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NIHR Themed Review Comprehensive Care - Older People Living with Frailty in Hospital
People are living longer and many are enjoying healthy lives. However, a significant percentage of older people are particularly vulnerable to even relatively minor changes in their circumstances, and so need particular attention when admitted to a hospital. Comprehensive Care looks at the concept of ‘frailty’ in older people living in hospital. It brings together NIHR research on what can be done to identify and manage the needs of this group of people and avoid potential problems. With the ri...
NIHR Signal An end of life strategy probably improved choice of where to die for people with severe respiratory disease
Most people prefer not to die in hospital, but the majority of patients with long-term diseases other than cancer end up dying there. In England, an NIHR study based on routine collected national data showed that roll-out of the End of Life Care strategy in 2004 was linked to a reduction in deaths in hospital. The number of deaths here fell by 6% for people with chronic obstructive pulmonary disease (COPD), and 3% for people with interstitial lung diseases. However, hospital deaths did not fall ...
NIHR Signal How nurses support families of intensive care patients towards the end of life
Families of people dying in intensive care need to receive personalised communication and ongoing support, and be involved in the dying process. Researchers gathered evidence on how nurses care for patients and their families in intensive care when life-sustaining treatment is withdrawn. The included studies explored the care of the family before, during and after the process. Most of the studies in this small, mixed methods review were qualitative. Reviewers identified three main ways, or the...
NIHR Signal A person’s preferred place to die often goes unrecorded in their notes
Most people say they do not want to die in hospital, but most people do die there. Where wishes are recorded, care is usually better. The preference was not thought to have been recorded for over 80% of people towards the end of life, in this study. People whose family knew they had a preferred place of death recorded by healthcare staff in England were more likely to avoid dying in hospital. They also had better home care support, quality of life and pain relief during the last three months of...
NIHR Signal How to improve ‘do not resuscitate’ decisions in England
This review has highlighted some variations in how ‘do not attempt cardiopulmonary resuscitation’ decisions are made across NHS hospitals. By describing the literature and giving examples where things have gone well and less well in the past it begins to surface promising areas for improvement. These include the designing and implementing of structured forms to record decisions, talking sensitively about the decisions with patients and their families early and letting other health pr...
NIHR Themed Review Better Endings - right care, right place, right time
Helping people to die with dignity, compassion and comfort is an important goal of any health service. Recent accounts have provided rich insights into some of the challenges for healthcare professionals trying to meet the needs of people at the end of life, ranging from reports of inequalities in access to specialist palliative care to skills and training gaps for general staff caring for the dying. Better Endings is the NIHR Dissemination Centre’s first Themed Review. It brings together evide...
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