End-of-Life Transitions among Nursing Home Residents with Cognitive Issues

Among nursing home residents with cognitive impairment, burdensome transitions between the nursing home and the hospital or hospice during the last months of life were common, varied according to state, and were associated with a poor quality of care. Health care transitions, such as the hospitaliza...

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Bibliographic Details
Published in:The New England journal of medicine Vol. 365; no. 13; pp. 1212 - 1221
Main Authors: Gozalo, Pedro, Teno, Joan M, Mitchell, Susan L, Skinner, Jon, Bynum, Julie, Tyler, Denise, Mor, Vincent
Format: Journal Article
Language:English
Published: Waltham, MA Massachusetts Medical Society 29.09.2011
Subjects:
Activities of daily living
Advance directives
Aged
Aged, 80 and over
Aging
Biological and medical sciences
Cardiovascular disease
Cognition Disorders - therapy
Cognitive ability
Continuity of Patient Care
Dementia
Ethics
Feeding
Female
General aspects
Hospitalization
Hospitalization - statistics & numerical data
Humans
Male
Medical sciences
Medicare
Nursing Homes
Palliative care
Patient Transfer - statistics & numerical data
Patients
Pneumonia
Pressure ulcers
Public health. Hygiene
Public health. Hygiene-occupational medicine
Quality
Quality of Health Care
Sociodemographics
Teaching. Deontology. Ethics. Legislation
Terminal Care - standards
Terminal Care - statistics & numerical data
United States
United States
Medicine
Ethics
Long stay
Nursing home for the aged
Transition
Resident
Cognition
End of life
Homes for the aged
Nursing home
ISSN:0028-4793, 1533-4406, 1533-4406
Online Access:Get full text
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Description
Summary:Among nursing home residents with cognitive impairment, burdensome transitions between the nursing home and the hospital or hospice during the last months of life were common, varied according to state, and were associated with a poor quality of care. Health care transitions, such as the hospitalization of nursing home residents, have the potential for fragmentation of care, changes in the management of chronic diseases, duplication of diagnostic workups, and medical errors. 1 – 7 Few previous reports have described health care transitions among nursing home residents who had advanced cognitive impairment. These patients and their family members are especially vulnerable to the adverse consequences resulting from transitions, particularly during end-of-life care. Pertinent sources of distress include the trauma of the physical transfer, increased confusion because of unfamiliar settings and providers, inadequate ability to address the patient's special needs (e.g., assistance with . . .
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ISSN:0028-4793
1533-4406
1533-4406
DOI:10.1056/NEJMsa1100347