RESUMEN
INTRODUCTION: Multiple morbidities, including neurodegenerative diseases such as dementia, which result in diminished decision-making capacity (DMC), make care and care planning complicated for residential aged care facility (RACF) residents. While advance care planning has been highlighted as essential for ensuring that this population receives care that is coherent with their wishes, there are few models specifically designed for this population. This study aimed to explore the current practices for care planning and decision-making for Swiss RACF residents who no longer have medical DMC. METHODS: Semi-structured focus groups were conducted with 23 nurses in three RACFs and with 13 physicians working in 9 RACFs. Semi-structured interviews were conducted with 18 health care proxies of 16 residents without DMC. Thematic analysis was conducted to identify the most salient themes across the dataset. RESULTS: Analyses identified many collaborative processes between nurses, physicians, and health care proxies including family meetings, reconstructing residents' presumed will, making anticipatory decisions, and documenting these decisions. These processes were, however, highly variable and differed between institutions and between residents within each facility, with a lack of standardization. This variability was highlighted to be problematic for information transmission within facilities and in case of hospital or facility transfer. CONCLUSIONS: These results highlight the importance of standardized yet flexible processes of care planning for people who no longer have DMC and provide insights for the development of such models specifically designed to address this problem.
Asunto(s)
Hogares para Ancianos , Médicos , Anciano , Humanos , Suiza , Toma de Decisiones Clínicas , Atención a la SaludRESUMEN
Delirium is common in community-dwelling as well as in hospitalized older persons aged 75 years and older. Often underdiagnosed, delirium is associated with increased morbidity and mortality. Screening (with CAM and 3D-CAM) and identification of older people at increased risk for delirium is essential to enhance non-pharmacological preventative measures and monitor their evolution to allowing an early diagnosis. Screening instruments are currently available, such as the CAM and 3D-CAM. Pharmacological treatment is proposed only in situations where the patients endanger him-herself or other persons. In patients without previously known cognitive impairment, a cognitive assessment is mandated within the next 6 to 12 months period following the delirium episode.
L'état confusionnel aigu (ECA) est fréquent chez le patient âgé de plus de 75 ans, tant à domicile qu'en soins aigus. Souvent sous-diagnostiqué, il s'accompagne d'une morbi-mortalité accrue. L'identification des patients à risque d'ECA, tout comme un dépistage rapide avec des échelles validées (par exemple, Confusion Assessment Method (CAM) ou 3D-CAM), sont primordiaux afin de mettre en place une prévention active essentiellement non pharmacologique. Le traitement pharmacologique devrait être réservé aux situations dans lesquelles le patient se met en danger ou met en danger d'autres personnes. Un ECA n'est pas anodin et nécessite d'être signalé pour les prises en charge ultérieures. En l'absence de troubles neurocognitifs antérieurs connus, un bilan cognitif est recommandé dans les 6 à 12 mois suivant l'ECA.