Betere zorg rond levenseinde van patiënten met dementie

Objective

To analyse possible trends in families’ evaluations of the quality of end-of-life care and the quality of dying in dementia.

Design

Analysis of individual patient data from 3 studies (2 solely retrospective (after death) and 1 partly prospective).

Method

We combined data on 372 residents with dementia from 38 nursing homes and 13 residential homes (‘psychogeriatric’ wards) over the period 2005-2010. Outcome measures were the End-of-Life in Dementia-Satisfaction With Care scale (EOLD-SWC; range: 10-40) to assess quality of, or satisfaction with, end-of-life care, and the EOLD-Comfort Assessment in Dying scale (EOLD-CAD; range: 12-42) to assess quality of dying (comfort). Regression analyses were performed with time (trend) as an independent factor and were adjusted for clustering of residents within homes. We also adjusted for differences between residents, homes, and study designs.

Results

We found a consistent trend of increasing family satisfaction with end-of-life care over the years (unadjusted: 0.5 points per year increment on the EOLD-SWC, and adjusted: 1.2 points; mean total score: 32.4 (SD: 5.3)). Results for the EOLD-CAD scale (mean: 32.2 (SD: 5.7)) were inconclusive; only the exclusively retrospective data indicated increased comfort. Item- and subscale-level analyses showed that, in particular, families were more satisfied with general (comfort) measures for residents and the emotional support provided for families; further, families reported lower levels of emotional distress in residents.

Conclusion

We found a positive trend of increased satisfaction with end-of-life care. Families also reported a possible increase in residents’ end-of-life comfort. Ongoing surveillance of outcomes measuring end-of-life quality is important in view of the increasing healthcare budget constraints.

Conflict of interest: a disclosure form provided by the author is available along with the full text of this article at www.ntvg.nl, search for A5324; click on ‘Belangenverstrengeling’ (‘Conflict of interest’). Financial support: NWO: Veni-grant no. 916.66.073; ZonMw: Program Palliative Care no. 1151.0001 and no. 1150.0003.