Research round-up
ACP uptake remains low; emergency department use near end of life; nutritional benefits of Meals on Wheels investigated; world’s largest primary prevention aspirin study.
In this article:
- ACP uptake remains low
- Emergency department use near end of life
- Nutritional benefits of Meals on Wheels investigated
- World’s largest primary prevention aspirin study
ACP uptake remains low
More than half of Australians hospitalised with advanced disease are denied the chance to adequately discuss their end-of-life care wishes, according to new research published in the Medical Journal of Australia.
Professor Ian Scott, director of the Department of Internal Medicine and Clinical Epidemiology at Princess Alexandra Hospital in Brisbane, said almost a quarter of intensive care beds were occupied by patients receiving potentially inappropriate care. Furthermore, up to a quarter of health budgets were spent on inpatient care during the last 18 months of life “without any real prospects of extending overall survival or impacting on quality of life.”
The authors identified several barriers to increased uptake of advanced care planning, including:
- reluctance to acknowledge impending death;
- perceived irrelevance (“too healthy”);
- issues of timing;
- diffusion of the responsibility of initiating and coordinating ACP;
- limited clinician time for discussion;
- limitations of surrogate decision makers, ambiguous or poorly recorded wishes and differing perceptions of ACP.
Professor Scott said that in order for ACP to become part of routine practice, healthcare organisations needed to commit to systematically talking with patients about their care preferences and then documenting and enacting those wishes.
Emergency department use near end of life
Researchers at Curtin University have been awarded a National Health and Medical Research Council grant for a three-year study investigating the use of emergency departments by people nearing the end of life.
The study will be led by Professor Lorna Rosenwax, from Curtin’s School of Occupational Therapy and Social Work, in collaboration with Professors Beverley McNamara, James Semmens and Peter O’Leary.
“People in their last year of life who attend EDs can often be better cared for elsewhere,” Professor Rosenwax said. “Severely overcrowded EDs, and the staff who work in them, can be poorly equipped to provide suitable end-of-life care.”
The research will analyse 450,000 presentations to EDs which occurred over a two-year period in Western Australia. It will determine which ED presentations for people at the end-of-life may be preventable through the provision of timely, adequate and appropriate non-hospital services in the community.
“The research will provide much needed evidence to demonstrate how an alternative care pathway can reduce ED demand and cost.”
The multidisciplinary research team want to better understand what health services people use in their last year of life with a particular interest in EDs, but will also look at the use of hospitals and Silver Chain community care.
The researchers are trying to determine who uses EDs, which ED visits are potentially preventable and if the use of community-based palliative care reduces demand for, and cost of, ED visits.
Nutritional benefit of Meals on Wheels investigated
Meals on Wheels SA (MoWSA) has embarked on new research into how effectively it assists older South Australians to achieve dietary targets and improve their nutritional health and wellbeing.
The study will compare the health outcomes of clients over 70 receiving standard Meals on Wheels meals, versus a meal with additional protein and energy. These results will be compared with a group of older people who do not use Meals on Wheels’ services.
It seeks to find, over a 12-week period, whether undernourished older people receiving Meals on Wheels meals that are fortified with extra energy and protein achieve their estimated energy and protein requirements more readily than people receiving standard meals, or no meals. Whether the fortification facilitates a greater improvement in nutritional and health status is also being investigated.
The ongoing study is being conducted in collaboration with the University of Adelaide, Flinders University and CSIRO Animal, Food and Health Sciences. It is expected to be completed in six months.
Research Scientist, Dr Natalie Luscombe-Marsh, CSIRO and University of Adelaide affiliate, said early indicators of the research were positive. “Preliminary findings show that Meals on Wheels is helping older people reach their nutrition requirements,” she said.
Dr Luscombe-Marsh called on more people over 70 to be involved in the research. The study is confidential and at no cost to participants.
World’s largest primary prevention aspirin study
ASPREE, the world’s largest primary prevention aspirin study in the elderly, has reached its final recruitment phase and aims to enrol 3,500 more Australian participants by mid-2014.
ASPREE (ASPirin in Reducing Events in the Elderly) is a double-blinded placebo-controlled clinical trial; participants are randomly assigned daily low-dose aspirin tablet (100mg) or a placebo tablet for an average of five years. The study uses a composite endpoint of disability and dementia free years to determine aspirin’s potential to prevent or delay common age-related disease such as cardiovascular disease, dementia and some cancers in healthy people aged 70 and over.
From its pilot study origins of 200 participants in Melbourne, the study is now an international exercise jointly run with researchers in the US, funded by the US National Institute on Aging, the NHMRC and the Victorian Cancer Agency (VCA). Some 13,000 healthy older people are already enrolled in the trial.
Early results of the ASPREE study should be known by 2018.
