Browsing by Subject "Quality of life (QOL)"

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    An Analysis of Palliative Care Provider Nursing Home Consultations for Patients with Cognitive Impairment
    (Oxford University Press, 2024-12-31) Nesvet, Matthew; Floyd, Alex; Cagle, John; Elftmann, Hanley; Unroe, Kathlee; Medicine, School of Medicine
    Nursing homes (NH) are important sites of care for people with serious illnesses in need of end-of-life care. Extant studies have shown NH residents with dementia struggle to receive high quality care. There is some evidence that palliative care (PC) interventions may improve quality of life (QOL) and care. There is little prior description of PC consults conducted in the nursing home setting. We examined notes PC providers wrote after initial consults with 197 residents of 8 nursing homes enrolled in UPLIFT, an NIH-funded clinical trial evaluating implementation of a PC model of care. Residents enrolled in UPLIFT who screened positive for PC needs were referred for consultations. We analyzed initial consult notes to learn about the residents referred and content of the consultative visits, including recommendations made. Mean age of the residents was 75 years. 70% were White, 19% Black/African American, and 52% female. Goals of care were discussed in 83% of the PC consults, the most commonly observed intervention. The most frequent types of recommendations by PC providers were: 1) medication-related (n=207); 2) referrals to other clinical services (n=103); 3) non-pharmacologic symptom relief (n=53); and 4) specific recommendations for NH staff-based activities (n=40). In total, PC providers averaged three recommendations when at least one family member, friend, or guardian was present during the clinical encounter in person (n=127) or by phone (n=38), and two when only the resident participated in the encounter (n=33).
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    Loneliness and Quality of Life in Older Adult Primary Care Patients
    (Oxford University Press, 2023-12-21) Williams-Farrelly, Monica; Schroeder, Matthew; Li, Claudia; Fowler, Nicole; Medicine, School of Medicine
    Loneliness, defined as the perceived discrepancy in an individual’s desired and actual social relationships, is common among older adults. Loneliness among older adult primary care patients is lacking, considering the implications it has on physical and mental health. Our objective was to determine the relationship between loneliness and quality of life (QOL) in older adult primary care patients. Data come from the Caregiver Outcomes of Alzheimer’s Disease Screening (COADS) study, an ongoing randomized controlled trial evaluating benefits and risks of Alzheimer’s disease and related dementias screening among older primary care patients and their family members. Loneliness (5-item NIH Toolbox), quality of life (QOL)—as measured by physical and mental health component scores— and depression (PHQ-9) and anxiety symptomatology (GAD-7) were measured among primary care patients aged 65 and older from April 2020 to September 2021. Spearman correlation analyses reveal that loneliness was moderately correlated with mental health (r(601) = -.43, p< 0.001), anxiety (r(601) =.44, p< 0.001), and depression (r(601) = .42, p< 0.001), while weakly correlated with physical health (r(601) = -.15, p< 0.001). After conducting unadjusted and adjusted linear regression models, we found that loneliness was associated with both lower mental (p< 0.001) and physical health component scores (p< 0.001). Furthermore, loneliness remained significantly associated with worse mental health when adjusting for depression, anxiety, sociodemographic characteristics, and comorbidity. Primary care providers should discuss loneliness with their older adult patients and provide resources to help patients develop and maintain meaningful social relationships.