Older nursing home residents with advanced dementia have limited life expectancies. These individuals often receive intensive medical care towards the end-of-life thereby incurring burdensome interventions and antimicrobials of questionable benefit. We aimed to describe the frequency, nature, and predictors of burdensome interventions and antimicrobials received by Ontario nursing home residents with advanced dementia during the last 30 days of life. A population-based retrospective cohort study was conducted using linked administrative records. Logistic regression was used to determine the patient and facility characteristics associated with receipt of burdensome interventions. We included 27,243 Ontario nursing home residents with advanced dementia who died between June 2010 and March 2015. The majority (71.1%) were women and the average age of death was 87.1 ± 7.2 years. Nearly half (46.8%) were dependent for their basic activities of daily living with 8.1% being totally bedbound. In the last 30 days of life, 21.8% were hospitalized, 8.9% visited an emergency department, and 9.8% received medical resuscitation. More than 1 in 3 (36.2%) were dispensed an antibiotic, and 86.6% of residents received a physical restraint. Male sex, fewer days in nursing home prior to death, and lower income were all independently associated with transfer to acute care and medical resuscitation, while palliative care consultation, bedbound status, and older age were negative predictors. We conclude that many older Ontario nursing home residents with advanced dementia receive burdensome interventions and antimicrobial agents at the end-of-life. The provision of care for these patients must align with their life expectancies and goals of care.

INTRODUCTION:This study provides a comprehensive summary of the sociodemographic, psychosocial and health characteristics of a large population-based cohort of Ontario home care clients (aged 50 years and over) with dementia and examines the variation in these characteristics in those with co-existing neurological conditions.METHODS:Clients were assessed with the Resident Assessment Instrument-Home Care (RAI-HC) between January 2003 and December 2010. Descriptive analyses examined the distribution of these characteristics among clients with dementia relative to several comparison groups, as well as clients with other recorded neurological conditions.RESULTS:Approximately 22% of clients (n=104 802) had a diagnosis of dementia (average age 83 years, 64% female) and about one in four within this group had a co-existing neurological condition (most commonly stroke or Parkinson disease). About 43% of those with dementia did not live with their primary caregiver. Relative to several comparison groups, clients with dementia showed considerably higher levels of cognitive and functional impairment, aggression, anxiety, wandering, hallucinations/delusions, caregiver distress and a greater risk for institutionalization. Conversely, they showed a lower prevalence of several chronic conditions and lower levels of recent health service use. Depressive symptoms were relatively common in the dementia and other neurological groups.CONCLUSION:Clients with co-existing neurological conditions exhibited unique clinical profiles illustrating the need for tailored and flexible home care services and enhanced caregiver assistance programs.

PURPOSE:Multidisciplinary cancer conferences (MCCs) provide an opportunity for health professionals to discuss diagnosis and treatment options to optimize patient management. The purpose of this study was to explore the barriers and facilitators in implementing MCCs in Canada.METHODS:This exploratory study used qualitative interviews and observation to explore the experiences of implementing MCCs in four hospitals in Ontario, Canada. Interviews were transcribed verbatim and analyzed using standard qualitative research methodology guided by grounded theory principles.RESULTS:Thirty-seven MCCs for gastrointestinal cancer were observed across three hospital sites, and 48 interviews were conducted among a range of clinical specialists and administrators. The dominant theme suggested that MCCs can most effectively be implemented if administrators and health professionals see value in MCCs, despite the time and effort required. A number of factors (eg, provincial policy, hospital administrative and clinician support, and an efficient MCC process) influenced whether MCCs were valued.CONCLUSION:Variation exists in the enthusiasm of health professionals and the administrative capacity of institutions regarding routine implementation of MCCs. A systematic implementation plan for MCCs is needed involving both cancer care providers and administrators.