Eine steigende Anzahl älterer, oft chronisch kranker Menschen verbringt ihre letzte Lebensphase in einem Pflegeheim. Krankenhausaufenthalte am Lebensende sind für Pflegeheimbewohner sehr belastend und ein Großteil der Bewohner wünscht sich im vertrauten Umfeld anstatt in einem Krankenhaus zu versterben. Die im Rahmen der vorliegenden Dissertation durchgeführten Studien haben gezeigt, dass Pflegeheimbewohner sowohl mit als auch ohne Demenz in Deutschland häufig am Lebensende in ein Krankenhaus kommen und diese Anteile im internationalen Kontext als vergleichsweise hoch einzuordnen sind. Ebenfalls aus hausärztlicher Sicht wird die Versorgung von Pflegeheimbewohnern am Lebensende sowie deren häufige Hospitalisierung kritisch bewertet. Auf Basis der gewonnenen Ergebnisse werden mögliche Implikationen für die Praxis zur Verbesserung palliativer Strukturen, der Umsetzung von Advance Care Planning sowie der pflegerischen und hausärztlichen Versorgung aufgezeigt.
An increasing number of older, often chronically ill people spend their last days of life in a nursing home. Hospital stays at the end of life are burdensome for nursing home residents and the majority of residents wish to die in their familiar environment and not in the hospital. The studies on which this dissertation is based showed that nursing home residents with and without dementia are often hospitalized shortly before death and that the proportion in Germany is relatively high in international comparison. Also, general practitioners tend to be critical regarding the end-of-life care of nursing home residents as well as the frequency of hospitalization shortly before death. Based on these results, possible implications for practice to improve palliative care structures, the implementation of advance care planning as well as nursing and primary care are identified.
Background Nursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany. Methods A cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested. Results 486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement. Conclusions Together with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.
BMC palliative care London : BioMed Central, 2002 Volume 19 (2020), number 1, article 2, Seite 1-9 Online-Ressource
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