Nursing home care trajectories for older adults following in-hospital palliative care consultation.
Joan G Carpenter, Patricia H Berry, Mary Ersek
PMID 28457493WHAT IT FOUND
Ten of twelve patients discharged to a nursing home after palliative care received aggressive rehabilitation despite poor prognoses, often contradicting their own goals.
Only two followed a comfort-focused path. Most patients experienced high symptom burden and rehospitalization, with no documented spiritual support or goal renegotiation in the nursing home.
Key findings
01Ten of twelve participants received a care trajectory focused on aggressive rehabilitation and interventions to improve function, despite poor medical prognosis during hospitalization.
02Surrogates for three patients without decisional capacity made decisions incongruent with the patients' previously stated goals, leading to aggressive care such as feeding tubes and CPR orders.
03Goals of care were generally not renegotiated or discussed after nursing home admission, and hospice was offered only once at discharge in the rehabilitative group.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPsWhat it means for RNs
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What it does not show
The study was conducted at only one hospital and one nursing home, limiting generalizability. The sample size was small (12 participants). Important information regarding ongoing goals of care discussions and comfort-focused interventions may not have been recorded in the medical records, leading to an incomplete picture. The study relied on medical records and interviews, which may be subject to recall bias or social desirability bias. Staff perspectives were not included, so the findings reflect only patient and surrogate experiences.
Declared interests
No author has any declared conflict of interest.
The easy way to misread this
Do not assume that hospital palliative care recommendations are automatically followed in nursing homes. This study shows that most patients received aggressive rehabilitation despite poor prognoses and contrary to their stated goals, because care trajectories were not renegotiated after admission.