Discussing end-of-life issues in nursing homes: a nationwide study in France

Age Ageing. 2016 May;45(3):395-402. doi: 10.1093/ageing/afw046. Epub 2016 Mar 24.

Abstract

Background: discussing end-of-life issues with nursing home residents and their relatives is needed to ensure patient-centred care near the end of life.

Objectives: this study aimed to estimate the frequency of nursing home physicians discussing end-of-life issues with residents and their relatives and to investigate how discussing end-of-life issues was associated with care outcomes in the last month of life.

Methods: post-mortem cohort study in a nationwide, representative sample of 78 nursing home facilities in France. Residents who died from non-sudden causes between 1 October 2013 and 31 May 2014 in these facilities were included (n = 674).

Results: end-of-life issues were discussed with at most 21.7% of the residents who died during the study period. In one-third of the situations (32.8%), no discussion about end-of-life-related topics ever occurred, either with the resident or with the relatives. Older people with severe dementia were less likely to have discussed more than three of the six end-of-life topics we investigated, compared with residents without dementia (OR = 0.17, 95% CI = 0.08-0.22). In the last month of life, discussing more than three end-of-life issues with the residents or their relatives was significantly associated with reduced odds of dying in a hospital facility (adjusted OR = 0.51, 95% CI = 0.33-0.79) and with a higher likelihood of withdrawing potentially futile life-prolonging treatments (adjusted OR = 2.37, 95% CI = 1.72-3.29).

Conclusion: during the last months of life, discussions about end-of-life issues occurred with only a minority of nursing home decedents, although these discussions may improve end-of-life care outcomes.

Keywords: communication; end-of-life care; long-term care; nursing home; older people.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Communication
  • Cross-Sectional Studies
  • Decision Making
  • Family Relations
  • Female
  • France
  • Geriatric Assessment / methods*
  • Homes for the Aged / organization & administration*
  • Humans
  • Long-Term Care / methods*
  • Long-Term Care / psychology
  • Male
  • Nursing Homes / organization & administration*
  • Physician-Patient Relations*
  • Risk Factors
  • Terminal Care / methods*
  • Terminal Care / psychology