Latest Evidence

December 2017

Pereira-Salgado A, Mader P, O’Callaghan C, Boyd L, Staples M. Religious leaders’ perceptions of advance care planning: a secondary analysis of interviews with Buddhist, Christian, Hindu, Islamic, Jewish, Sikh and Bahá’í leaders. BMC Palliat Care. 2017 Dec 28;16(1):79. doi: 10.1186/s12904-017-0239-3.
This study looked at how religious leaders’ perspectives could improve how ACP programs respect patients’ faith backgrounds. Interview transcripts from a primary qualitative study conducted with religious leaders to inform an ACP website, ACPTalk, were used as the data source for analysis. The authors noted that most leaders had some understanding of ACP and held ACP in positive regard. However, religious followers’ preferences for end-of-life care reflected family and geographical origins, cultural traditions, personal attitudes, and religiosity and faith interpretations.

Hunt LJ, Lee SJ, Harrison KL, Smith AK. Secondary Analysis of Existing Datasets for Dementia and Palliative Care Research: High-Value Applications and Key Considerations. J Palliat Med. 2017 Dec 21. doi: 10.1089/jpm.2017.0309. [Epub ahead of print]
The authors looked at the role that secondary datasets could play in providing information germane to dementia and palliative care research. They conducted a broad search of a variety of resources to identify relevant datasets and to review potential applications and use of the data. They also noted potential validity and reliability concerns. The authors concluded that while secondary analysis of existing datasets requires consideration of key limitations, it can be a powerful tool for efficiently enhancing knowledge of palliative care needs among people with dementia.

Borotkanics R, Rowe C, Georgiou A, Douglas H, Makeham M, Westbrook J. Changes in the profile of Australians in 77 residential aged care facilities across New South Wales and the Australian Capital Territory. Aust Health Rev. 2017 Dec;41(6):613-620. doi: 10.1071/AH16125.
This study characterised the demographic profile and utilisation of a large cohort of residential aged care residents, including trends over a 3-year period.  The researchers found that the median age at admission over the 3-year period remained constant at 86 years  but there were statistically significant decreases in separations to home (z = 2.62, P = 0.009) and a 1.35% increase in low care admissions. Widowed females were the common residents as well as the oldest. They also had the longest lengths of stay. Most permanent residents had resided in aged care for less than 3 years. Approximately 30% of residents were not born in Australia. Aboriginal residents made up less than 1% of the studied population. 

Mallery LH, Moorhouse P, McLean Veysey P, Allen M, Fleming I. Severely frail elderly patients do not need lipid-lowering drugs. Cleve Clin J Med. 2017 Feb;84(2):131-142. doi: 10.3949/ccjm.84a.15114.
After performing a systematic review, members of the Palliative and Therapeutic Harmonization (PATH) program and the Dalhousie Academic Detailing Service found that evidence does not support lipid-lowering therapy for severely frail elderly patients.  They argue that there should be careful review of evidence before applying clinical practice guidelines to those who are frail.

Salamanca-Balen N, Seymour J, Caswell G, Whynes D, Tod A. The costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs: A systematic review of international evidence. Palliat Med. 2017 Jun 1:269216317711570. doi: 10.1177/0269216317711570. [Epub ahead of print]
This systematic review looked at the costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs. Those with palliative care needs were defined as seriously ill patients and those with advanced disease or frailty who are unlikely to be cured, recover or stabilise. The authors found that Clinical Nurse Specialist interventions could help in reducing specific resource use such as hospitalizations/re-hospitalizations/admissions, length of stay and health care costs. However, they noted that costs-effectiveness was not able to be established given variability in study types and quality.

November 2017

Painter V, Le Couteur DG, Waite LM. Texture-modified food and fluids in dementia and residential aged care facilities. Clin Interv Aging. 2017 Aug 2;12:1193-1203. doi: 10.2147/CIA.S140581.
Dysphagia is common in people living with dementia and associated with increased risk of aspiration pneumonia, dehydration, malnutrition, and death. Texture-modified food and fluids (TMF) are commonly used. This review aimed to evaluate the evidence for TMF in dementia. After reviewing the 22 studies that met the inclusion criteria the authors concluded that there is a lack of evidence for people living with dementia and in residential care facilities that TMF improves clinical outcomes such as aspiration pneumonia, nutrition, hydration, morbidity, and mortality.

Milte R, Ratcliffe J, Bradley C, Shulver W. Evaluating the quality of care received in long-term care facilities from a consumer perspective: development and construct validity of the Consumer Choice Index – Six Dimension instrument. Ageing Soc. 2017 Sept:1-23 First View.
The Consumer Choice Index – Six Dimension (CCI-6D) is a new instrument designed specifically to evaluate the quality of care received in long-term care from a consumer perspective. The analyses presented in this paper present evidence of construct validity for the individual dimensions of the CCI-6D instrument, as assessed through the relationships with variables hypothesised to be associated with the dimensions of the instrument. Therefore, the CCI-6D shows promise in its ability to evaluate the quality of care processes from the perspective of consumers in long-term care facilities.

Shepperd S, Cradduck-Bamford A, Butler C, Ellis G, Godfrey M, Gray A, et al. A multi-centre randomised trial to compare the effectiveness of geriatrician-led admission avoidance hospital at home versus inpatient admission. Trials. 2017 Oct 23;18(1):491. doi: 10.1186/s13063-017-2214-y.
This trial registration describes planning for a multi-site randomised open trial of geriatrician-led admission avoidance hospital at home, compared with admission to hospital. Participants are randomised to geriatrician-led admission avoidance hospital at home or a control group of inpatient admission in a 2:1 ratio in favour of the intervention. The primary endpoint is 'living at home' (the inverse of death or living in a residential care setting).

Cartwright C, White B, Willmott L, Parker M, Williams G. Australian doctors’ knowledge of and compliance with the law relating to end-of-life decisions: implications for LGBTI patients. Cult Health Sex. 2017 Oct 25:1-13. doi: 10.1080/13691058.2017.1385854.
Little is known about medical practitioners’ knowledge of, or attitudes to, the law in this area, especially in relation to LGBTI people, or how the law influences their decision-making. An Australian postal survey explored knowledge and attitudes of medical specialists to legal issues relating to withdrawing/ withholding life-sustaining treatment from adults without capacity. The authors reported that less than one-third of respondents correctly identified the same-sex partner as the legally authorised decision-maker. They concluded that LGBTI people may face multiple obstacles to having their end-of-life wishes respected.

Cardona-Morrell M, Kim JCH, Brabrand M, Gallego-Luxan B, Hillman K. What is inappropriate hospital use for elderly people near the end of life? A systematic review. Eur J Intern Med. 2017 Jul;42:39-50. doi: 10.1016/j.ejim.2017.04.014. Epub 2017 May 11.
This review looked at the extent and causes of inappropriate hospital admission among older patients near the end of life. The authors found that the definition of ‘Inappropriate admissions’ near the end of life incorporated system factors, social and family factors meaning estimating the prevalence of inappropriate admissions varied substantially with non-clinical reasons reported such as poor availability of alternative sites of care; family requests; or too late an admission to be of benefit. The authors proposed two underlying concepts: Inappropriateness encompassing the patient's social circumstances or system factors; and avoidability when clinical management could have been dealt with at a lower level facility.

October 2017

Bone AE, Gomes B, Etkind SN, Verne J, Murtagh FE, Evans CJ, et al. What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death. Palliat Med. 2017 Oct 1:269216317734435. doi: 10.1177/0269216317734435. [Epub ahead of print]
Population ageing represents a global challenge for future end-of-life care. This study looked at where people will die from 2015 to 2040 across all care settings in England and Wales.  The projections show that if current trends continue, numbers of deaths in care homes and homes will increase by 108.1% and 88.6%, with care home the most common place of death by 2040. If care home capacity does not expand and additional deaths occur in hospital, hospital deaths will start rising by 2023.

Hilmer SN, Gnjidic D. Prescribing for frail older people. Aust Prescr. 2017 Oct 3;40:174-8.
People who are frail experience a higher incidence and severity of adverse drug events because of their medicine use and potential changes in pharmacokinetics and pharmacodynamics. Prescribing for these patients requires constant vigilance and review, considering the impact of every medicine, as well as overall drug load, comorbidities, function and goals of care. This article provides a useful overview of issues and considerations.

Fleming J, Calloway R, Perrels A, Farquhar M, Barclay S, Brayne C, et al. Dying comfortably in very old age with or without dementia in different care settings – a representative “older old” population study. BMC Geriatr. 2017 Oct 5;17(1):222. doi: 10.1186/s12877-017-0605-2.
This study looked at associations between factors potentially related to reported comfort during very old people’s final illness: physical and cognitive disability, place of care and transitions in their final illness, and place of death. The results showed that care homes can provide care akin to hospice for the very old and support an approach of supporting residents to stay in their care home or own home if possible. Findings on reported high prevalence of multiple symptoms can inform policy and training to improve older old people’s end-of-life care in all settings.

Silva RS, Caldeira S, Coelho AN, Apóstolo JLA. Forgiveness facilitation in palliative care: a scoping review protocol. JBI Database System Rev Implement Rep. 2017 Oct;15(10):2469-2479. doi: 10.11124/JBISRIR-2016-003.
The objective of this scoping review is to map the nature and extent of forgiveness facilitation interventions that have been implemented and evaluated in palliative care contexts. 

De Roo ML, Tanghe MF, Van Den Noortgate NJ, Piers RD. Development and Validation of the Symptom Assessment to Improve Symptom Control for Institutionalized Elderly Scale. Am Med Dir Assoc. 2017 Oct 14. pii: S1525-8610(17)30480-2. doi: 10.1016/j.jamda.2017.08.013. [Epub ahead of print]
This paper reports on the development of a multiple symptom self-assessment tool for use in nursing homes. The scale ws developed from a Delphi process. A study of its use with residents showed that nurses found that the SATISFIE instrument was useful, applicable in daily practice, and sufficiently comprehensible for the patients.

Forbat L, Chapman M, Lovell C, Liu WM, Johnston N. Improving specialist palliative care in residential care for older people: a checklist to guide practice. BMJ Support Palliat Care. 2017 Aug 2;0:1-7. Online First.
This study aimed ot develop an evidence-based checklist in order to support specialist palliative care clinicians integrate care in residential nursing homes for older people. It was a grounded theory ethnographic study, involving non-participant observation and qualitative interviews. A palliative care needs round checklist was developed.

September 2017 

Cardona-Morrell M, Benfatti-Olivato G, Jansen J, Turner RM, Fajardo-Pulido D, Hillman K. A systematic review of effectiveness of decision aids to assist older patients at the end of life. Patient Educ Couns. 2017 Mar;100(3):425-435. doi: 10.1016/j.pec.2016.10.007. Epub 2016 Oct 11.
Decision aids (DAs) provide high quality, synthesised information to help patients and clinicians compare the risks and benefits of treatment options. These tools can assist in making a shared decision about what is the best option. DAs at the end of life (EoL) can be helpful at a time of prognostic uncertainty. Existing DAs for EoL care in older adults were reviewed to assess their effectiveness and acceptability, and the involvement of family in decision-making. Overall, the available DAs seemed to enhance patient or surrogate-decision-makers’ knowledge of the care options and to reduce decisional conflict. The authors suggest some future improvements in DAs to guide people in the complex and sensitive treatment choices at the end of life.

Currow DC, Phillips J, Agar M. Population-based models of planning for palliative care in older people. Curr Opin Support Palliat Care. 2017 Sep 16. doi: 10.1097/SPC.0000000000000304. [Epub ahead of print]
The world’s population is ageing more rapidly than ever before. To meet the current and projected care needs of older people, services require a broad understanding of demographic, clinical and health system issues. This review outlines the recent literature that can help to inform planning of palliative care services for older people.

Vermunt NPCA, Harmsen M, Westert GP, Olde Rikkert MGM, Faber MJ. Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review. BMC Geriatr. 2017 Jul 31;17(1):167. doi: 10.1186/s12877-017-0534-0.
The number of morbidities and the proportion of people suffering from multimorbidity increase with age. A patient-goal-oriented approach to health care could be beneficial and contribute to a patient’s wellbeing and quality of life. This study describes the emerging concepts of ‘collaborative goal setting’ and ‘priority setting’.

Holyoke P, Stephenson B. Organization-level principles and practices to support spiritual care at the end of life: a qualitative study. BMC Palliat Care. 2017 Apr 11;16(1):24. doi: 10.1186/s12904-017-0197-9.
How can hospice palliative care - which recognises the importance of spiritual care at the end of life - better meet the religious, spiritual, and existential questions and needs often present at end of life? This study looked to hospice programs founded and operated on specific spiritual foundations to identify organisational-level practices that support high-quality spiritual care that then might be applied in secular healthcare organisations. Nine Principles for organisational support for spiritual care emerged from the interviews. They are presented as a potential multi-pronged framework for improving spiritual care, along with some organisational practices that could support each of the Principles.

August 2017

Threapleton DE, Chung RY, Wong SYS, et al. Care Toward the End of Life in Older Populations and Its Implementation Facilitators and Barriers: A Scoping Review. J Am Med Dir Assoc. 2017 Jun 13. pii: S1525-8610(17)30225-6. doi: 10.1016/j.jamda.2017.04.010
A scoping review identified key themes in EOL care. The authors found that quality EOL care for older populations requires many core components but the local context and implementation issues may ultimately determine if these elements can be incorporated into the system to improve care. Changes at the macro-level (system/national), meso-level (organizational), and micro-level (individual) wall need to be harnessed to implement service changes to provide holistic and person-centered EOL care for elderly populations.

Hiam L, Dorling D, Harrison D, McKee M. Why has mortality in England and Wales been increasing? An iterative demographic analysis. J R Soc Med. 2017 Apr;110(4):153-162. doi: 10.1177/0141076817693599
Mortality increased in England and Wales in 2015. Demographic analysis indicates that the e largest contributors to this change in population life expectancy  was from those aged over 85 years, with dementias making the greatest contributions in both sexes. The possible impacts of health and social  system contexts were also raised. 

Easton T, Milte R, Crotty M, Ratcliffe J. Where's the evidence? a systematic review of economic analyses of residential aged care infrastructure. BMC Health Serv Res. 2017 Mar 21;17(1):226. doi: 10.1186/s12913-017-2165-8.
This review aimed to summarise the existing literature of economic evaluations of residential care infrastructure. Fourteen studies were included in the analysis. The authors noted there was a wide variation in approaches taken for valuing the outcomes associated with differential residential care infrastructures and little specific economic analysis. 

Huntley AL, Chalder M, Shaw ARG, Hollingworth W, et al. A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission. BMJ Open. 2017 Aug 1;7(7):e016236. doi: 10.1136/bmjopen-2017-016236.
What admission alternatives are there for older patients and are they safe, effective and cost-effective? This review found 19 studies and 7 systematic reviews relevant to the topic. A number of interventions were identified including paramedic/emergency care practitioners (n=3), emergency department-based interventions (n=3), community hospitals (n=2) and hospital-at-home services (n=11). The data suggested that alternatives to admission appear safe with potential to reduce secondary care use and length of time receiving care. 

July 2017

Morley JE, Arai H, Cao L, Dong B, Merchant RA, Vellas B, et al. Integrated Care: Enhancing the Role of the Primary Health Care Professional in Preventing Functional Decline: A Systematic Review. J Am Med Dir Assoc. 2017 Jun 1;18(6):489-494.
A number of validated screening tests for older persons at risk for physical and cognitive frailty have been developed. These tools can be used by primary care health providers to recognize older persons with early frailty. There are medical and lifestyle interventions that appear to have the ability to slow down the development of frailty. The use of computer-assisted diagnosis and management programs may also be helpful in increasing the reach and effectiveness of these screening activities. The evidence suggests that use of these programs by primary health providers may lead to improved function in older persons.

Cook I, Kirkup AL, Langham LJ, Malik MA, Marlow G, Sammy I. End of Life Care and Do Not Resuscitate Orders: How Much Does Age Influence Decision Making? A Systematic Review and Meta-Analysis. Gerontol Geriatr Med. 2017 Jun 12;3:2333721417713422. doi: 10.1177/2333721417713422. eCollection 2017 Jan-Dec.
With population aging, "do not resuscitate" (DNAR) decisions are becoming more common. This review examined the relationship between age and DNAR. Ten studies were included and eight showed that age affected DNAR independent of other mediating factors such as illness severity and likely outcome. Patients aged 75 to 84 and ≥85 years were more likely to have a DNAR compared with those <65 years. The authors noted that age increases the use of "do not resuscitate" orders, but more research is needed to determine whether this represents "ageism."

June 2017

Ellis-Smith C, Evans CJ, Murtagh FE, Henson LA, Firth AM, Higginson IJ, et al. Development of a caregiver-reported measure to support systematic assessment of people with dementia in long-term care: The Integrated Palliative care Outcome Scale for Dementia. Palliat Med. 2017 Jul;31(7):651-660.
This study used focus groups and interviews to examine the contetnt valdity and acceptability of the Intergated Palliatvie Care outcome Scale for Dementia. Participants saw it as a a comprehensive and acceptable caregiver-reported measure and that it  could be used without professional training. 

Wongrakpanich S, Susantitaphong P, Isaranuwatchai S, Chenbhanich J, Eiam-Ong S, Jaber BL. Dialysis Therapy and Conservative Management of Advanced Chronic Kidney Disease in the Elderly: A Systematic Review. Nephron. 2017 May 25. doi: 10.1159/000477361. [Epub ahead of print]
This systematic review looked at retrospective and prospective cohort studies of older adults with stage-5 chronic kidney disease who chose dialysis (hemodialysis or peritoneal dialysis) or opted for conservative management (including management of complications of CKD and palliative care. Generally older patients opteed for more conservative management but there was significant heterogeneity in the studies.

Burkett E, Martin-Khan MG, Scott J, Samanta M, Gray LC. Trends and predicted trends in presentations of older people to Australian emergency departments: effects of demand growth, population aging and climate change. Aust Health Rev. 2016 Jul 29;41(3):246-253.
The present study examined national ED presentation trends from July 2006 to June 2011, with specific emphasis on trends in presentation by age group. They found growth in ED presentations was greater than expected from population growth alone. Rates of presentation per head of population were highest for those over 85 years. This highlights the need for ED workforce planning and education in caring for this complex patient cohort. Funding models to incentivise investment in ED avoidance and substitutive care models targeting older people may also be needed.

Wallace CL, Swagerty D, Barbagallo M, Vellas B, Cha HB, Holmerova I, Dong B. IAGG/IAGG GARN International Survey of End-of-Life Care in Nursing Homes. J Am Med Dir Assoc. 2017 Jun 1;18(6):465-469.
This study surveyed 18 long-term care experts from 15 countries in a two step process. Experts provided definitions of core concepts such as palliative care and hospice care and then provided their level of agreement to a series of statements about end of life care. Overall, the  experts agreed that hospice and palliative care should be available in long term facilities. However there was substantial variation in the access to palliative  care and the need for greater education and training was highlighted.

Froggatt K, Payne S, Morbey H, Edwards M, Finne-Soveri H, Gambassi G, et al. Palliative Care Development in European Care Homes and Nursing Homes: Application of a Typology of Implementation. J Am Med Dir Assoc. 2017 Jun 1;18(6):550.e7-550.e14. doi: 10.1016/j.jamda.2017.02.016
Institutional long-term care for older people varies across Europe reflecting different models of health care delivery. This study underook a mapping exercise in 29 European countires to identify how palliative care is being implemented into the care home setting. The researchers completed a descriptive and thematic analysis of the collected data and identiifed levels of implementation - macro at the policy level with legislative, financial and regulatory drivers, meso using education, tools, frameworks and research, and micro the actual delivery level.The autors concluded that implementation at the meso and micro levels is supported by macro-level engagement, but can happen with limited macro strategic drivers.

May 2017

Cardona-Morrell M, Kim JCH, Brabrand M, Gallego-Luxan B, Hillman K. What is inappropriate hospital use for elderly people near the end of life? A systematic review. Eur J Intern Med. 2017 May 11. pii: S0953-6205(17)30162-0. doi: 10.1016/j.ejim.2017.04.014. [Epub ahead of print]
Thiis systematic review suggests that the definition of 'inappropriate admissions' near the end-of-life incorporates system factors, social and family factors. This makes it difficult to provide an accurate estimation of clinically innappropriate hospital use by older people.

Harrison JK, Reid J, Quinn TJ, Shenkin SD. Using quality assessment tools to critically appraise ageing research: a guide for clinicians. Age Ageing. 2017 May;46:359-365. doi: 10.1093/ageing/afw223.
This article is a review of research methods. It aims to help aged care practitioners learn about the principles and processes associated  with criitcal appraisal. A range of quality assessment tools are discussed and there is advice on when it is useful to use tools in appraisal.

Tait PA, Cheung WH, Wiese M, Staff K. Improving community access to terminal phase medicines in Australia: identification of the key considerations for the implementation of a core medicines list. Aust J Prim Health. 2017 May 11. doi: 10.1071/PY16153.
Access to medicines to support people who are dying at home can be challenging. This study looked at the views of specialist and generalist health professionals around community access to terminal phase medicines. Six themes emerged frorm focus group discussions around accessing medicines for management of terminal phase symptoms. They were: Medication Supply; Education and Training; Caregiver Burden; Safety; Funding; and Clinical Governance.

Mitchell GK, Senior HE, Rhee JJ, Ware RS, Young S, Teo PC, et al. Using intuition or a formal palliative care needs assessment screening process in general practice to predict death within 12 months: A randomised controlled trial. Palliat Med. 2017 Mar 1:269216317698621. doi: 10.1177/0269216317698621.
This study aimed to determine if screening for likely death within 12 months is more effective using screening tools or intuition. An RCT compared the Surprise Question with the SPICT against unguided intuition. The study showed that the screening tool was better at predicting actual death than intuition, but had a higher false positive rate.

Page updated 22 December 2017