[Continuation of end-of-life care in a special elderly nursing home and the role of doctors].

AIM: As 2 years have passed since its implementation, and we have received several comments regarding our original article, we report the recent developments of end-of-life (EOL) care in a special elderly (SE) nursing home and describe the role of doctors. PARTICIPANTS: A total of 7 female EOL care patients (age, 101.5±4 years) in a special elderly home and 130 patients (98 years, 42 men, 88 women; age, 87±6.5 years) receiving palliative therapy in a hospital. RESULTS: Four of the 7 EOL care patients died after an average of 480±297 days within our EOL care system, while 3 patients spent an average of 805±662 days in our SE home. Among the hospitalized patients, 93 (71.5%; 27 men and 66 women; age, 86.7±10 years) were able to be discharged to our facility, whereas 37 (28.5%; 15 men, 22 women; age, 86.4±11 years) died during hospital care. A number of patients who could discharge had a greater incidence of gastrointestinal disorders than congestive heart failure (p<0.05). Among 15 patients (≥98 years) who could not enter EOL care because of family problems, 12 were hospitalized and 9 died before discharge. This number was significantly greater than the number who died before discharge and who were <98 years (p<0.05). One patient (aged 103 years) who had a solid breast tumor successfully underwent surgery and was discharged after 3 days of admission, but she died within 90 days of EOL. The death rates in our nursing home were significantly lower than the average death rate in other facilities (15.3% vs. 37.2%, p<0.01). CONCLUSION: Patients of over 98 years old did not live longer, despite hospitalized care; however, the number of patients (28%) who were less than 98 years could be discharged and were alive was significantly less than centenarians (p<0.05). Doctors in nursing homes should provide communication support for nursing homes and hospitals after providing medical education for care workers.

Spiritual activation in very elderly individuals assessed as heart rate variability and plasma IL/10/IL-6 ratios.

Proinflammatory cytokine responses might occur in elderly individuals with cardiovascular (CV) disease, cerebro-vascular (CVA) disease, and/or pulmonary disease (PD). Spiritual activation is an important coping mechanism, since psychiatric depression is an important risk factor for these individuals. Thirty-three very elderly individuals (87 ± 8 years) with previous CVD, CVA and/or PD participated in weekly 30 minute sermons by chaplains for over 20 months of chaplain liturgy (CL group). All underwent Holter ECG during the procedures and cardiac autonomic activities were assessed by maximum entropy analysis. Plasma IL-10 and IL-6 levels were compared with 26 age-matched (85 ± 10 years) individuals who did not participate in these activities (non-CL group). Both high frequency (HF) and pNN50 of heart rate variability (HRV) were higher in the CL group than in the non-CL group (HF, 190 ± 55 versus 92 ± 43 nu, P < 0.05; pNN50, 10.5 ± 16% versus 3.6 ± 3.8%, P < 0.05), whereas LF/HF was lower (1.4 ± 1.5 versus 2.2 ± 2.8, P < 0.05). Levels of IL-10/IL-6 were higher in the CL group (3.96 ± 5.0 versus 1.79 ± 1.6, P < 0.05). Hospitalization rates due to CVD and/or PD were lower in the CL group than in the non-CL group (4/33 versus 11/26, P < 0.05). We conclude that spiritual activation can modify proinflammatory cytokines and suppress CVD, CVA and/or PD via vagal modifications. Spiritual activation might be helpful for health in these very elderly individuals.

[End-of-life care in special elderly nursing home for very elderly adults in comparison with emergency palliative therapy in general hospitals].

AIM: Although the facilities for end-of-life care in the special elderly (SE) nursing home are increasing, there are no standard guidelines for end-of-life care interventions. Furthermore, in the SE nursing home, there are not enough data concerning those who have had end-of-life care and/or emergency hospital palliative therapy. Therefore, we compared the clinical outcome of end-of-life care patients and emergency palliative therapy patients. PARTICIPANTS: Five end-of-life care patients (99+/-10 years old) in the SE nursing home, and 48 emergency palliative therapy patients (89+/-15 years old) in the hospitals. RESULTS: All end-of-life care patients are still living after 300+/-70 days by standard nursing care (mainly fluid diets with small doses of vasodilators and antibiotics) with bed side music. Their average CRP values in terminal end-of-life care patients decreased from 10+/-12 mg/dl to 1.2+/-0.5 (p<0.05), serum albumin levels increased from 2.7+/-1.6 g/dl to 3.5+/-2.6 and body mass index increased from 16+/-1.6 to 18.3+/-0.75 (p<0.05). Among 48 emergency hospitalized palliative patients, 32 patients were discharged to our facility after 120+/-26 days of hospitalization, whereas 16 patients died in hospital after 100+/-36 days of hospitalization (aspiration pneumonia: 11 patients, heart failure: 3 patients and G-I causes: 2 patients). CONCLUSION: End-of-life care in the SE nursing home prolonged their life expectancy despite centenarian status. Hospital mortality rates of palliative emergency therapy were higher than usual end-of-life care. These data suggest that end-of-life care interventions, including bed side music, could provide physical satisfaction.