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Статті в журналах з теми "Mental-palliative comorbidity"
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Kharlamova, U. V., О. V. Kurchenkova, A. О. Abdalov, К. A. Shubina, and S. I. Samodurov. "Indicators of the psychoemotional state of palliative polymorbid cancer patients." Ural Medical Journal 20, no. 2 (July 19, 2021): 69–74. http://dx.doi.org/10.52420/2071-5943-2021-20-2-69-74.
Повний текст джерелаАнотація:
Introduction. Palliative care is aimed at maintaining and improving the quality of life of the patient. Without taking into account the psychosocial aspects, psychological rehabilitation is impossible in the conditions of a psychotraumatic situation of the disease.The aim of the study was to assess the psychoemotional state of polymorbid palliative cancer patients.Materials and methods. An observational, analytical, single-stage (cross-sectional) study was conducted, which included 74 cancer patients of a palliative profile. The patients underwent laboratory and instrumental examination. The following tests were evaluated: resilience (S. Maddy's method, D. A. Leontiev's adaptation), life-sense orientations, the level of subjective control, C. D. Spielberger, the severity of chronic pain syndrome; the value of the Charlson comorbidity index, the Karnovsky index (ECOG) was calculated.Results. The level of the comorbidity index was 3 [2; 5] points, the intensity of chronic pain syndrome-2 [2; 3] points, ECOG-2 [2; 3] points. In polymorbid cancer palliative patients, the presence of a belief in the impact of the struggle on the outcome of what is happening was revealed, however, patients are not always ready to act in a difficult situation. In the examined group, signs of dissatisfaction with their life in the present prevailed, the lack of sufficient freedom of choice, the existence of hope for recovery as a result of the actions of others, primarily doctors. The average (and in some cases high) level of situational and personal anxiety was noted. The association of the comorbidity index and the indicators of the life-meaning orientations test; the indicator of the general internality scale and the ECOG value; the glomerular filtration rate and the indicator of resilience, risk acceptance was revealed. A number of correlations between the indicators of the psychoemotional state and laboratory parameters (the level of hemoglobin, albumin, iron, C-reactive protein) were noted.Conclusion. In cancer patients with a palliative profile, signs of mental maladaptation were revealed. The average (and in some cases high) level of situational and personal anxiety was noted. The revealed number of correlations focuses on the role of chronic non-communicable diseases in aggravating the psychoemotional status of chronic polymorbid cancer palliative patients.
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Masel, Eva K., Anna S. Berghoff, Aleksandra Mladen, Sophie Schur, Bruno Maehr, Magdalena Kirchhoff, Ralph Simanek, Martin Bauer, Herbert H. Watzke, and Michaela Amering. "Psyche at the end of life: Psychiatric symptoms are prevalent in patients admitted to a palliative care unit." Palliative and Supportive Care 14, no. 3 (October 8, 2015): 250–58. http://dx.doi.org/10.1017/s1478951515000899.
Повний текст джерелаАнотація:
AbstractObjective:Our aim was to evaluate the frequency and treatment of psychiatric symptoms in patients at palliative care units (PCUs).Method:Patients admitted to one of five participating PCUs in Austria were included. The short version of the Patient Health Questionnaire (PHQ–D) was used to evaluate their mental health status. Pain intensity was rated on a numeric rating scale (NRS) from 0 to 10 by patients and physicians. Patients with a previously diagnosed psychiatric disorder were compared to those without or with newly diagnosed psychiatric symptoms, based on PHQ–D results. Pain and psychopharmacological medication were assessed. Opioid doses were converted into oral morphine equivalents (OMEs).Results:Some 68 patients were included. Previously undetected psychiatric symptoms were identified in 38% (26 of 68), preexisting psychiatric comorbidities were evident in 25% (17), and no psychiatric symptoms were observed in 37% (25). Patients with a preexisting psychiatric comorbidity received antidepressants and benzodiazepines significantly more often than patients without or with previously undetected psychiatric symptoms (p < 0.001). Patient and physician median NRS ratings of pain intensity correlated significantly (p = 0.001). Median NRS rating showed no significant difference between patients with preexisting, previously undetected, or without psychiatric symptoms. OMEs did not differ significantly between preexisting, without, or previously undetected psychiatric symptoms. Patients with undetected and preexisting psychiatric comorbidities had a greater impairment in their activities of daily living than patients without psychiatric symptoms (p = 0.003).Significance of Results:Undetected psychiatric comorbidities are common in patients receiving palliative care. Screening for psychiatric symptoms should be integrated into standard palliative care to optimize treatment and reduce the psychosocial burden of the disease.
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Obasohan, Owen, Deepak Tokas, and Mamta Kumari. "End of life care in a secure hospital setting." BJPsych Open 7, S1 (June 2021): S96. http://dx.doi.org/10.1192/bjo.2021.288.
Повний текст джерелаАнотація:
AimsTo measure the standard of care provided to patients who had a natural and expected death whilst in secure care at Roseberry Park Hospital, Middlesbrough.Mallard ward is a low secure psychiatric ward for older aged men suffering from cognitive difficulties and significant physical comorbidity in addition to a severe and enduring mental illness. The patient population is such that it will remain the most appropriate placement for some patients until their death. It is vital that staff members on Mallard ward and indeed all parts of the Trust are aware of the priorities for care of the dying person and ensure that care is provided in accordance with these priorities.The Leadership Alliance for the Care of Dying People (LACDP), a coalition of 21 national organisations, published One Chance to get it Right – Improving people's experience of care in the last few days and hours of life in June 2014. This document laid out five priorities for care of the dying person focussing on sensitive communication, involvement of the person and relevant others in decisions and compassionately delivering an individualised care plan.MethodThe data collection tool was adapted from End of Life Care Audit: Dying in Hospital, a national clinical audit commissioned by Healthcare Quality Improvement Partnership (HQIP) and run by the Royal College of Physicians. Data were collected from both electronic and paper records. There were three natural and expected deaths in the last two years.ResultFor all three patients, there was documented evidence that they were likely to die in the coming hours or days.End of life care discussion was held with the nominated persons and not with the patients due to their lack of mental capacity.The needs of the patients and their nominated persons were explored in all three cases.All patients had an individualised care plan which was followed.The palliative care team supported the staff with the care of these patients.The care provided was largely consistent with the priorities listed.ConclusionThe national audit compares performance of only acute NHS Trusts with no data to reflect the performance of mental health hospitals. It is imperative that mental health services work in collaboration with physical health and palliative care services so they are able to continue providing a high level of care to this patient group. Clinicians and staff involved in the care of dying patients also need to be adequately trained.
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Dasgupta, Monidipa, and Loretta M. Hillier. "Factors associated with prolonged delirium: a systematic review." International Psychogeriatrics 22, no. 3 (January 21, 2010): 373–94. http://dx.doi.org/10.1017/s1041610209991517.
Повний текст джерелаАнотація:
ABSTRACTBackground: Delirium frequently accompanies acute illness. With treatment of the illness, some individuals recover from delirium while for others the symptoms persist. It is not understood why some individuals improve but others do not. The purpose of this paper is to review systematically what is known about the factors associated with the persistence of delirium.Methods: A medical literature search was conducted using several bibliographic databases, supplemented by manual searches of the references. English or French studies were included if they compared two groups of delirious individuals in delirium duration or persistence up to six months after the onset of delirium, diagnosed prospectively with the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria (or a scale derived and validated against the DSM). Information was collected on the association between possible non-therapeutic prognostic variables and delirium persistence.Results: Twenty-one observational studies were included, in various settings (e.g. mixed medical-surgical, medical or geriatric, surgical, psychiatric, cancer or palliative care units). Variables assessed included patient characteristics (e.g. age, dementia, medical comorbidity, functional status), delirium characteristics (e.g. presence of hypoactive symptoms, delirium severity) and illness characteristics (e.g. severity of illness, and underlying acute illness). Overall, studies suggested that delirium is often persistent at discharge or beyond. Persistence was associated with dementia, increasing numbers of medical conditions, increasing severity of delirium, hypoactive symptoms and hypoxic illnesses.Conclusions: Preliminary findings suggest that some factors may identify those at risk for persistent delirium; however, more research is needed.
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Kashyap, Mehr, Jeremy Phillip Harris, Daniel Tandel Chang, and Erqi L. Pollom. "Emergency department use at the end of life in elderly patients with gastrointestinal malignancies and mental health comorbidities." Journal of Clinical Oncology 38, no. 4_suppl (February 1, 2020): 811. http://dx.doi.org/10.1200/jco.2020.38.4_suppl.811.
Повний текст джерелаАнотація:
811 Background: Aggressive care at the end-of-life can contradict patients’ wishes, negatively impact patient quality of life, and contribute to overall health care expenditures. Patients with mental disorders (MD) often experience disparities in medical care and have poorer clinical outcomes. We investigated the impact of mental disorders on emergency department (ED) use at the end of life among elderly patients with gastrointestinal (GI) malignancies. Methods: We conducted a retrospective cohort study using the SEER-Medicare database. We identified patients aged 66 years and older with GI malignancies (colorectal, pancreatic, gastric, hepatic, biliary, esophageal, small bowel, and anal cancer) diagnosed between 2004 and 2013 who had recorded death. We assessed the association between MD (depression, bipolar disorder, psychotic disorder, anxiety, dementia, and substance abuse) and ED use within 30 days of death using logistic regression models. Results: Of the 160,367 decedents included, 54,461 (34.1%) had at least one MD diagnosis between one year prior to cancer diagnosis and death. Those with MD were more likely to use the ED more than once in the last 30 days of life (14.7% vs. 12.4% p < 0.01). ED use was highest among decedents with anxiety disorder (15.8%) and substance abuse (16.3%). Among decedents with mental disorders, risk factors associated with ED use at end of life include being male (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 1.10 – 1.22), younger (aOR 1.14, 95% CI 1.06 - 1.23), and black (aOR 1.33, 95% CI 1.23 – 1.45), living in a lower income zip code (1.21, 95% CI 1.13 – 1.30), and having a higher Charlson comorbidity score (aOR 1.71, 95% CI 1.56 – 1.87). ED use was also associated with pancreatic (aOR 1.16, 95% CI 1.08 - 1.25), hepatic (aOR 1.21, 95% CI 1.11 - 1.33), biliary (aOR 1.16, 95% CI 1.03 - 1.30) and esophageal (aOR 1.16, 95% CI 1.04 - 1.29) cancer compared to colorectal cancer. Conclusions: MD is associated with increased ED use at the end of life among elderly patients with GI cancer. Palliative and supportive care including mental health services early in the disease course may improve quality of end-of-life care in this vulnerable population.
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Dastidar, Joyeeta G., and Min Jiang. "Characterization, Categorization, and 5-Year Mortality of Medicine High Utilizer Inpatients." Journal of Palliative Care 33, no. 3 (May 6, 2018): 167–74. http://dx.doi.org/10.1177/0825859718769095.
Повний текст джерелаАнотація:
Background: Patients who are frequently admitted to Medicine inpatient services comprise a distinct subset of readmitted patients about whom not much is known. Objective: We sought to characterize this group including mortality rates, with the goal of better understanding this population. Design: Observational study of frequently hospitalized patients defined as 4 or more admissions over a 6-month period, with hospitalization defined as nonelective admission to the hospital. Setting: Single large academic medical center. Patients: Adult inpatients on general medicine and medicine subspecialty services. Measurements: The number of nonelective medicine hospitalizations, age, clinical conditions and comorbidities, calculation of an age-adjusted Charlson Comorbidity Index (CCI), outpatient and emergency department visits, length of stay, costs of hospitalization, and mortality over a 5-year period. Descriptive statistics were used to characterize variables of interest. Results: We identified 153 patients with a total of 781 nonelective hospitalizations, totaling greater than 4000 hospital days and with charges of approximately US$9 million during the 6 months. Nearly all had insurance coverage and good outpatient follow-up (median of 7 appointments over the 6-month study period). Only 14% of those admissions qualified for observation status. Over 40% of patients had comorbid mental health disease or chronic narcotic dependence. Twenty-nine percent of patients died within 1 year; 50% were dead within 5 years. Age-adjusted CCI scores ranged annually from 3.00 to 3.58 among surviving patients versus 4.31 to 6.60 among deceased patients. Conclusions: These findings point to distinct groups of patients who are frequently hospitalized, and therefore would benefit from tailored management strategies: Those with progression of end-stage disease comprised one-third of the group and targeting that subset with palliative care referrals could help decrease readmission rates. Those with recurrent exacerbations of a chronic medical condition could be managed through telemanagement programs. Those with exacerbations of chronic pain could be addressed through collaboration with pain management specialists. Individualized care management plans may be useful for all, especially the latter two groups. Based on differences between survivors and deceased patients, an age-adjusted CCI score of 4 or 5 could be valuable sensitive or specific cutoffs, respectively, for predicting those who would benefit most from palliative care consultation regarding end-of-life goals and management.
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Vyas, Pooja, Prashant Malhotra, Santiago Lopez, Bruce Hirsch, and Kayla D. Finuf. "1081. Use of Antimicrobials at the End of Life (EOL): A Retrospective Cohort Study Analyzing Providers’ Reasons for Prescribing Antimicrobials at the EOL, Their Benefits and Adverse Effects." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S383—S384. http://dx.doi.org/10.1093/ofid/ofz360.945.
Повний текст джерелаАнотація:
Abstract Background Infections are common in terminally ill patients, and although antibiotics are frequently prescribed, their benefit for symptom relief is not clear. Antimicrobials at the end of life (EOL) increase the risk of antimicrobial resistance and Clostridium difficile infection. Very few studies have described the risks and benefits of antimicrobials in patients at EOL. Here, we describe a retrospective chart review of antimicrobial use at EOL. Methods We reviewed electronic medical records of patients admitted in a palliative care unit of a tertiary care hospital between 2017 and 2018 and assessed antimicrobial use in the last 14 days of life. The analysis excluded neutropenic patients. Differences in demographics and symptom control between patients who did or did not receive antibiotics (AB+ or AB−) were analyzed using chi-square analyses; P-values were computed using Mann–Whitney tests. Results Of a total of 133 patients included, 89 (67%) received antimicrobials (AB+); however, the role of antibiotics was documented in only 12% of patients. The AB− and AB+ groups were similar with respect to demographics, including sex, and Charleston Comorbidity Index except for age (table). Documented infections were similar between AB− and AB+ groups, except urinary tract infections. No statistically significant differences were noted in documented symptoms including pain, dyspnea, fever, lethargy, and alteration of mental state or length of stay (LOS). Conclusion Our study did not show differences in frequencies of documented symptoms with use of antimicrobials at EOL. These results indicate that the risks of antimicrobial use may outweigh potential benefits and their use should be a part of goals of care discussions at EOL. Disclosures All authors: No reported disclosures.
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Martín-Jiménez, Paloma, Mariana I. Muñoz-García, David Seoane, Lucas Roca-Rodríguez, Ana García-Reyne, Antonio Lalueza, Guillermo Maestro, et al. "Cognitive Impairment Is a Common Comorbidity in Deceased COVID-19 Patients: A Hospital-Based Retrospective Cohort Study." Journal of Alzheimer's Disease 78, no. 4 (December 8, 2020): 1367–72. http://dx.doi.org/10.3233/jad-200937.
Повний текст джерелаАнотація:
We analyzed the frequency of cognitive impairment (CI) in deceased COVID-19 patients at a tertiary hospital in Spain. Among the 477 adult cases who died after admission from March 1 to March 31, 2020, 281 had confirmed COVID-19. CI (21.1% dementia and 8.9% mild cognitive impairment) was a common comorbidity. Subjects with CI were older, tended to live in nursing homes, had shorter time from symptom onset to death, and were rarely admitted to the ICU, receiving palliative care more often. CI is a frequent comorbidity in deceased COVID-19 subjects and is associated with differences in care.
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Huijer, Huda Abu-Saad, Souha Fares, Rachele Bejjani, Suzanne Dhaini, Samar Noureddine, and Husam Ghusn. "Symptom prevalence and management in older adult patients in Lebanon." Palliative and Supportive Care 17, no. 04 (September 21, 2018): 464–71. http://dx.doi.org/10.1017/s1478951518000676.
Повний текст джерелаАнотація:
AbstractObjectiveThe purpose of this study is to explore symptoms and the effectiveness of their management in older adult palliative care candidates in Lebanon. The aims of this study were to: (1) determine symptom prevalence in Lebanese older adults who qualify for palliative care; (2) identify the severity and distress of symptoms; (3) identify the prevalence of symptom management and its efficacy; and (4) explore the relationship between overall symptom burden and its correlates.MethodThis study uses an observational cross-sectional design using convenience sampling (N = 203) to recruit older adults qualifying for palliative care from three major medical centers in Lebanon.ResultThe mean age of the sample was 78.61 years. The most prevalent symptoms were lack of energy (93.5%), worrying (83.2%), and pain (71.4%). Psychological symptoms had the highest mean scores, preceded only by the physical symptoms and lack of energy. The most treated symptoms were physical with pain having the highest treatment prevalence (91%). Although psychological symptoms were the most burdensome, they were poorly treated. Multiple regression analysis showed that symptom scores had significant positive associations with financial status, social functioning, and comorbidities; there was a negative association with age.Significance of resultsLack of energy and psychological symptoms were the most prevalent, with the latter having the highest mean total symptom scores. Treatment was poor for psychological symptoms and effective for physical ones. Associations were found between age, comorbidity, financial problems, social functioning, and total physical and psychological mean symptom burden scores. More attention needs to be given to psychological symptoms and their management among older adults receiving palliative care.
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Zeppegno, P., and C. M. Gramaglia. "Homicide and Suicide in the Elderly." European Psychiatry 65, S1 (June 2022): S34—S35. http://dx.doi.org/10.1192/j.eurpsy.2022.122.
Повний текст джерелаАнотація:
Homicide and suicide are complex phenomena raising questions and interest which go far beyond the medical and psychiatric field, as they represent a challenge for an understanding which is, first of all, human. In older adults, homicide and suicide may present together in the homicide-suicide phenomenon. The most common motive underlying this behavior in intimate partner relationships is the so-called “mercy killing”, where the perpetrator kills the partner to eventually allow relief from declining health conditions, and then commits suicide. Actually, older adults account for a disproportionately high number of suicide deaths and approximately 55% of late-life suicides are associated with physical illness, notwithstanding psychiatric comorbidity. Physical illness is more likely to eventually lead to suicidal behaviour when it represents a threaten for the individual’s independence, autonomy, self-esteem and dignity, and when it impacts on quality of and pleasure with life, sense of meaning, usefulness and purpose in life. As the current historical period is one marked by opportunities which have allowed a rapid increase of life expectancy and longevity, it clearly emerges the need to balance benefits and harms of curative and palliative therapies, especially for painful, terminal illnesses. The expression of suicidal thoughts in older adults, as well as behaviours suggesting “silent” or indirect suicidal attitudes, should be carefully investigated and clinicians should try to decode the possible communicative role of suicidal behaviour while avoiding premature conclusions about the “rationality” of patients’ decision to die. Disclosure No significant relationships.
Дисертації з теми "Mental-palliative comorbidity"
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Goullet, Jillian. "Experiences, education and support needs of residential aged care staff caring for older adults with mental-palliative comorbidity." Thesis, 2021. https://vuir.vu.edu.au/42957/.
Повний текст джерелаАнотація:
Australia’s ageing population is contributing to an increased demand for residential aged care services (RACS). At the same time, these services are increasingly providing care for older adults with long-standing mental disorders (e.g., major depression, bipolar disorder and schizophrenia spectrum disorders) and life-limiting physical illnesses requiring palliative care. These older adults have multiple care requirements, including cognitive, behavioural and palliative care needs. However, RACS care staff are often ill- equipped to care for them. The aims of this study were to: (i) examine the experience of RACS staff caring for residents with mental-palliative comorbidity, and (ii) identify their initial and ongoing education and support needs. An interpretative phenomenological analysis approach was used, incorporating semi-structured interviews. A purposive sample of 12 RACS staff participated in semi-structured interviews. The study identified several strategies to enhance mental-palliative care in RACS. The overarching theme was conceptualised as Adopting a person-centred approach to care. This was supported by five main themes: Understanding each person, Complexities in assessing and managing pain, Preventing and responding to behaviours of concern, Organisational provision for staff development and wellbeing promotion and Engaging in interdisciplinary collaboration. These findings may contribute to a greater understanding of the experience of RACS staff caring for residents with mental-palliative comorbidity and highlight areas for improvement in the education and support of staff caring for this cohort.
Частини книг з теми "Mental-palliative comorbidity"
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Dietz, Andreas. "The Surgical Approach to Elderly Patients with HNSCC." In Critical Issues in Head and Neck Oncology, 111–18. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-63234-2_8.
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AbstractDespite the fact that elderly people are the main incidental and continuously growing patient group with head and neck cancer, prospective trials focusing on special issues regarding head and neck surgery in elderlies are missing. To avoid complications during and after surgery in that patient category, comprehensive evaluation of functional status, comorbidities, performance status, social support and mental condition is mandatory. Regarding functional parameters, cardiac and respiratory conditions play a major role for any primary surgical procedure. Nevertheless, other comorbidities, medication and patients view on self-determination have carefully to be taken into consideration. It has repeatedly been shown that fit elderly individuals may benefit from intensive therapies like reconstructive surgery with microvascular free tissue transfer, concurrent chemoradiotherapy in the locoregionally advanced disease setting, and even from the standard first- and second-line palliative systemic therapies. Since it is well known that tolerance of systemic nonsurgical treatments in elderly people is less and therefore death from noncancer-related causes in that population is higher, moderate surgical procedures can be even more effective regarding quality of life in situations facing higher comorbidities, or functional constraints with limited life expectancy compared to nonsurgical standard approaches. Older people usually are at increased risk of postoperative complications. In particular, organ failure progresses much faster in multiple organ failure. The preoperative clarification of comorbidity for the avoidance of surgical complications is therefore of major importance. Close coordination with anesthesia and rapid postoperative mobilization are essential for this. Decision-making and treatment based on specific assessment in an experienced multidisciplinary team is key.