Researchers question end-of-life practices at nursing homes

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Researchers question end-of-life practices at nursing homes
Researchers question end-of-life practices at nursing homes
Kidney dialysis treatments near the end of life might do more harm than good and aggressive care for individuals with advanced dementia may be well-intentioned but misdirected efforts, results from a pair of new studies suggest.

A study of more than 300 people in Boston-area nursing homes who could not walk, talk or recognize loved ones led to the conclusion that many of the 177 who died during the 18-month study period suffered needlessly in their final days, researchers said. Clinically, many of their symptoms were similar to other more recognized terminal illnesses, according to investigators from the Institute for Aging Research at Harvard Medical School.

While other studies have suggested that dementia patients should be treated with palliative care, this is the first to follow the clinical course of dementia and equate it to other similar terminal illnesses. By better understanding the clinical course, caregivers in nursing homes or home care can perhaps avoid performing “interventions of questionable benefit,” as lead author Susan L. Mitchell, M.D., M.P.H., calls them. The full report appears in the Oct 15 edition of the New England Journal of Medicine.

Another study in that same journal calls into question the efficacy of kidney dialysis in nursing home patients. The Stanford University study of 3,700 nursing home residents found that those who began dialysis treatment experienced a rapid decline in functionality and ability to perform activities of daily living.

Researchers called the discovery that dialysis lead to more rapid functional decline “sobering” since one of the rationales for kidney dialysis is that it will improve quality of life by relieving symptoms of kidney failure.

"We probably need to be offering a palliative care option to many more patients to make the last days of their lives as comfortable as possible," said Dr. Mark Zeidel of the Beth Israel Deaconess Medical Center in Boston, who was not involved in the studies, in a published report. Palliative care focuses on managing symptoms of a disease and a main goal is to relieve pain at the end of life.


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