Suchergebnisse

Objectives To examine the rate and characteristics of hospitalisation in the last month of life and place of death among nursing home residents and to identify related care processes, facility factors and residents' characteristics. Setting A cross-sectional study (2015) of deceased residents in 322 nursing homes in six European countries. Participants The nursing home manager (N=1634), physician (N=1132) and primary nurse (N=1384) completed questionnaires. Outcome measures Hospitalisation and place of death were analysed using generalised linear and logistic mixed models. Multivariate analyses were conducted to determine associated factors. Results Twelve to 26% of residents were hospitalised in the last month of life, up to 19% died in-hospital (p<0.001). Belgian residents were more likely to be hospitalised than those in Italy, the Netherlands and Poland. For those dying in-hospital, the main reason for admission was acute change in health status. Residents with a better functional status were more likely to be hospitalised or to die in-hospital. The likelihood of hospitalisation and in-hospital death increased if no conversation on preferred care with a relative was held. Not having an advance directive regarding hospitalisations increased the likelihood of hospitalisation. Conclusions Although participating countries vary in hospitalisation and in-hospital death rates, between 12% (Italy) and 26% (Belgium) of nursing home residents were hospitalised in the last month of life. Close monitoring of acute changes in health status and adequate equipment seem critical to avoiding unnecessary hospitalisations. Strategies to increase discussion of preferences need to be developed. Our findings can be used by policy-makers at governmental and nursing home level.

OBJECTIVES: To examine the rate and characteristics of hospitalisation in the last month of life and place of death among nursing home residents and to identify related care processes, facility factors and residents' characteristics. SETTING: A cross-sectional study (2015) of deceased residents in 322 nursing homes in six European countries. PARTICIPANTS: The nursing home manager (N=1634), physician (N=1132) and primary nurse (N=1384) completed questionnaires. OUTCOME MEASURES: Hospitalisation and place of death were analysed using generalised linear and logistic mixed models. Multivariate analyses were conducted to determine associated factors. RESULTS: Twelve to 26% of residents were hospitalised in the last month of life, up to 19% died in-hospital (p<0.001). Belgian residents were more likely to be hospitalised than those in Italy, the Netherlands and Poland. For those dying in-hospital, the main reason for admission was acute change in health status. Residents with a better functional status were more likely to be hospitalised or to die in-hospital. The likelihood of hospitalisation and in-hospital death increased if no conversation on preferred care with a relative was held. Not having an advance directive regarding hospitalisations increased the likelihood of hospitalisation. CONCLUSIONS: Although participating countries vary in hospitalisation and in-hospital death rates, between 12% (Italy) and 26% (Belgium) of nursing home residents were hospitalised in the last month of life. Close monitoring of acute changes in health status and adequate equipment seem critical to avoiding unnecessary hospitalisations. Strategies to increase discussion of preferences need to be developed. Our findings can be used by policy-makers at governmental and nursing home level.

Background The provision of institutional long-term care for older people varies across Europe reflecting different models of health care delivery. Care for dying residents requires integration of palliative care into current care work, but little is known internationally of the different ways in which palliative care is being implemented in the care home setting. Objectives To identify and classify, using a new typology, the variety of different strategic, operational, and organizational activities related to palliative care implementation in care homes across Europe. Design and methods We undertook a mapping exercise in 29 European countries, using 2 methods of data collection: (1) a survey of country informants, and (2) a review of data from publically available secondary data sources and published research. Through a descriptive and thematic analysis of the survey data, we identified factors that contribute to the development and implementation of palliative care into care homes at different structural levels. From these data, a typology of palliative care implementation for the care home sector was developed and applied to the countries surveyed. Results We identified 3 levels of palliative care implementation in care homes: macro (national/regional policy, legislation, financial and regulatory drivers), meso (implementation activities, such as education, tools/frameworks, service models, and research), and micro (palliative care service delivery). This typology was applied to data collected from 29 European countries and demonstrates the diversity of palliative care implementation activity across Europe with respect to the scope, type of development, and means of provision. We found that macro and meso factors at 2 levels shape palliative care implementation and provision in care homes at the micro organizational level. Conclusions Implementation at the meso and micro levels is supported by macro-level engagement, but can happen with limited macro strategic drivers. Ensuring the delivery of consistent and ...

Background: End-of-life care practices in long-term care facilities (LTCFs) are the focus of growing attention in Europe, due to rapidly increasing number of older persons living in LTCFs. The knowledge about end-of-life discussions or existence of written advance directives in the European LTCFs is scarce. This study's aim is to investigate the prevalence of written advance directives and their sociodemographic associates, among recently deceased LTCF residents, in six European countries. Methods: Data from the European Union-funded PACE database were collected from 322 LTCFs in six European countries in 2014. The assessments were performed by using two questionnaires designed for LTCF administrative staff and for staff member. LTCFs were selected within each country by using proportional stratified random sampling procedure. Facilities with certain types and sizes were included from each country. Multilevel multivariate analyses were performed to evaluate associations between written advance directives and selected predictors. Results: In total, 32.5 % of the 1384 deceased LTCF residents had a written advance directive with a range from 0% to 77 % between countries. The proportion of the most common advance directive, ⠀ Do not resuscitate in case of cardiac or respiratory arrest (DNR)', varied correspondingly from 0% to 75%. LTCF type (OR 2.86 95% CI 1.59 to 5.23) and capability of expressing at the time of admission (OR 3.26 95% CI 2.26 to 4.71) were the independent predictors for advance directive. Residents living in LTCFs where physician was available were less likely to have advance directive compared with residents from LTCFs where physician was not available. Conclusion: Extensive differences for prevalence of written advance directive exist between countries among older LTCF residents in Europe. Timely and appropriate response to LTCF resident's health needs and preferences efforts advance care planning.

The European population is ageing rapidly: its median age is the highest in the world. The topic of ageing has received significant attention in recent years, as is evident in the multiple international reports on ageing published during the last five years and the existence of at least eight active working groups on ageing at the EU level. The SAPEA Working Group on Transforming the Future of Ageing aims to provide a scientific perspective to address the question of what policies at the EU level could support the member states in their response to the current and future opportunities and challenges posed by ageing. In this project, SAPEA assembled a large multi-disciplinary working group, with world-leading expertise in the biomedical, human, social and engineering sciences. The Federation of European Academies of Medicine network led the project. The resulting report reflects not only the outstanding knowledge of the experts, but also their exemplary commitment to the voluntary task of collaborating in an interdisciplinary way and bringing the best and latest scientific knowledge into evidence-based policymaking. The report aims to make a unique contribution from a broad public health standpoint to a complex topic in a way that complements other related resources, thereby providing evidence-based science advice for the highest policy level in Europe. In particular, the working group has made a conscious effort not to duplicate the same aspects of ageing covered in existing reports. Likewise, by adopting a multi-disciplinary approach in the present report, the working group has distinguished itself from other EU ageing-related initiatives. These include the European Innovative partnership for Active and Healthy Ageing, Horizon 2020 projects in response to identified societal challenges posed by ageing, and the EU health programme managed by DG Santé focusing on healthy ageing, as well as existing networks funded by the EU, such as Innovation, Futurage, Mopact, Nestpar, and SHARE . The choice of topics covered in this report, or excluded, is based upon the expressed interest of policymakers throughout the scoping process, e.g. health, social affairs, employment, and technology. SAPEA is an integral part of the European Commission's Scientific Advice Mechanism (SAM). This Evidence Review Report is presented to the European Group of Chief Scientific Advisors, informing their Scientific Opinion which will be published later in 2019. Both this report and the Scientific Opinion are delivered directly to the College of Commissioners, and will be used for planning and policymaking. By such means, the best available science, distilled and analysed by the leading experts in Europe, should have a direct and tangible impact on decisions taken by the European Commission which influences the lives of some 500 million people across our continent.

The European population is ageing rapidly: its median age is the highest in the world. The topic of ageing has received significant attention in recent years, as is evident in the multiple international reports on ageing published during the last five years and the existence of at least eight active working groups on ageing at the EU level. The SAPEA Working Group on Transforming the Future of Ageing aims to provide a scientific perspective to address the question of what policies at the EU level could support the member states in their response to the current and future opportunities and challenges posed by ageing. In this project, SAPEA assembled a large multi-disciplinary working group, with world-leading expertise in the biomedical, human, social and engineering sciences. The Federation of European Academies of Medicine network led the project. The resulting report reflects not only the outstanding knowledge of the experts, but also their exemplary commitment to the voluntary task of collaborating in an interdisciplinary way and bringing the best and latest scientific knowledge into evidence-based policymaking. The report aims to make a unique contribution from a broad public health standpoint to a complex topic in a way that complements other related resources, thereby providing evidence-based science advice for the highest policy level in Europe. In particular, the working group has made a conscious effort not to duplicate the same aspects of ageing covered in existing reports. Likewise, by adopting a multi-disciplinary approach in the present report, the working group has distinguished itself from other EU ageing-related initiatives. These include the European Innovative partnership for Active and Healthy Ageing, Horizon 2020 projects in response to identified societal challenges posed by ageing, and the EU health programme managed by DG Santé focusing on healthy ageing, as well as existing networks funded by the EU, such as Innovation, Futurage, Mopact, Nestpar, and SHARE . The choice of topics covered in this report, or excluded, is based upon the expressed interest of policymakers throughout the scoping process, e.g. health, social affairs, employment, and technology. SAPEA is an integral part of the European Commission's Scientific Advice Mechanism (SAM). This Evidence Review Report is presented to the European Group of Chief Scientific Advisors, informing their Scientific Opinion which will be published later in 2019. Both this report and the Scientific Opinion are delivered directly to the College of Commissioners, and will be used for planning and policymaking. By such means, the best available science, distilled and analysed by the leading experts in Europe, should have a direct and tangible impact on decisions taken by the European Commission which influences the lives of some 500 million people across our continent.

The European population is ageing rapidly: its median age is the highest in the world. The topic of ageing has received significant attention in recent years, as is evident in the multiple international reports on ageing published during the last five years and the existence of at least eight active working groups on ageing at the EU level. The SAPEA Working Group on Transforming the Future of Ageing aims to provide a scientific perspective to address the question of what policies at the EU level could support the member states in their response to the current and future opportunities and challenges posed by ageing. In this project, SAPEA assembled a large multi-disciplinary working group, with world-leading expertise in the biomedical, human, social and engineering sciences. The Federation of European Academies of Medicine network led the project. The resulting report reflects not only the outstanding knowledge of the experts, but also their exemplary commitment to the voluntary task of collaborating in an interdisciplinary way and bringing the best and latest scientific knowledge into evidence-based policymaking. The report aims to make a unique contribution from a broad public health standpoint to a complex topic in a way that complements other related resources, thereby providing evidence-based science advice for the highest policy level in Europe. In particular, the working group has made a conscious effort not to duplicate the same aspects of ageing covered in existing reports. Likewise, by adopting a multi-disciplinary approach in the present report, the working group has distinguished itself from other EU ageing-related initiatives. These include the European Innovative partnership for Active and Healthy Ageing, Horizon 2020 projects in response to identified societal challenges posed by ageing, and the EU health programme managed by DG Santé focusing on healthy ageing, as well as existing networks funded by the EU, such as Innovation, Futurage, Mopact, Nestpar, and SHARE . The choice of topics covered in this report, or excluded, is based upon the expressed interest of policymakers throughout the scoping process, e.g. health, social affairs, employment, and technology. SAPEA is an integral part of the European Commission's Scientific Advice Mechanism (SAM). This Evidence Review Report is presented to the European Group of Chief Scientific Advisors, informing their Scientific Opinion which will be published later in 2019. Both this report and the Scientific Opinion are delivered directly to the College of Commissioners, and will be used for planning and policymaking. By such means, the best available science, distilled and analysed by the leading experts in Europe, should have a direct and tangible impact on decisions taken by the European Commission which influences the lives of some 500 million people across our continent.

The European population is ageing rapidly: its median age is the highest in the world. The topic of ageing has received significant attention in recent years, as is evident in the multiple international reports on ageing published during the last five years and the existence of at least eight active working groups on ageing at the EU level. The SAPEA Working Group on Transforming the Future of Ageing aims to provide a scientific perspective to address the question of what policies at the EU level could support the member states in their response to the current and future opportunities and challenges posed by ageing. In this project, SAPEA assembled a large multi-disciplinary working group, with world-leading expertise in the biomedical, human, social and engineering sciences. The Federation of European Academies of Medicine network led the project. The resulting report reflects not only the outstanding knowledge of the experts, but also their exemplary commitment to the voluntary task of collaborating in an interdisciplinary way and bringing the best and latest scientific knowledge into evidence-based policymaking. The report aims to make a unique contribution from a broad public health standpoint to a complex topic in a way that complements other related resources, thereby providing evidence-based science advice for the highest policy level in Europe. In particular, the working group has made a conscious effort not to duplicate the same aspects of ageing covered in existing reports. Likewise, by adopting a multi-disciplinary approach in the present report, the working group has distinguished itself from other EU ageing-related initiatives. These include the European Innovative partnership for Active and Healthy Ageing, Horizon 2020 projects in response to identified societal challenges posed by ageing, and the EU health programme managed by DG Santé focusing on healthy ageing, as well as existing networks funded by the EU, such as Innovation, Futurage, Mopact, Nestpar, and SHARE . The choice of topics covered in this report, or excluded, is based upon the expressed interest of policymakers throughout the scoping process, e.g. health, social affairs, employment, and technology. SAPEA is an integral part of the European Commission's Scientific Advice Mechanism (SAM). This Evidence Review Report is presented to the European Group of Chief Scientific Advisors, informing their Scientific Opinion which will be published later in 2019. Both this report and the Scientific Opinion are delivered directly to the College of Commissioners, and will be used for planning and policymaking. By such means, the best available science, distilled and analysed by the leading experts in Europe, should have a direct and tangible impact on decisions taken by the European Commission which influences the lives of some 500 million people across our continent.