Place of Death for Young Adults With Chronic Illness.

BACKGROUND: Little is known about where young adults with chronic illness die in the United States and factors associated with place of death. OBJECTIVES: This study aimed to examine place of death and factors associated with place of death for young adults with chronic illness using the most recent national data. METHODS: Our sample ( N = 405,535) from the National Center for Health Statistics Division of Vital Statistics death certificate data (2003-2018) included young adults (age 18-39 years) who died from chronic conditions common in childhood or young adulthood. Conditions were grouped by underlying pathophysiology (oncological, cardiovascular, neuromuscular, metabolic, hematological/immunological, renal, chromosomal/congenital, gastrointestinal, and respiratory). Place of death was dichotomized into acute care (inpatient, outpatient/emergency room, and dead on arrival) or nonacute care (home, hospice, nursing home/long-term care, other, and unknown). Examined factors were gender, year of death, age, race (White, Black, Asian/Pacific Islander, American Indian/Alaskan Native), cause of death, and city of residence population (100,000 or greater and under 100,000). Descriptive statistics and logistic regression were used to examine factors related to place of death. RESULTS: Over half of young adults died in acute care settings. Young adults who were Asian/Pacific Islander or Black or who died from a respiratory or renal cause of death were most likely to die in an acute care setting. Rates of acute care death decreased over the studied years. DISCUSSION: Many young adults died in an acute care setting. Race and cause of death were the most influential factors associated with place of death. Young adults with an oncological cause of death were less likely to die in an acute care setting than patients with other underlying causes. This may indicate that specific care needs or preferences at the end of life may differ in certain disease populations and may affect place of death. Previous research has shown similar results in other developmental populations; however, given the complex psychosocial concerns that often arise during young adulthood, further research is needed to describe how the young adult status may specifically affect place of death.

Long-term health-related quality of life of adult patients treated with extracorporeal membrane oxygenation (ECMO): An integrative review.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO), a rescue treatment for patients with severe pulmonary and/or cardiac dysfunction, is increasingly being used worldwide. A better understanding of long-term health-related quality of life (HRQOL) is needed. OBJECTIVE: To synthesize research on long-term (at least 6 months post-ECMO) HRQOL of adults treated with ECMO. METHODS: In this integrative review, we searched 3 electronic databases and did a hand search of relevant journals for articles published 2000-2019, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Thirty-one studies, representing 913 patients treated with ECMO, were included. Long-term HRQOL was slightly better for patients treated with veno-venous ECMO than veno-arterial ECMO, and mental health outcomes tended to be better than physical ones. Survivors frequently experienced physical complications, functional limitations, anxiety, depression, and post-traumatic stress symptoms, although improvements were observed over time. CONCLUSIONS: Early identification and management of physical and mental health problems may improve HRQOL outcomes.