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Living in uncertain times: trajectories to death in residential care homes

Barclay, S, Froggatt, K, Crang, C, Mathie, E, Handley, M, Iliffe, S, Manthorpe, J, Gage, H and Goodman, C (2014) Living in uncertain times: trajectories to death in residential care homes BRITISH JOURNAL OF GENERAL PRACTICE, 64 (626). E576-E583.

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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.

Item Type: Article
Subjects : Economics
Divisions : Faculty of Arts and Social Sciences > School of Economics
Authors :
AuthorsEmailORCID
Barclay, SUNSPECIFIEDUNSPECIFIED
Froggatt, KUNSPECIFIEDUNSPECIFIED
Crang, CUNSPECIFIEDUNSPECIFIED
Mathie, EUNSPECIFIEDUNSPECIFIED
Handley, MUNSPECIFIEDUNSPECIFIED
Iliffe, SUNSPECIFIEDUNSPECIFIED
Manthorpe, JUNSPECIFIEDUNSPECIFIED
Gage, HUNSPECIFIEDUNSPECIFIED
Goodman, CUNSPECIFIEDUNSPECIFIED
Date : 1 September 2014
Identification Number : 10.3399/bjgp14X681397
Copyright Disclaimer : This article is Open Access: CC BY 3.0 license (http://creativecommons.org/ licenses/by/3.0/).
Uncontrolled Keywords : Science & Technology, Life Sciences & Biomedicine, Primary Health Care, Medicine, General & Internal, General & Internal Medicine, care homes, dying trajectories, end-of-life care, palliative care, primary health care, END-OF-LIFE, NURSING-HOMES, PLACE, PREFERENCES, PATTERNS, DECLINE
Related URLs :
Depositing User : Symplectic Elements
Date Deposited : 12 Aug 2016 13:11
Last Modified : 12 Aug 2016 13:11
URI: http://epubs.surrey.ac.uk/id/eprint/808876

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