Journal of palliative medicine
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Increasing advance care planning (ACP) among older adults is a national priority. Documentation of ACP in the electronic health record (EHR) is particularly important during emergency care. ⋯ In a sample of older ED patients likely to benefit from ACP, few patients had documented end-of-life care preferences in the EHR.
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Bereaved families endure tremendous grief. However, few studies have longitudinally investigated caregivers' bereavement grief for more than one year postloss and none is from family-oriented Asian countries. ⋯ Bereaved family caregivers' severe depressive symptoms decreased significantly over the first two years postloss. Healthcare professionals should appropriately assess at-risk bereaved caregivers when patients are still alive and provide effective interventions to facilitate caregivers' return to normal life.
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Accurate prediction of mortality for patients admitted to the intensive care units (ICUs) is an important component of medical care. However, little is known about the role of multimorbidity in predicting end of life for high-risk and vulnerable patients. ⋯ The MMI improved the accuracy of predicting short- and long-term all-cause mortality for ICU patients. Further prospective studies are needed to validate the index in different clinical settings and test generalizability of results in patients outside the VA system of care.
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Comparative Study
Predictors for Development of Pressure Ulcer in End-of-Life Care: A National Quality Register Study.
The scientific knowledge about pressure ulcers (PUs) is growing, but there is a shortage of studies of PUs at end of life. The recommendations regarding PU prevention in palliative care (PC) are based on consensus documents. ⋯ The SRPC could be a unique resource for quality improvement and research. The present study cannot prove causation, but it can report correlations between background variables and PU prevalence. More studies, with different designs, are warranted to establish the roles of risk factors for PU in end-of-life care.
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People with advanced illness usually want their healthcare where they live-at home-not in the hospital. Innovative models of palliative care that better meet the needs of seriously ill people at lower cost should be explored. ⋯ HBPC within an ACO was associated with significant cost savings, fewer hospitalizations, and increased hospice use in the final months of life.