ABSTRACT
The Edmonton Symptom Assessment Scale (ESAS) was administered daily by nursing staff in a long-term care facility (LTCF) to monitor symptoms. Scores greater than or equal to 5 on a 0-10 scale were considered moderate-to-severe and triggered prompt treatment. One hundred and eight patients with advanced illness and perceived prognosis of less than 6 months were identified for rapid symptom management over a 7-month period. Forty-six (43%) of these patients had at least one episode of moderate-to-severe symptoms during the follow-up period. Thirty-one of these patients (67%) had a primary diagnosis of advanced AIDS and 12 (26%) had advanced cancer. Pain was the most frequent of the 15 symptoms measured, occurring in 29 patients. In the case of pain (P = 0.001), tiredness (P = 0.004), and well-being (P = 0.003), rapid symptom management led to significantly improved distress scores within 48 hours. These data suggest that it is feasible for nurses in an LTCF to use the ESAS on a daily basis to assess patients and obtain prompt treatment for distressful symptoms. Rapid treatment of symptoms can be an important quality indicator in nursing home patients with advanced illness.
Subject(s)
Acquired Immunodeficiency Syndrome/nursing , Long-Term Care/methods , Neoplasms/nursing , Nursing Assessment/methods , Pain/prevention & control , Palliative Care/methods , Terminal Care/methods , Acquired Immunodeficiency Syndrome/epidemiology , Adult , Aged , Aged, 80 and over , Humans , Long-Term Care/statistics & numerical data , Male , Middle Aged , Neoplasms/epidemiology , New York/epidemiology , Nursing Assessment/statistics & numerical data , Pain/epidemiology , Palliative Care/statistics & numerical data , Pilot Projects , Quality Assurance, Health Care/methods , Terminal Care/statistics & numerical dataABSTRACT
OBJECTIVES: This study sought to identify potential predictive variables of death within 6 months in patients with advanced AIDS. METHODS: Investigators enrolled a consecutive series of patients with advanced AIDS admitted to a skilled nursing facility in New York City over a 1-year period. Demographic, clinical, laboratory, and outcome data were abstracted from medical records using a standardized data collection instrument. RESULTS: Of the 152 patients enrolled during the study period, 61 patients (40%) died within 6 months from date of admission. Serum albumin, percent deviation from ideal body weight, and number of comorbidities at the time of admission proved to be the best combination of predictors of death within 6 months. SIGNIFICANCE OF RESULTS: The decrease in AIDS mortality over the past decade, along with an increase in prevalence due to longer survival, has been attributed primarily to the successful use of highly active antiretroviral therapy (HAART). HAART regimens, however, can also produce both short-term adverse effects and long-term complications. The prognostic model developed by this study may be useful in guiding treatment decisions in patients with advanced AIDS for whom a more palliative care plan may be sought.
