Cargando…

Advance care plans and hospitalized frail older adults: a systematic review

INTRODUCTION: Frail older people are known to have low rates of advance care planning (ACP). Many frail patients prefer less aggressive treatment, but these preferences are often not known or respected. Frail patients often have multiple hospital admissions, potentially providing opportunities for A...

Descripción completa

Detalles Bibliográficos
Autores principales: Hopkins, Sarah A, Bentley, Allison, Phillips, Veronica, Barclay, Stephen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286036/
https://www.ncbi.nlm.nih.gov/pubmed/32241957
http://dx.doi.org/10.1136/bmjspcare-2019-002093
_version_ 1783544808955969536
author Hopkins, Sarah A
Bentley, Allison
Phillips, Veronica
Barclay, Stephen
author_facet Hopkins, Sarah A
Bentley, Allison
Phillips, Veronica
Barclay, Stephen
author_sort Hopkins, Sarah A
collection PubMed
description INTRODUCTION: Frail older people are known to have low rates of advance care planning (ACP). Many frail patients prefer less aggressive treatment, but these preferences are often not known or respected. Frail patients often have multiple hospital admissions, potentially providing opportunities for ACP. OBJECTIVE: To systematically review the literature concerning ACP with frail older people in the acute hospital, with particular reference to: (1) Does ACP improve outcomes? (2) What are the views of patients, relatives and healthcare professionals regarding ACP? (3) Does ACP currently occur? (4) What are the facilitators and barriers to ACP? DESIGN: Systematic literature review and narrative synthesis. Electronic search of MEDLINE, CINAHL, ASSIA, PsycINFO and Embase databases from January 1990 to May 2019 inclusive. Studies in the acute setting of populations with a mean age >75 years, not focused on a disease-specific terminal condition were included. RESULTS: 16 133 articles were retrieved, 14 met inclusion criteria. No studies used an objective measure of frailty. One randomised controlled trial (RCT) found that ACP improves outcomes for older patients. Although 74%–84% of capacitous older inpatients are receptive to ACP, rates of ACP are 0%–5%; the reasons for this discrepancy have been little studied. The nature of ACP in clinical practice is unknown thus the extent to which it reflects the RCT intervention cannot be assessed. The outcomes that are important to patients are poorly understood and family and physician experiences have not been explored. CONCLUSIONS: A better understanding of this area could help to improve end-of-life care for frail older people. PROSPERO REGISTRATION NUMBER: CRD42017080246.
format Online
Article
Text
id pubmed-7286036
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-72860362020-06-15 Advance care plans and hospitalized frail older adults: a systematic review Hopkins, Sarah A Bentley, Allison Phillips, Veronica Barclay, Stephen BMJ Support Palliat Care Review INTRODUCTION: Frail older people are known to have low rates of advance care planning (ACP). Many frail patients prefer less aggressive treatment, but these preferences are often not known or respected. Frail patients often have multiple hospital admissions, potentially providing opportunities for ACP. OBJECTIVE: To systematically review the literature concerning ACP with frail older people in the acute hospital, with particular reference to: (1) Does ACP improve outcomes? (2) What are the views of patients, relatives and healthcare professionals regarding ACP? (3) Does ACP currently occur? (4) What are the facilitators and barriers to ACP? DESIGN: Systematic literature review and narrative synthesis. Electronic search of MEDLINE, CINAHL, ASSIA, PsycINFO and Embase databases from January 1990 to May 2019 inclusive. Studies in the acute setting of populations with a mean age >75 years, not focused on a disease-specific terminal condition were included. RESULTS: 16 133 articles were retrieved, 14 met inclusion criteria. No studies used an objective measure of frailty. One randomised controlled trial (RCT) found that ACP improves outcomes for older patients. Although 74%–84% of capacitous older inpatients are receptive to ACP, rates of ACP are 0%–5%; the reasons for this discrepancy have been little studied. The nature of ACP in clinical practice is unknown thus the extent to which it reflects the RCT intervention cannot be assessed. The outcomes that are important to patients are poorly understood and family and physician experiences have not been explored. CONCLUSIONS: A better understanding of this area could help to improve end-of-life care for frail older people. PROSPERO REGISTRATION NUMBER: CRD42017080246. BMJ Publishing Group 2020-06 2020-04-02 /pmc/articles/PMC7286036/ /pubmed/32241957 http://dx.doi.org/10.1136/bmjspcare-2019-002093 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Review
Hopkins, Sarah A
Bentley, Allison
Phillips, Veronica
Barclay, Stephen
Advance care plans and hospitalized frail older adults: a systematic review
title Advance care plans and hospitalized frail older adults: a systematic review
title_full Advance care plans and hospitalized frail older adults: a systematic review
title_fullStr Advance care plans and hospitalized frail older adults: a systematic review
title_full_unstemmed Advance care plans and hospitalized frail older adults: a systematic review
title_short Advance care plans and hospitalized frail older adults: a systematic review
title_sort advance care plans and hospitalized frail older adults: a systematic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286036/
https://www.ncbi.nlm.nih.gov/pubmed/32241957
http://dx.doi.org/10.1136/bmjspcare-2019-002093
work_keys_str_mv AT hopkinssaraha advancecareplansandhospitalizedfrailolderadultsasystematicreview
AT bentleyallison advancecareplansandhospitalizedfrailolderadultsasystematicreview
AT phillipsveronica advancecareplansandhospitalizedfrailolderadultsasystematicreview
AT barclaystephen advancecareplansandhospitalizedfrailolderadultsasystematicreview