Komal Patel Murali

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Palliative care improves the quality of life for seriously ill patients, but misconceptions and knowledge gaps hinder its implementation in home healthcare (HHC). This study developed and pilot-tested HHC-specific questionnaires to measure palliative care knowledge, attitudes, and confidence (PC-KAC) among clinicians, patients, and caregivers. Using literature reviews, expert input, and cognitive interviews, the questionnaires were refined to ensure clarity, practical relevance, and content validity. Pilot testing revealed widespread confusion about palliative care, with patients and caregivers often conflating it with hospice care and holding misconceptions about opioid use for pain and symptom management. While clinicians demonstrated adequate knowledge, gaps in pain management and confidence in handling emergencies were evident. These findings highlight the need for targeted education and training to integrate palliative care effectively into HHC, improving patient outcomes and supporting interdisciplinary collaboration.

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BACKGROUND AND OBJECTIVES: Goal-concordant transition to hospice is an important facet of end-of-life care for people living with dementia. The objective of this integrative review was to appraise existing evidence and gaps focused on interventions and predictors of transition to hospice and end-of-life care for persons living with dementia across healthcare to inform future research.RESEARCH DESIGN AND METHODS: Using integrative review methodology by Whittemore and Knafl, five databases were searched (PubMed, CINAHL, Web of Science, Google Scholar, Cochrane Database for Systematic Reviews) for articles between 2000 and 2023. The search focused on dementia, hospice care, transitions, care management and/or coordination, and intervention studies.RESULTS: Fourteen articles met inclusion criteria after critical appraisal. Most were cross-sectional in design and conducted in nursing homes and hospitals in the U.S. persons living with dementia had multiple chronic conditions including cancer, diabetes, heart disease, and stroke. Interventions included components of hospice decision-making delivered through advance care planning, checklist-based care management for hospice transition, and palliative care for those with severe dementia. Predictors included increasing severity of illness including functional decline, organ failure, intensive care use, and the receipt of palliative care. Other predictors were related to insurance status, race and ethnicity, and caregiver burden. Overall, despite moderate to high-quality evidence, the studies were limited in scope and sample and lacked racial and ethnic diversity.DISCUSSION AND IMPLICATIONS: Prospective, multisite randomized trials and population-based analyses including larger and diverse samples are needed for improved end-of-life dementia illness counseling and hospice care transitions for persons living with dementia and their caregivers.

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Background: The growing prevalence of multiple chronic conditions (MCC) has significant impacts on health care systems and quality of life. Understanding the prevalence of MCC throughout adulthood offers valuable insights into the evolving burden of chronic diseases and provides strategies for more effective health care outcomes. Objective: This study estimated the prevalence and combinations of MCC among adult participants enrolled in the All of Us (AoU) Research Program, especially studying the variations across age categories. Methods: We conducted an exploratory analysis using electronic health record (EHR) data from adult participants (N=242,828) in the version 7 Controlled Tier AoU Research Program data release. Data analysis was conducted using Python in a Jupyter notebook environment within the AoU Researcher Workbench. Descriptive statistics included condition frequencies, the number of chronic conditions per participant, and prevalence according to age categories. The presence of a chronic condition was determined by documentation of one or more ICD-10 (International Statistical Classification of Diseases, Tenth Revision) codes for the respective condition. Age categories were established and aligned with diagnosis dates and stages of adulthood (early adulthood: 18-39 years; middle adulthood: 40-49 years; late middle adulthood: 50-64 years; late adulthood: 65-74 years; advanced old age: 75-89 years). Results: Our findings demonstrated that approximately 76% (n=183,753) of AoU participants were diagnosed with MCC, with over 40% (n=98,885) having 6 or more conditions and prevalence increasing with age (from 33.78% in early adulthood to 68.04% in advanced old age). The most frequently occurring MCC combinations varied by age category. Participants aged 18-39 years primarily presented mental health–related MCC combinations (eg, anxiety and depressive disorders; n=845), whereas those aged 40-64 years frequently had combinations of physical conditions such as fibromyalgia, chronic pain, fatigue, and arthritis (204 in middle adulthood and 457 in late middle adulthood). In late adulthood and advanced old age, hyperlipidemia and hypertension were the most commonly occurring MCC combinations (n=200 and n=59, respectively). Conclusions: We report notable prevalence of MCC throughout adulthood and variability in MCC combinations by age category in AoU participants. The significant prevalence of MCC underscores a considerable public health challenge, revealed by distinct condition combinations that shift across different life stages. Early adulthood is characterized predominantly by mental health conditions, transitioning to cardiometabolic and physical health conditions in middle, late, and advanced ages. These findings highlight the need for targeted, innovative care modalities and population health initiatives to address the burden of MCC throughout adulthood.

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