The palliative care in assisted living (PCAL) pilot study

Successes, shortfalls, and methodological implications

Anthony F Jerant, Rahman S. Azari, Thomas S Nesbitt, Adrienne Edwards-Goodbee, Frederick J Meyers

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Troubling deficits exist in palliative care (PC) of older adults under the prevailing "terminal care"-oriented model. We previously described a PC model - TLC - that provides a blueprint for remedying these shortfalls. In this model, PC is envisioned as Timely and Team-oriented, Longitudinal, and Collaborative and Comprehensive. We present results of the Palliative Care in Assisted Living pilot, comparing two TLC model-based, facility delivered interventions for improving the PC of elderly assisted living residents in Sacramento, California, a growing and under-researched population. The less intensive intervention involved one assessment followed by a PC improvement recommendation letter to the resident, family member, primary provider, and facility staff, while the more intensive intervention involved assessments and letters every three months. Primary outcomes were SF-36 Physical (PCS) and Mental (MCS) Component scores and recommendation adherence. Eighty-one subjects enrolled (mean age 85), 58 in the more and 23 in the less intensive group. A loved one attended 56% of baseline assessments. Most subjects expressed a preference for maintaining current quality of life over prolonging life at reduced quality. None were eligible for hospice care. A total of 418 recommendations (mean 5.1 per subject) were generated concerning symptoms, mood, functional impairments, and advance directives. We found no significant differences in recommendation adherence between more (42%) and less (44%) intensive groups, and no significant changes in PCS and MCS scores within or between groups. However, a loved one's attendance of the baseline assessment was associated with improved PCS scores (p=0.04). Our pilot study had methodological limitations that could account for the lack of significant outcome effects. In this context, and given the myriad unmet PC needs we detected, interventions based on the TLC model might allow delivery of timely PC to assisted living residents not eligible for hospice care. Further studies exploring the TLC model appear warranted.

Original languageEnglish (US)
Pages (from-to)199-207
Number of pages9
JournalSocial Science and Medicine
Volume62
Issue number1
DOIs
StatePublished - Jan 2006

Fingerprint

assisted living
Palliative Care
hospice
resident
Hospice Care
terminal care
Group
quality of life
Advance Directives
mood
Terminal Care
family member
Palliative care
deficit
staff
recommendation
lack
Quality of Life
Thin-layer Chromatography

Keywords

  • 80 and over
  • Aged
  • Evaluation studies
  • Hospice care
  • House calls
  • Palliative care
  • Residential facilities
  • USA

ASJC Scopus subject areas

  • Economics and Econometrics
  • Public Health, Environmental and Occupational Health
  • Social Psychology
  • Development
  • Health(social science)

Cite this

The palliative care in assisted living (PCAL) pilot study : Successes, shortfalls, and methodological implications. / Jerant, Anthony F; Azari, Rahman S.; Nesbitt, Thomas S; Edwards-Goodbee, Adrienne; Meyers, Frederick J.

In: Social Science and Medicine, Vol. 62, No. 1, 01.2006, p. 199-207.

Research output: Contribution to journalArticle

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