Journal of the American Medical Directors Association
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To describe Chinese nursing home residents' knowledge of advance directive (AD) and end-of-life care preferences and to explore the predictors of their preference for AD. ⋯ Most nursing home residents did not know about AD, and nearly one-third showed positive attitudes toward it. AD should be promoted in mainland China. Education of residents, the proxy decision maker, and nursing home staff on AD is very important. Necessary policy support, legislation, or practice guidelines about AD should be made with flexibility to respect nursing home residents' rights in mainland China.
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Currently there is no risk factor scale that identifies older persons at risk of frailty. ⋯ The FRI is a validated instrument for assessing frailty risk in community-living older persons. FRI may be a useful rapid assessment tool to identify vital body system deficits underlying the frailty syndrome.
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The purpose of the study was to examine the frequency of burdensome care transitions at the end of life, the difference between different types of residential care facilities, and the changes occurring between 2002 and 2008. ⋯ The ongoing change in long-term care from institutional care to housing services causes major challenges to the continuity of end-of-life care. To guarantee good quality during the last days of life for people with dementia, the underlying reasons behind transitions at the end of life should be investigated more thoroughly.
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Multicenter Study Observational Study
Clinical characteristics and prognostic significance of chronic obstructive pulmonary disease in patients with atrial fibrillation: results from a multicenter atrial fibrillation registry study.
Atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) are 2 common morbidities and often coexist. Studies have shown that COPD is a risk factor for cardiovascular disease, but the characteristics in patients with COPD and AF, as well as the impact of COPD on the outcomes of AF were lacking. The aim of present study was to analyze the clinical characteristics and to evaluate the association of COPD with 1-year outcomes in patients with AF. ⋯ Anticoagulation treatment is inadequate in patients with AF and COPD. The presence of COPD in patients with AF is an independent risk factor for 1-year all-cause mortality and cardiovascular mortality but not a risk factor for stroke.
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Continuous sedation until death (CSD), the removal of consciousness of an incurably ill patient until death, has become a controversial practice. Some consider CSD a palliative treatment, whereas others claim that CSD is frequently used with the intention to hasten death. In nursing homes in Flanders, the rate of CSD has tripled over the past decade, whereas legal euthanasia remains a rare practice. This study wants to investigate to what extent CSD is used to hasten death (CSD+) and to identify possible associated factors. ⋯ In nursing homes in Flanders, CSD is frequently used to hasten the patient's death. In some cases, CSD can even be considered a substitute for legal euthanasia.