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End-of-life care in the oldest old

Published online by Cambridge University Press:  27 September 2010

Marie Ernsth Bravell ,
Bo Malmberg  and
Stig Berg
Marie Ernsth Bravell*
Affiliation:
Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden
Bo Malmberg
Affiliation:
Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden
Stig Berg
Affiliation:
Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden
*
Address correspondence and reprint requests to: Marie Ernsth Bravell, Box 1026, 551 11, Jönköping, Sweden. E-mail: [email protected]
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Abstract

Objective:

The aim of this study was to describe the last year of life of a sample of the oldest old, focusing on care trajectories, health, social networks, and function in daily life activities.

Method:

Data originated from the NONA study, a longitudinal study of 193 individuals among the oldest old living in a Swedish municipality. During this longitudinal study, 109 participants died. Approximately one month after their death, a relative was asked to participate in a telephone interview concerning their relative's last year of life. One hundred two relatives agreed to participate.

Results:

Most of the elderly in this sample of the oldest old (74.5%) died at an institution and the relatives were mostly satisfied with the end-of-life care. The oldest old relatives estimated that the health steadily declined during the last year of life, and that there was a decline in performing of daily life activities. They also estimated that those dying in institutions had fewer social contacts than those dying in a hospital or at home.

Significance of results:

Care at end of life for the oldest old is challenged by problems with progressive declines in ability to perform activities of daily living and health. The findings also highlight the need to support social networks at eldercare institutions.

Keywords

Location at time of deathCare qualityProblems with activities of daily livingSocial supportHealth
Type
Original Articles
Information
Palliative & Supportive Care , Volume 8 , Issue 3 , September 2010 , pp. 335 - 344
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

Ahmed, N., Bestall, J.C., Ahmedzai, S.H., et al. (2004). Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals. Palliative Medicine, 18, 525–542.CrossRefGoogle ScholarPubMed
Allen, M.S., Foster, A. & Berg, K. (2001). Receiving help at home: The interplay of human and technological assistance. Journal of Gerontology: Social Sciences, 56B, 374–382.CrossRefGoogle Scholar
Andersson, E-B., Sundström, G. & Thulin, A. (2003). Det sista levnadsåret. En undersökningav omsorg och vård för mycket gamla personer som avled i Jönköpings sjukvårdsområde 1999. En förstudie (The Last Year of Life. A Study of Services and Health Care for Very Old Individuals Dying in the County Council of Jönköping in 1999. A Pilot Study). Jönköping: Institute of Gerontology,Google Scholar
Augustsson, O., Matousek, M., Eriksson, B.G., et al. (2003). Social and medical risk indicators for 8-year mortality in a Swedish urban elderly population. Achives of Gerontology and Geriatrics, 36, 155–171.CrossRefGoogle Scholar
Avlund, K., Damsgaard, M.T. & Holstein, B.E. (1998). Social relations and mortality. An eleven year follow-up study of 70-year-old men and women in Denmark. Social Science & Medicine, 47, 635–643.CrossRefGoogle ScholarPubMed
Avlund, K., Lund, R., Holstein, B., et al. (2004). The impact on structural and functional characteristics of social relations as determinants of functional decline. Journal of Gerontology: Social Sciences, 59B, 44–51.CrossRefGoogle Scholar
Bertera, E.M. (2003). Physical activity and social network contacts in community dwelling older adults. Activities, Adaptation and Aging, 27, 113–127.Google Scholar
Catt, S., Blanchard, M., Addington-Hall, J., et al. (2005) Older adults' attitudes to death, palliative treatment and hospice care. Palliative Medicine, 19, 402–410.CrossRefGoogle ScholarPubMed
Covinsky, K.E., Eng, C., Lui, L-Y., et al. (2003b). The last 2 years of life: Functional trajectories of frail older people. Journal of the American Geriatrics Society, 51, 492–498.CrossRefGoogle ScholarPubMed
Covinsky, K.E., Palmer, R.M., Fortinsky, R.H., et al. (2003a). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. Journal of the American Geriatrics Society, 51, 451–458.CrossRefGoogle ScholarPubMed
Davey, A., Johansson, L., Malmberg, B., et al. (2006). Unequal but equitable: An analysis of variations in old-age care in Sweden. European Journal of Ageing, 3, 34–40.CrossRefGoogle ScholarPubMed
Di Mauro, S., Scalia, G., Leotta, C., et al. (2000). The care of elderly, terminally ill oncological patients in caregiving sanitary residences. Achives of Gerontology and Geriatrics, 31, 85–94.CrossRefGoogle Scholar
Diehr, P., Williamson, J., Burke, G.L., et al. (2002). The aging and dying processes and the health of older adults. Journal of Clinical Epidemiology, 55, 269–278.CrossRefGoogle ScholarPubMed
Eriksson, B.G., Hessler, R.M., Sundh, V., et al. (1999). Cross-cultural analysis of longevity among Swedish and American elders: The role of social networks in the Gothenburg and Missouri longitudinal studies. Archives of Gerontology and Geriatrics, 28, 131–148.CrossRefGoogle ScholarPubMed
Ernsth Bravell, M., Berg, S. & Malmberg, B. (2007). Health, Functional Capacity, Formal Care,and Survival in the Oldest Old: A Longitudinal Study. Archives of Gerontology and Geriatrics, 46, 1–14.CrossRefGoogle Scholar
Hallberg, I.R. (2006) Palliative care as a framework for older peoples' long-term care. International Journal of Palliative Nursing, 12, 224–229.CrossRefGoogle ScholarPubMed
Hellström, Y. & Hallberg, I.R. (2001). Perspective of elderly people receiving home help on health, care and quality of life. Health and Social Care in the Community, 9, 61–71.CrossRefGoogle ScholarPubMed
Hyduk, C.A. (1996). The dynamic relationship between social support and health in older adults: Assessment implications. Journal of Gerontological Social Work, 27, 149–165.CrossRefGoogle Scholar
Kessler, D., Peters, T.J., Lee, L., et al. (2005). Social class and access to specialist palliative care services. Palliative Medicine, 19, 105–110.CrossRefGoogle ScholarPubMed
LaPlante, M.P., Kaye, H.S., Kang, T., et al. (2004). Unmet need for personal assistance services: Estimating the shortfall in hours of help and adverse consequences. Journal of Gerontology: Social Sciences, 59B, 98–108.CrossRefGoogle Scholar
Li, W.L. (2005). Trajectories of ADL disability among community-dwelling frail older persons. Research on Aging, 27, 56–79.CrossRefGoogle Scholar
Liptzin, B. (2006). End of life issues in elderly patients. Palliative and Supportive Care, 4, 155–157.CrossRefGoogle ScholarPubMed
Litwin, H. (2003). Association of disability, sociodemographic background, and social network type in later life. Journal of Aging and Health, 15, 391–408.CrossRefGoogle ScholarPubMed
Mendes de Leon, C.F., Glass, T.A., Beckett, L.A., et al. (1999). Social networks and disability transitions across eight intervals of yearly data in the New Haven EPESE. Journal of Gerontology: Social Sciences, 54B, 162–172.CrossRefGoogle Scholar
Murata, C., Takaaki, K., Tamakoshi, K., et al. (2006) Determinants of self-rated health: Could health status explain the association between self-rated health and mortality. Archives of Gerontology and Geriatrics, 43, 369–380.CrossRefGoogle ScholarPubMed
National Board of Health and Welfare (1997). Den kommunala vården i livets slutskede. En kunskapsöversikt (Municipal Care at End-of-Life. A Review). Stockholm: National Board of Health and Welfare,Google Scholar
National Board of Health and Welfare. (2005) Var dör de äldre – på sjukhus, särskilt boende eller hemma? En registerstudie (Where do the Elderly Die – in Hospital, Special Housing, or at Home?). Stockholm: National Board of Health and Welfare.Google Scholar
National Board of Health and Welfare. (2006). Vård i livets slutskede. Socialstyrelsens bedömning av utveckling i kommun och landsting (Terminal care. Estimation from National Board of Health and Welfare Concerning the Development in Municipalities and County Councils). Stockholm: National Board of Health and Welfare.Google Scholar
Raymond, S.K. & Woo, J. (2001). Palliative care in old age. Reviews in Clinical Gerontology, 11, 149–157.Google Scholar
Rinell Hermansson, A. (1990). Caring in the Last Year of Life. Doctoral dissertation. Uppsala, Sweden: Uppsala University, Department of Social Medicine and the Centre for Caring Sciences.Google Scholar
Ringdal, G.I., Ringdal, K., JordhØy, M.S., et al. (2007). Does social support from family and friends work as a buffer against reactions to stressful life events such as terminal cancer? Palliative and Supportive Care, 5, 61–69.CrossRefGoogle ScholarPubMed
Stuck, A.E., Walthert, J.M., Nikolaus, T., et al. (1999). Risk factors for functional status decline in community-living elderly people: A systematic literature review. Social Science & Medicine, 48, 445–469.CrossRefGoogle ScholarPubMed
Sutton, L.M., Demark-Wahnefried, W. & Clipp, E.C. (2003). Management of terminal cancer inelderly patients. The Lancet Oncology, 4, 149–157.CrossRefGoogle Scholar
Teno, J.M., Clarridge, B.R., Casey, V., et al. (2004). Family perspectives on end-of-life care at the last place of care. Journal of the American Medical Association, 291, 88–93.CrossRefGoogle ScholarPubMed