Journal of the American Medical Directors Association
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To examine nutrition status and to explore risk factors for malnutrition in an urban veterans' long-term care (LTC) facility in Western Canada to determine whether nutrition should be a higher priority for managers, physicians, and staff. ⋯ Most residents were found to be at risk or actually malnourished. Analyses of the results indicate that managers, physicians, and staff need to focus on residents with depression and dementia, and those whose health is unstable. Ethical considerations are important in choosing appropriate interventions because many LTC residents are at an end-of-life stage. Effective nutrition interventions (eg, adding resources to support residents during meals, changing environmental factors) exist but what has not been well investigated are the methods for translating such knowledge into practice.
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Vitamin D deficiency remains a poorly recognized pandemic and is closely linked to increased health care costs in veterans. Projected health care needs in veterans are expected to increase over the next decade. Intensive care unit (ICU) costs contribute significantly to hospital costs and stem from intervention services and management of sepsis including nosocomial infections. Vitamin D has immunomodulating and antimicrobial properties through antimicrobial peptides such as cathelicidin. ⋯ A vitamin D-replete state may reduce costs and confer survival advantages in critical illness. We recommend that 25(OH)D levels be routinely checked and deficiencies treated in ICU patients.
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Although pain is common among advanced cancer patients, it can be controlled in a large proportion of patients. Several barriers hinder this, including the concern that opioids hasten death. We examined whether opioids influence survival among advanced cancer patients. ⋯ Opioid usage, even at high dosages, had no effect on survival among advanced cancer patients in a hospice setting.
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The objectives of the present study were to describe the knowledge and preferences of Hong Kong Chinese older adults regarding advance directives and end-of-life care decisions, and to investigate the predictors of preferences for advance directive and community end-of-life care in nursing homes. ⋯ Most of our cognitively normal Chinese nursing home older adults prefer having an advance directive, and one-third of them would prefer to die in nursing homes.
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The burden of suffering among patients with end-stage chronic diseases may be greater than those of cancer patients, as a result of longer duration of illness trajectory and high prevalence of symptoms, yet they may be less likely to receive palliative care services. To improve the quality of care of these patients, we carried out a continuous quality improvement initiative among medical and nursing staff of a convalescent facility. ⋯ It is possible to improve quality-of-life care for elderly patients with end-stage chronic diseases by staff education, and culture and system change, not only without additional resources, but likely savings were achieved in terms of reduced use of health care resources.