Living in uncertain times: trajectories to death in residential care homes.

Autor:	Barclay S; Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge., Froggatt K; International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster., Crang C; Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge., Mathie E; Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield., Handley M; Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield., Iliffe S; Department of Primary Care and Population Health, University College London, London., Manthorpe J; Social Care Workforce Research Unit, King's College London, London., Gage H; Department of Economics, University of Surrey, Guildford., Goodman C; Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield.
Jazyk:	angličtina
Zdroj:	The British journal of general practice : the journal of the Royal College of General Practitioners [Br J Gen Pract] 2014 Sep; Vol. 64 (626), pp. e576-83.
DOI:	10.3399/bjgp14X681397
Abstrakt:	Background: Older people living in care homes often have limited life expectancy. Practitioners and policymakers are increasingly questioning the appropriateness of many acute hospital admissions and the quality of end-of-life care provided in care homes. Aim: To describe care home residents' trajectories to death and care provision in their final weeks of life. Design and Setting: Prospective study of residents in six residential care homes in three sociodemographically varied English localities: Hertfordshire, Essex, and Cambridgeshire. Method: Case note reviews and interviews with residents, care home staff, and healthcare professionals. Results: Twenty-three out of 121 recruited residents died during the study period. Four trajectories to death were identified: 'anticipated dying' with an identifiable end-of-life care period and death in the care home (n = 9); 'unexpected dying' with death in the care home that was not anticipated and often sudden (n = 3); 'uncertain dying' with a period of diagnostic uncertainty or difficult symptom management leading to hospital admission and inpatient death (n = 7); and 'unpredictable dying' with an unexpected event leading to hospital admission and inpatient death (n = 4). End-of-life care tools were rarely used. Most residents who had had one or more acute hospital admission were still alive at the end of the study. Conclusion: For some care home residents there was an identifiable period when they were approaching the end-of-life and planned care was put in place. For others, death came unexpectedly or during a period of considerable uncertainty, with care largely unplanned and reactive to events. (© British Journal of General Practice 2014.)
Databáze:	MEDLINE
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