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
