheidszorg (SIG)1998;Google Scholar
15.
Reisberg  BFerris  SHde Leon  MJCrook  T The Global Deterioration Scale for assessment of primary degenerative dementia.  Am J Psychiatry 1982;1391136- 1139PubMedGoogle Scholar
16.
Stichting Informatiecentrum voor de Gezondheidszorg (SIG), Classificatie van ziekten voor de verpleeghuisgeneeskunde.  [Classification Codes of Diseases for Nursing Home Medicine]. Utrecht, the Netherlands Stichting Informatiecentrum voor de Gezondheidszorg (SIG)1994;Google Scholar
17.
World Health Organization, International Classification of Diseases, 10th Revision (ICD-10).  Geneva, Switzerland World Health Organization1992;
18.
Bouter  LMRosendaal  RF Wrong tracks in methodology [in Dutch].  Ned Tijdschr Geneeskd 2002;14657- 60Google Scholar
19.
Hall  PSchroder  CWeaver  L The last 48 hours of life in long-term care: a focused chart audit.  J Am Geriatr Soc 2002;50501- 506PubMedGoogle ScholarCrossref
20.
Addington-Hall  JFakhoury  WMcCarthy  M Specialist palliative care in nonmalignant disease.  Palliat Med 1998;12417- 427PubMedGoogle ScholarCrossref
21.
Field  D Special not different: general practitioners' accounts of their care of dying people.  Soc Sci Med 1998;461111- 1120PubMedGoogle ScholarCrossref
22.
Teno  JMCoppola  KM For every numerator, you need a denominator: a simple statement but key to measuring the quality of care of the “dying.”  J Pain Symptom Manage 1999;17109- 113PubMedGoogle ScholarCrossref
23.
Hanson  LCHenderson  M Care of the dying in long-term care settings.  Clin Geriatr Med 2000;16225- 237PubMedGoogle ScholarCrossref
24.
Teno  JMWeitzen  SFennell  MMor  V Dying trajectory in the last year of life: does cancer trajectory fit other diseases?  J Palliat Med 2001;4457- 464PubMedGoogle ScholarCrossref
Original Investigation
February 14, 2005

Symptoms, Signs, Problems, and Diseases of Terminally Ill Nursing Home Patients: A Nationwide Observational Study in the Netherlands

Author Affiliations

Author Affiliations: Department of Nursing Home Medicine and Institute for Research in Extramural Medicine (Ms Brandt and Drs Ooms, van der Steen, and Ribbe), and Department of Social Medicine and Institute for Research in Extramural Medicine (Ms Brandt and Drs Deliens, van der Steen, and van der Wal), VU University Medical Center, Amsterdam, the Netherlands; and Department of Medical Sociology and Health Sciences, End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium (Dr Deliens).

Arch Intern Med. 2005;165(3):314-320. doi:10.1001/archinte.165.3.314
Abstract

Background  Nursing homes (NHs) are less well studied than hospices or hospitals as a setting for terminal care. For more targeted palliative care, more information is needed about the patient characteristics, symptoms, direct causes and underlying diseases, and incidence of terminally ill NH patients. These aspects are examined in this study.

Methods  Prospective observational cohort study in 16 NHs representative of the Netherlands. All long-term care patients assessed by an NH physician to have a life expectancy of 6 weeks or less were enrolled in our study.

Results  The terminal disease phase was marked with symptoms of low fluid and food intake, general weakness, and respiratory problems or dyspnea. Direct causes of these conditions were diseases of the respiratory system (mainly pneumonia) and general disorders (eg, cachexia). The 2 main underlying diseases of the terminal phase were mental and behavioral disorders and diseases of the circulatory system. Cancer was the underlying disease in only 12% of the patients. Patients with cancer showed a different pattern of symptoms than those without cancer. Per 100 beds per year, 34 NH patients entered the terminal phase. Most patients (82.9%) died within 7 days of inclusion.

Conclusions  For patients without cancer in Dutch NHs, the terminal disease phase is difficult to predict, and once diagnosed, patient survival time is short. A better identification of the symptom burden might improve the prognostication of life expectancy in elderly patients.

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