Daily Archives: 20 March 2024

Numerous older adults who are provided with home care do not receive palliative care before passing away

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A significant portion of older adults who receive home care do not benefit from palliative care services before their demise, highlighting the necessity for improved strategies to identify those in need of such support. This conclusion is drawn from recent findings published in the Canadian Medical Association Journal (CMAJ), which emphasize the importance of palliative care from the moment of diagnosis for individuals with life-limiting illnesses. Dr. Amy Hsu, a leading researcher at the Bruyère Research Institute and a faculty member in the Department of Family Medicine at the University of Ottawa, emphasized palliative care as a critical element of holistic, patient-centred care.

Introducing palliative care during the final months of life has been associated with enhanced end-of-life experiences, encompassing better quality of life, reduced anxiety, and improved management of pain and symptoms. This may possibly lead to less invasive care in the final stages. Yet, it is estimated that in Canada, only 15% of people receive palliative care at home during their last year of life.

The study, carried out by researchers in Ottawa, analyzed data from nearly a quarter of a million community-dwelling older adults who underwent at least one interRAI Home Care assessment between August 2018 and September 2019. Utilizing the RESPECT tool, designed to identify the palliative care needs of frail older adults, the research team estimated the risk of death within six months following an assessment. It examined the healthcare services received by these individuals.

Findings revealed that only about half of those with a life expectancy of less than three months had accessed formal palliative home care, predominantly those identified by physicians as having a terminal prognosis. Dr Doug Manuel, a family medicine physician, senior scientist at the Ottawa Hospital Research Institute, and one of the study’s co-authors, highlighted the potential of prediction algorithms like RESPECT to enhance care delivery for frail individuals by aiding clinicians in recognizing care needs and optimal timing.

Dr. Hsu further noted the importance of these tools and data in facilitating early discussions regarding patients’ preferences, goals, and wishes for their end-of-life care and supporting advance care planning. Ms Maya Murmann, a research associate at the Bruyère Research Institute, pointed out that many clients, potentially in their final months or years, do not receive palliative care, resulting in continued admissions to hospitals and long-term care facilities. She emphasized the common preference among Canadians to spend their final moments at home or in a homelike setting, surrounded by loved ones. Without community support, end-of-life care experiences may not align with individuals’ preferences.

The researchers advocate for implementing the RESPECT calculator, available at ProjectBigLife.ca, across home, community care, and long-term care settings to meet Canadians’ palliative care needs better, working alongside partners in these areas to integrate RESPECT into their services.

More information: Maya Murmann et al, Estimated mortality risk and use of palliative care services among home care clients during the last 6 months of life: a retrospective cohort study, Canadian Medical Association Journal. DOI: 10.1503/cmaj.221513

Journal information: Canadian Medical Association Journal

Survey reveals that 72% of individuals with eczema experienced symptoms of poor mental health ranging from 1 to 10 days in the previous month

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Individuals living with atopic dermatitis (AD), also known as eczema, face a heightened risk of experiencing depression and anxiety. This risk is further exacerbated when they also suffer from additional allergic symptoms. A recent study showcased at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Anaheim, California, reveals that out of those affected by AD, 72% encountered symptoms of poor mental health for between 1 to 10 days in the last month. In comparison, 17% experienced these symptoms for over 11 days.

“Allison Loiselle, PhD, the study’s lead author from the National Eczema Association, highlights the lack of awareness among those not afflicted by AD about its severe impact. The condition is not only about the intense itchiness and the discomfort of dry, cracked skin but also about the significant disturbances it causes to sleep and the broader deterioration in quality of life and overall well-being. The unpredictability and chronic nature of AD also contribute to the development of depression and anxiety among sufferers.

Of the 954 participants who participated in the survey, 23% consulted with an allergist as part of their treatment plan for eczema. Specifically, for 124 individuals (96 adults and 28 caregivers), an allergist was the primary care provider for their or their child’s eczema. The majority of respondents classified their current AD severity as mild (36%), and again, 72% reported experiencing poor mental health symptoms for 1 to 10 days in the last month, with 17% reporting such symptoms for more than 11 days. Notably, one-third (35%) of respondents had never discussed their mental health with their allergist, and 57% indicated that their allergist had never inquired about it. However, 45% mentioned that their allergist had referred them to mental health services or resources.

Tamara Hubbard, MA, LCPC, a counsellor specializing in assisting parents of children with allergies and asthma and a member of the ACAAI Public Relations Committee (not involved in the study), emphasizes the severe challenges of living with AD. The constant itching and concern over the impact on one’s appearance can be overwhelming. The repercussions of AD on quality of life are substantial, leading to social withdrawal, emotional and behavioural issues, and severe psychological distress, including depression, anxiety, and thoughts of suicide. Hubbard stresses the importance of open communication between patients and healthcare providers regarding mental health issues and the necessity of being informed about available resources and mental health professionals who can offer assistance. Engaging with an allergist to explore treatments that mitigate the effects of AD, in tandem with support from a mental health professional, can significantly alleviate the emotional and psychological burden of AD.”

More information: A. Loiselle et al, Atopic dermatitis patient experience with discussing and addressing mental health concerns with allergists, Annals of Allergy Asthma & Immunology. DOI: 10.1016/j.anai.2023.08.278

Journal information: Annals of Allergy Asthma & Immunology Provided by American College of Allergy Asthma and Immunology