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        Living in Uncertain Times: trajectories to death in residential care homes

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        Author
        Barclay, Stephen
        Froggatt, Katherine
        Crang, Claire
        Mathie, Elspeth
        Handley, Melanie
        Iliffe, Steve
        Manthorpe, Jill
        Gage, Heather
        Goodman, Claire
        Attention
        2299/19028
        Abstract
        Abstract Background Older people living in care homes often have limited life expectancy. Practitioners and policymakers are increasingly questioning the appropriateness of many acute hospital admissions and the quality of end-of-life care provided in care homes. Aim To describe care home residents’ trajectories to death and care provision in their final weeks of life. Design and setting Prospective study of residents in six residential care homes in three sociodemographically varied English localities: Hertfordshire, Essex, and Cambridgeshire. Method Case note reviews and interviews with residents, care home staff, and healthcare professionals. Results Twenty-three out of 121 recruited residents died during the study period. Four trajectories to death were identified: ‘anticipated dying’ with an identifiable end-of-life care period and death in the care home (n = 9); ‘unexpected dying’ with death in the care home that was not anticipated and often sudden (n = 3); ‘uncertain dying’ with a period of diagnostic uncertainty or difficult symptom management leading to hospital admission and inpatient death (n = 7); and ‘unpredictable dying’ with an unexpected event leading to hospital admission and inpatient death (n = 4). End-of-life care tools were rarely used. Most residents who had had one or more acute hospital admission were still alive at the end of the study. Conclusion For some care home residents there was an identifiable period when they were approaching the end-of-life and planned care was put in place. For others, death came unexpectedly or during a period of considerable uncertainty, with care largely unplanned and reactive to events.
        Publication date
        2014-09-01
        Published in
        British Journal of General Practice
        Published version
        https://doi.org/10.3399/bjgp14X681397
        Other links
        http://hdl.handle.net/2299/19028
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