Evidence map›Paper›PMID 25179072›Full record

ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2014

Living in uncertain times: trajectories to death in residential care homes.

Stephen Barclay, Katherine Froggatt, Clare Crang, Elspeth Mathie, Melanie Handley, Steve Iliffe, Jill Manthorpe, Heather Gage, Claire Goodman

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  20. Timing of GP end-of-life recognition in people aged ≥75 years: retrospective cohort study using data from primary healthcare records in England.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Stephen BarclayPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge.
Katherine FroggattInternational Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster.
Clare CrangPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge.
Elspeth MathieCentre for Research in Primary and Community Care, University of Hertfordshire, Hatfield.
Melanie HandleyCentre for Research in Primary and Community Care, University of Hertfordshire, Hatfield.
Steve IliffeDepartment of Primary Care and Population Health, University College London, London.
Jill ManthorpeSocial Care Workforce Research Unit, King's College London, London.
Heather GageDepartment of Economics, University of Surrey, Guildford.
Claire GoodmanCentre for Research in Primary and Community Care, University of Hertfordshire, Hatfield.

Funding

Department of Health PB-PG-0906-11387
6 · The paper itself

Abstract

backgroundOlder people living in care homes often have limited life expectancy. Practitioners and policymakers are increasingly questioning the appropriateness of many acute hospital admissions and the quality of end-of-life care provided in care homes.

aimTo describe care home residents' trajectories to death and care provision in their final weeks of life. DESIGN AND

settingProspective study of residents in six residential care homes in three sociodemographically varied English localities: Hertfordshire, Essex, and Cambridgeshire.

methodCase note reviews and interviews with residents, care home staff, and healthcare professionals.

resultsTwenty-three out of 121 recruited residents died during the study period. Four trajectories to death were identified: 'anticipated dying' with an identifiable end-of-life care period and death in the care home (n = 9); 'unexpected dying' with death in the care home that was not anticipated and often sudden (n = 3); 'uncertain dying' with a period of diagnostic uncertainty or difficult symptom management leading to hospital admission and inpatient death (n = 7); and 'unpredictable dying' with an unexpected event leading to hospital admission and inpatient death (n = 4). End-of-life care tools were rarely used. Most residents who had had one or more acute hospital admission were still alive at the end of the study.

conclusionFor some care home residents there was an identifiable period when they were approaching the end-of-life and planned care was put in place. For others, death came unexpectedly or during a period of considerable uncertainty, with care largely unplanned and reactive to events.

Indexed as

Frail ElderlyPrimary Health CareAdvance Care PlanningAgedAged, 80 and overAttitude of Health PersonnelEnglandHealth Services ResearchHomes for the AgedHospitalizationHumansNursing HomesPolicy MakingProfessional-Patient RelationsProspective StudiesQualitative Researchcare homesdying trajectoriesend-of-life carepalliative careprimary health care

Identifiers

PMID25179072
PMCPMC4141615

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.