[Show abstract][Hide abstract] ABSTRACT: Background Evidence-based guidelines concerning the older head and neck cancer (HNCA) patient are lacking. Accurate patient selection for optimal care management is therefore challenging. We examined if geriatric assessment is indicative of long-term health-related quality of life (HRQOL) and overall survival in this unique population. Methods All HNCA patients, aged ≥65 years, eligible for curative radio(chemo)therapy were evaluated with the Geriatric-8 (G-8) questionnaire and a comprehensive geriatric assessment (CGA). Euroqol-5 dimensions (EQ-5D) and survival were collected until 36 months post treatment start. Repeated measures ANOVA was applied to analyse HRQOL evolution in ‘fit’ and ‘vulnerable’ patients, defined by G-8. Kaplan-Meier curves and cox proportional hazard analysis were established for determination of the prognostic value of geriatric assessments. Quality-adjusted survival was calculated in both patient subgroups. Results One hundred patients were recruited. Seventy-two percent of patients were considered vulnerable according to CGA (≥2 abnormal tests). Fit patients maintained a relatively acceptable long-term HRQOL, whilst vulnerable patients showed significantly lower median health states. The difference remained apparent at 36 months. Vulnerability, as classified by G-8 or CGA, came forward as independent predictor for lower EQ-5D index scores. After consideration of confounders, a significantly lower survival was observed in patients defined vulnerable according to G-8, compared to fit patients. A similar trend was seen based on CGA. Calculation of quality-adjusted survival showed significantly less remaining life months in perfect health in vulnerable patients, compared to fit ones. Conclusions G-8 is indicative of quality-adjusted survival, and should be considered at time of treatment decisions for the older HNCA patient.
BMC Cancer 11/2015; 15(1). DOI:10.1186/s12885-015-1800-1 · 3.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Numbers of people dying with cognitive impairment (intellectual disability (ID), dementia or delirium) are increasing. We aimed to examine a range of European national palliative care guidelines to determine if, and how well, pain detection and management for people dying with impaired cognition are covered.
Questionnaires were sent to 14 country representatives of the European Pain and Impaired Cognition (PAIC) network who identified key national palliative care guidelines. Data was collected on guideline content: inclusion of advice on pain management, whether cognitively impaired populations were mentioned, assessment tools and management strategies recommended. Quality of guideline development was assessed with the Appraisal of Guidelines Research and Evaluation (AGREE) instrument.
11 countries identified palliative care guidelines, 10 of which mentioned pain management in general. Of these, seven mentioned cognitive impairment (3 dementia, 2 ID and 4 delirium). Half of guidelines recommended the use of pain tools for people with cognitive impairment; recommended tools were not all validated for the target populations. Guidelines from the UK, the Netherlands and Finland included most information on pain management and detection in impaired cognition. Guidelines from Iceland, Norway and Spain scored most highly on AGREE rating in terms of developmental quality.
European national palliative care guidelines may not meet the needs of the growing population of people dying with cognitive impairment. New guidelines should consider suggesting the use of observational pain tools for people with cognitive impairment. Better recognition of their needs in palliative care guidelines may drive improvements in care.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Supportive and Palliative Care 04/2015; 5(3). DOI:10.1136/bmjspcare-2014-000813
[Show abstract][Hide abstract] ABSTRACT: Luisteren naar hun levensverhalen als hefboom voor een goede zorg.
Oudere mensen hebben een rijk gevuld leven achter de rug en dragen een schat aan verhalen met zich mee. Wanneer deze ouderen terminaal ziek worden, kan hun levensverhaal precies een houvast zijn voor hun zorgverleners.
In Zorgen voor zieke ouderen tot het einde vormen levensverhalen een krachtig kompas om kwetsbare ouderen beter te begrijpen. Tegelijk biedt het boek ook talrijke handvatten om de zorg te laten aansluiten bij het leven dat ouderen en mantelzorgers binnen familieverband in zich hebben.
[Show abstract][Hide abstract] ABSTRACT: Background
Despite the growing incidence of cancer among older people, little is understood about how older patients and their family caregivers experience receiving a cancer diagnosis and treatment and how their experiences mutually influence each other. Such knowledge is needed to provide meaningful support for both the older person and family caregivers.
Exploring lived experiences of older cancer patients, family caregivers and their interaction.
Qualitative interview design.
Six outpatient oncology departments at a University Hospital.
Participants. Thirty-two patients (age range 70–86) and 19 family caregivers (age range 42–83).
Semi-structured interviews with a fairly open framework were conducted and analyzed using the constant comparative method inspired by a grounded theory approach.
Older patients and family caregivers experience important demands when confronted with cancer. Patients feel the inherent need to search for hope, and the majority are able to do so by employing coping strategies. Because of their older age, patients anticipate getting a serious illness such as a cancer diagnosis. Family caregivers become ‘a family member of an older person with cancer’ and feel responsible for the patient's well-being and for providing care. If patients are able to maintain a ‘positive’ story, family caregivers support this ability. If not, they search for a ‘positive’ story and point this out to the patient. Most family caregivers perceive their care-giving as a normal process and find it difficult to request professional help for themselves. Nevertheless, knowing that professional help is available whenever they need it reassures them. Overall, life continues during the illness experience: the interaction between patients and family caregivers goes on, their relationship proceeds, the coping and care patterns continue.
The cancer diagnosis has a major impact on patients and family caregivers. This study offers a framework for understanding what is it like to have cancer in old age and outlines the importance of listening actively to the life stories of patients and family caregivers in order to comprehend coping strategies. This may result in better tailored patient-family centered care.
International Journal of Nursing Studies 07/2014; 52(1). DOI:10.1016/j.ijnurstu.2014.07.012 · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Advance care planning (ACP) is the process by which patients, together with their physician and loved ones, establish preferences for future care. Because previous research has shown that relatives play a considerable role in end-of-life care decisions, it is important to understand how family members are involved in this process.
To gain understanding of the involvement of family members in ACP for older people near the end of life by exploring their views and experiences concerning this process.
This was a qualitative research study, done with semistructured interviews. Twenty-one family members were recruited from three geriatric settings in Flanders, Belgium. The data were analyzed using the constant comparative method as proposed by the grounded theory.
Family members took different positions in the ACP process depending on how much responsibility the family member wanted to take and to what extent the family member felt the patient expected him/her to play a part. The position of family members on these two dimensions was influenced by several factors, namely acknowledgment of the imminent death, experiences with death and dying, opinion about the benefits of ACP, burden of initiating conversations about death and dying, and trust in health care providers. Furthermore, the role of family members in ACP was embedded in the existing relationship patterns.
This study provides insight into the different positions of family members in the end-of-life care planning of older patients with a short life expectancy. It is important for health care providers to understand the position of a family member in the ACP of the patient, take into account that family members may experience an active role in ACP as burdensome, and consider existing relationship patterns.
Journal of pain and symptom management 09/2013; 47(5). DOI:10.1016/j.jpainsymman.2013.06.007 · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Older adults with type 2 Diabetes Mellitus are at increased risk of falling. The current study aims to identify risk factors that mediate the relationship between diabetes and falls.
199 older adults (104 with diabetes and 95 healthy controls) underwent a medical screening. Gait (GAITRite®), balance (AccuGait® force plate), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars.
Compared to controls, diabetes participants scored worse on all physical and cognitive measures. Sixty-four participants (42 diabetes vs. 22 controls) reported at least one injurious fall or two non-injurious falls ("fallers"). Univariate logistic regression identified diabetes as a risk factor for future falls (Odds Ratio 2.25, 95%CI 1.21-4.15, p = 0.010). Stepwise multiple regressions defined diabetes and poor balance as independent risk factors for falling. Taking more medications, slower walking speed, shorter stride length and poor cognitive performance were mediators that reduced the Odds Ratio of the relationship between diabetes and faller status relationship the most followed by reduced grip strength and increased stride length variability.
Diabetes is a major risk factor for falling, even after controlling for poor balance. Taking more medications, poorer walking performance and reduced cognitive functioning were mediators of the relationship between diabetes and falls. Tailored preventive programs including systematic medication reviews, specific balance exercises and cognitive training might be beneficial in reducing fall risk in older adults suffering from diabetes.
PLoS ONE 06/2013; 8(6):e67055. DOI:10.1371/journal.pone.0067055 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: CONTEXT: Symptom control is an essential part of palliative care and important to achieve optimal quality of life. Studies showed that patients with all types of advanced cancer suffer from diverse and often severe symptoms. Research focusing on older persons is scarce because this group is often excluded from studies. Consequently, it is unclear which symptoms older palliative care patients with cancer experience and what is the prevalence of these symptoms. To date, no systematic review has been performed on the prevalence of symptoms in older cancer patients receiving palliative care. OBJECTIVES: The objective of this systematic review was to search and synthesize the prevalence figures of symptoms in older palliative care patients with cancer. METHODS: A systematic search through multiple databases and other sources was conducted from 2002 until April 2012. The methodological quality was evaluated. All steps were performed by two independent reviewers. A meta-analysis was performed to pool the prevalence of symptoms. RESULTS: Seventeen studies were included in this systematic review. Thirty-two symptoms were identified. The prevalence of these symptoms ranged from 3.5% to 77.8%. The most prevalent symptoms were fatigue, excretory symptoms, urinary incontinence, asthenia, pain, constipation, and anxiety and occurred in at least 50% of patients. CONCLUSION: There is a high degree of uncertainty about the reported symptom prevalence because of small sample sizes, high heterogeneity among studies, and the extent of instrument validation. Research based on rigorous methods is needed to allow more conclusive results.
Journal of pain and symptom management 06/2013; 47(1). DOI:10.1016/j.jpainsymman.2013.02.016 · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Delirium often occurs among hospitalized older patients and is associated with high rates of mortality and morbidity, institutionalization and increased length of stay. Despite its clinical importance, delirium is frequently not recognized and poorly managed in acute care settings. A clear policy or guideline can be of help in the early detection and management of patients with delirium.Objectives
Gain insight into the existence and use of structured delirium management protocols on geriatric wards of Belgian hospitals.Methods
This study involved 110 hospitals with an acute geriatric ward. A questionnaire was developed by a multidisciplinary panel of experts (geriatricians and nurses) and sent to the medical head of the geriatric department. The response rate was 59.1%.ResultsOnly one quarter (n = 17; 26.2%) of the Belgian hospitals have a written delirium policy at the geriatric department level. At hospital level, the presence of a policy is even less frequent (n = 10; 15.4%). Although the majority (n = 36; 72%) state to have an oral or written arrangement for delirium prevention, only few have a written protocol to identify the cause (n = 10; 15.4%) and to manage (n = 9; 13.8%) delirium. Furthermore, only 22.6% (n = 14.5) have an information leaflet available for patients and/or family.Conclusion
Given the high rates and complexity of delirium management in geriatric wards, hospitals need to further implement evidence-based prevention, screening and standard intervention care plans to maintain uniformity and quality of care in delirium management.
European geriatric medicine 06/2013; 4(3):209–213. DOI:10.1016/j.eurger.2013.04.006 · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose:
This study investigates (i) the potential discriminative role of a clinical measure of peripheral neuropathy (PN) in assessing postural performance and fall risk and (ii) whether the integration of a simple screening vibration perception threshold (VPT) for PN in any physical (fall risk) assessment among elderly should be recommended, even if they do not suffer from DM.
One hundred and ninety-five elderly were entered in a four-group model: DM with PN (D+; n = 75), DM without PN (D-; n = 28), non-diabetic elderly with idiopathic PN (C+; n = 31) and non-diabetic elderly without PN (C-; n = 61). Posturographic sway parameters were captured during different static balance conditions (AMTI AccuGait, Watertown, MA). VPT, fall data, Mini-Mental State Examination and Clock Drawing Test were registered. Two-factor repeated-measures ANOVA was used to compare between groups and across balance conditions.
The groups with PN demonstrated a strikingly comparable, though bigger sway, and a higher prospective fall incidence than their peers without PN.
The indication of PN, irrespective of its cause, interferes with postural control and fall incidence. The integration of a simple screening for PN (like bio-thesiometry) in any fall risk assessment among elderly is highly recommended. Implications for Rehabilitation The indication of peripheral neuropathy (PN), irrespective of its cause, interferes with postural control and fall incidence. Therefore, the integration of a simple screening for PN (like bio-thesiometry) in any fall risk assessment among elderly is highly recommended. It might be useful to integrate somatosensory stimulation in rehabilitation programs designed for fall prevention.
Disability and Rehabilitation 04/2013; 35(20). DOI:10.3109/09638288.2012.751136 · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:Given the growing life expectancy, the likelihood increases that health-care providers are confronted with older people having an adult child with a life-limiting disease.Aim:This literature review aimed to (1) explore the experiences of aged parents with regard to their position and role as a parent of an adult child with a life-limiting illness, (2) detect gaps in the existing literature and (3) make recommendations for future research.Design:A literature search of English articles, including both quantitative and qualitative designs.Data sources:Four electronic databases and the reference lists of included studies.Results:In total, 19 studies (7 quantitative and 12 qualitative) were included. Few studies describe the experiences of older people whose adult child has cancer or has died of cancer. Existing studies are merely descriptive and give no concrete recommendations for health-care providers in daily practice. The studies suggest that aged parents carry deep burdens from the prospect of losing their adult child. Aged parents want to stay involved but need to reconfigure their parent role. As soon as the cancer diagnosis is disclosed, parents are confronted with a re-awakening of parental nurturing, which clashes with the autonomy of the adult child. Even after the adult child is deceased, older parents retain the image of themselves as parents.Conclusions:There is a need for more in-depth research to understand the lived experience of these parents and what health-care providers can do to assist them.
Palliative Medicine 04/2013; 27(7). DOI:10.1177/0269216313483662 · 2.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To investigate the effect of peripheral neuropathy and cognition on gait perfermance in older adults with Type II Diabetes Mellitus. DESIGN: Cross-sectional study. SETTING: Community and residential aged care. PARTICIPANTS: 101 older adults (56 diabetics, of which 28 with peripheral neuropathy and 28 without peripheral neuropathy; 45 matched controls). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Spatiotemporal gait parameters were recorded under three conditions: simple, counting backwards by 3 from 40, and reciting animal names. Mini-Mental State Examination and Clock Drawing Test were used to estimate cognitive impairment levels. RESULTS: Compared to controls, older adults with diabetes walked slower, took shorter strides during all walking conditions, and showed more gait variability especially during dual task conditions. Gait patterns did not differ between diabetic participants with and without neuropathy. Compared to normal walking, dual task conditions affected all gait parameters similarly in all groups. Backward counting affected gait more than animal naming in participants with diabetes but not in healthy controls. Additional analyses in older adults with diabetes showed that participants with impaired cognitive function walked slower, took shorter strides, had shorter double support time and increased gait variability when compared to participants with intact cognitive function. CONCLUSIONS: This study showed that gait parameters are affected in older adults suffering from Type II Diabetes Mellitus. Gait was further affected by reduced cognitive function, irrespective of the presence of neuropathy.
Archives of physical medicine and rehabilitation 02/2013; 94(6). DOI:10.1016/j.apmr.2013.01.018 · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
About 40% of all adverse events in hospital are falls, but only about one in three Belgian hospitals have a fall prevention policy in place. The implementation of a national practice guideline is urgently needed.
Objective and design:
This multicentre study aimed to determine the feasibility of a previously developed guideline. SETTING, PARTICIPANTS AND METHOD: Seventeen geriatric wards, selected at random out of 40 Belgian hospitals who agreed to take part in the study, evaluated the fall prevention guideline. After the one-month test period, 49 healthcare workers completed a questionnaire on the feasibility of the guideline.
At the end of the study, 512 geriatric patients had been assessed using the practice guideline. The average time spent per patient on case finding, multifactorial assessment and initiating a treatment plan was 5.1, 76.1 and 30.6 min, respectively. For most risk assessments and risk modifications, several disciplines considered themselves as being responsible and capable. The majority (more than 69%) of the respondents judged the practice guideline as useful, but only a small majority (62.3%) believed that the guideline could be successfully integrated into their daily practice over a longer period of time. Barriers for implementation included a large time investment (81.1%), lack of communication between the different disciplines (35.8%), lack of motivation of the patient (34.0%), lack of multidisciplinary teamwork (28.3%), and lack of interest from the hospital management (15.4%).
Overall, the guideline was found useful, and for each risk factor (except for visual impairment), at least one discipline felt responsible and capable. Towards future implementation of the guideline, following steps should be considered: division of the risk-factor assessment duties and interventions among different healthcare workers; patient education; appointment of a fall prevention coordinator; development of a fall prevention policy with support from the management of the hospital.
International journal of nursing studies 10/2012; 50(4). DOI:10.1016/j.ijnurstu.2012.09.020 · 2.90 Impact Factor