Comfort and Satisfaction With Care of Home-Dwelling Dementia Patients at the End of Life

Despite the preference to pass away at home, many dementia patients die in institutions, resulting in a paucity of studies examining end-of-life care outcomes in the home setting. The objective of this study was to identify modifiable factors associated with the comfort of dementia patients dying at...

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Bibliographic Details
Published in:Journal of pain and symptom management 2020-05, Vol.59 (5), p.1019-1032.e1
Main Authors: Tay, Ri Yin, Hum, Allyn Y.M., Ali, Noorhazlina B., Leong, Ian.Y.O., Wu, Huei Yaw, Chin, Jing Jih, Lee, Angel O.K., Koh, Mervyn Y.H.
Format: Article
Language:English
Subjects:
Antibiotics
Bereavement
Caregivers
Clinical information
Cohort analysis
Comfort
Death & dying
Dementia
End of life decisions
end-of-life
Enteral nutrition
Functional assessment
home-dwelling
Hospice care
Intervention
Opioids
Palliative care
Pneumonia
satisfaction with care
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Summary:Despite the preference to pass away at home, many dementia patients die in institutions, resulting in a paucity of studies examining end-of-life care outcomes in the home setting. The objective of this study was to identify modifiable factors associated with the comfort of dementia patients dying at home and families' satisfaction with care. This is a prospective cohort study conducted from October 2014 to April 2019 in Singapore. Dementia patients at Stage 7 on the Functional Assessment Staging Scale, with albumin 1 antibiotic courses used in the last two weeks of life (77.2%) [β (95% CI) = −1.968 (−3.196 to −0.740), P = 0.002] were negatively associated. Independent factors associated with families' satisfaction with care were comfort [β (95% CI) = 0.149 (0.012–0.286), P = 0.033] and honoring of medical intervention preferences (96.0%) [β (95% CI) = 3.969 (1.485–6.453), P = 0.002]. Achieving comfort and satisfaction with care for dementia patients dying at home involves an interplay of modifiable factors. Honoring medical intervention preferences, such as those with palliative intent associated with patients' comfort, determined families' satisfaction with care.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2019.12.004