Study: End-of-life discussions in nursing homes improve outcomes, reduce odds of dying in hospital

A relatively low number of nursing home residents participate in end-of-life discussions, despite the potential they have to improve outcomes, according to a study in the March issue of Age and Ageing.

A study of nearly 80 French nursing homes found that a minority of the residents — 21.7% of those who died within the study period — discussed end-of-life issues with family members and facility staff. The study was conducted between October 2013 and May 2014, with 674 residents from the sample facilities dying in that timespan.

The end-of-life discussions tracked by the researchers included talks about the course and prognosis of a resident's disease, the approaching end of life, the possibility of stopping treatments, options for palliative care, psychological issues, and spiritual or existential problems.

Results of the study showed no discussions on any end-of-life topics were held with 32.8% of residents or their families prior to the resident's death. Older residents, and those with severe dementia, were less likely to have discussed more than three of the six end-of-life topics, compared to residents without dementia.

In their last months of life, residents who discussed three or more end-of-life topics with physicians were less likely to die in a hospital, more likely to appoint a surrogate or representative, and more likely to choose to withdraw life-prolonging medical treatments, researchers found.

Those results highlight the need for nursing home physicians to have end-of-life conversations with residents, researchers said, although those conversations may be challenging to initiate with very old residents, or those with dementia.

“In our opinion, this study raises an interesting paradox: It suggests that the more difficulties older persons may have in understanding what is said to them regarding the end of life,

the less likely nursing home physicians are to communicate with them,” wrote lead researcher Lucas Morin, a doctoral student at the Aging Research Center at Stockholm University. “For clinicians, the most obvious (and probably most difficult) challenge will be to find the appropriate balance between the need for more patient-centred dialogue and the pressure on professionals' time.”