Which has more influence on a family's assessment of the quality of dying of their long-term care resident with dementia: Frequency of symptoms or quality of communication with healthcare team?

OBJECTIVE: Symptoms present at the end of life and the quality of communication with the healthcare team have both been shown to impact family assessments of the quality of dying of their loved one with dementia. However, the relative contributions of these two factors to family assessments have not yet been investigated. To address this knowledge gap, we explored which of these two factors has more influence on family assessments of the quality of dying of long-term care (LTC) residents with dementia. METHOD: This is a secondary analysis of a mortality follow-back study. Ninety-four family members of LTC residents who had died with dementia assessed the quality of dying (very good or not very good), the frequency of symptoms, and the quality of communication with the healthcare team using a self-administered questionnaire mailed 1 month after the resident's death. Logistic regression analyses were performed to determine the relative contributions of the two independent variables of primary interest (frequency of symptoms and quality of communication) to the families' assessments of the quality of dying. RESULTS: Multivariate analyses revealed that the quality of communication with the healthcare team was closely linked to the quality of dying (p = 0.009, OR = 1.34, 95% CI = 1.09-1.65), whereas the frequency of symptoms was not (p = 0.142, OR = 1.05, 95% CI = 0.98-1.11) after controlling for potential confounders. SIGNIFICANCE OF RESULTS: Our findings show that healthcare providers' ability to engage in the end-of-life conversations with families outweighs the frequency of symptoms in family assessments of the quality of dying of their relative with dementia. Enhancing healthcare providers' ability to communicate with families about the end-of-life care could improve families' perceptions of the quality of dying of their relative with dementia and, consequently, ease their grieving process.

Social Workers' Attitudes Toward Medical Assistance in Dying for Persons With Dementia: Findings From a Survey Conducted in Quebec, Canada.

Canada has legalized medical assistance in dying (MAID) for mentally competent persons who satisfy the legal requirements. Debate is ongoing as to whether MAID should be accessible to no-longer-competent persons through an advance request. We conducted an anonymous vignette-based survey among 367 social workers from Quebec to (1) elicit their attitudes toward MAID in the context of dementia; (2) assess their underlying values and beliefs; and (3) compare their attitudes to those of nurses (n = 291) and physicians (n = 136). Acceptability of MAID among social workers ranges from 42% in the case where the person depicted in the vignette was still competent to request MAID herself, to 92% in that where she was incompetent, had requested MAID in writing before losing capacity, showed signs of severe distress, and was close to death. Acceptability tends to be higher among social workers than among nurses and physicians. Forty-one per cent of social workers dread the prospect of participating in the MAID process for a person lacking decisional capacity. Nonetheless, 83% would agree to be involved. Should MAID become accessible to persons lacking decisional capacity, social workers willing to be involved will need to be educated and trained in participating in this emotionally-charged process.

An exploratory study of individual and environmental correlates of fear of falling among community-dwelling seniors.

Objectives. The objective of this study was to identify individual and environmental correlates of fear of falling among community-dwelling seniors. Method. The study sample involved 288 community-dwelling adults aged 65 years or older going through the normal aging process. Fear of falling and a series of individual and environmental characteristics were measured with a questionnaire during home interviews. Results. Multivariate logistic regression procedures showed that the strongest correlates of fear of falling are gender, support from a spouse or partner, and residential area. Being a female as well as living in a smaller city or rural area were shown to be risk factors for fear of falling, whereas the availability of support from a spouse or partner was a protective factor. Discussion. Findings from this study suggest that researchers should adopt an ecological perspective to understanding the phenomenon of fear of falling among seniors and collect data on a broader range of individual and environmental factors.

Disability-based classification system for older people in integrated long-term care services: the Iso-SMAF profiles.

This study was conducted to develop and evaluate a disability-based classification system for management of long-term care (LTC) needs in an integrated service delivery system. We collected cross-sectional data on 29 items of the Functional Autonomy Measurement System (SMAF) from a stratified multistage sampling of 1977 elderly people with disabilities living in different environments. Disability profiles were identified using statistical clustering techniques combined with advice form a panel of experts. Their clinical meaningfulness, stability, reproducibility, homogeneity, heterogeneity and predictive validity were evaluated. The Iso-SMAF classification consisted of 14 homogeneous disability profiles characterized by a gradual progression in the severity of disabilities in instrumental activities of daily living (IADL) and activities of daily living (ADL) accompanied by predominant limitations either in mobility or mental functions. The profiles achieved a Kappa reproducibility coefficient of 0.67 through cross validation. A stable cluster structure emerged when the items were analyzed using different methods. They explained 82% of the variance in nursing care time, 80% of the variance in cost of nursing care (skilled and unskilled) and 57% of the variance in total costs including both formal and informal sources of LTC services. The conclusion recommends their use for planning, managing and predicting LTC service needs in an integrated care system.