The wish to die among palliative home care clients in Ontario, Canada: A cross-sectional study.

Background: In the pursuit to provide the highest quality of person centered palliative care, client preferences, needs, and wishes surrounding end of life should be used to inform the plan of care. During a clinical assessment for care services, clients may voluntarily express a 'wish to die' either directly to the clinician or it may be indirectly reported second-hand to the clinician through an informal caregiver or family member. This is the first study using data gathered from the interRAI Palliative Care Assessment instrument (interRAI PC) to examine socio-demographic, clinical, and psycho-social factors of palliative home care clients with the voluntary expression of a 'wish to die now'.

Correlates and Predictors of Changes in Dyspnea Symptoms Over Time Among Community-Dwelling Palliative Home Care Clients.

Context: Dyspnea is a frequently reported and highly distressing symptom for persons nearing end of life, affecting the quality of living and dying.

Objectives: This study described health and clinical characteristics of persons experiencing dyspnea who receive palliative home care services and identified factors affecting change in dyspnea over time.

Methods: Anonymized assessments (N = 6655 baseline; 959 follow-up) from the interRAI palliative care assessment instrument (interRAI PC) were collected during pilot implementation (2006-2011).

Care planning needs of palliative home care clients: Development of the interRAI palliative care assessment clinical assessment protocols (CAPs).

Background: The interRAI Palliative Care (interRAI PC) assessment instrument provides a standardized, comprehensive means to identify person-specific need and supports clinicians to address important factors such as aspects of function, health, and social support. The interRAI Clinical Assessment Protocols (CAPs) inform clinicians of priority issues requiring further investigation where specific intervention may be warranted and equip clinicians with evidence to better inform development of a person-specific plan of care. This is the first study to describe the interRAI PC CAP development process and provide an overview of distributional properties of the eight interRAI PC CAPs among community dwelling adults receiving palliative home care services.

Prevalence and risk factors of depressive symptoms in a Canadian palliative home care population: a cross-sectional study.

Background: Depression in palliative care patients is important because of its intrinsic burden and association with elevated physical symptoms, reduced immunity and increased mortality risk. Identifying risk factors associated with depression can enable clinicians to more readily diagnose it, which is important since depression is treatable. The purpose of this cross-sectional study was to determine the prevalence of depressive symptoms and risk factors associated with them in a large sample of palliative home care patients.

Predictors of caregiver distress among palliative home care clients in Ontario: evidence based on the interRAI Palliative Care.

Objective: This study examines predictors of caregiver distress among community-based palliative care clients. Analyses are based upon interRAI Palliative Care (interRAI PC) assessment data from palliative home care programs in three regions in Ontario, Canada.

Method: The study sample involved all community-based palliative care clients in Ontario who were assessed with the interRAI PC as part of normal clinical practice during pilot implementation of the instrument between 2007 and 2009 (N = 3,929).

Use of physical restraints and antipsychotic medications in nursing homes: a cross-national study.

Objectives: This study compares inter- and intra-country differences in the prevalence of physical restraints and antipsychotic medications in nursing homes, and examines aggregated resident conditions and organizational characteristics correlated with these treatments.

Methods: Population-based, cross-sectional data were collected using a standardized Resident Assessment Instrument (RAI) from 14,504 long-term care facilities providing nursing home level services in five countries participating in the interRAI consortium, including Canada, Finland, Hong Kong (Special Administrative Region, China), Switzerland, and the United States. Facility-level prevalence rates of physical restraints and antipsychotic use were examined both between and within the study countries.

Predicting social isolation among geriatric psychiatry patients.

Background: This exploratory study examines factors associated with isolation from informal social ties among geriatric psychiatry inpatients. Specifically, it examines the associations of diagnoses, psychiatric history, and measures of current functioning with social isolation.

Methods: Analyses rely upon data derived from the Resident Assessment Instrument-Mental Health (RAI-MH), which is a patient focused, multidimensional, comprehensive assessment instrument designed to be a component of a larger, integrated health information system linking mental health with home care, long-term care, acute care, rehabilitation, and palliative care.

Determinants of do-not-resuscitate orders in palliative home care.

Overview: Do-not-resuscitate (DNR) orders allow home care clients to communicate their own wishes over medical treatment decisions, helping to preserve their dignity and autonomy. To date, little is known about DNR orders in palliative home care. Basic research to identify rates of completion and determinants of DNR orders has yet to be examined in palliative home care.

Factors associated with pressure ulcers in palliative home care.

Background: Studies have identified factors associated with pressure ulcers in many health care settings including acute care, complex continuing care, long-term care, and home care.

Objective: The purpose of this study was to identify factors associated with pressure ulcers among palliative home care clients. Identifying associations specific to each setting is important for ulcer prevention and has implications for clients overall well-being and quality of life.

Depression in patients with advanced illness: an examination of Ontario complex continuing care using the Minimum Data Set 2.0.

Objective: In this study, we examined the prevalence of depression, its recognition, and its treatment in continuing care patients with advanced illness (AI).

Methods: All data were obtained from the Ontario (Canada) provincially-mandated MDS 2.0 form for chronic care.

Relationship of vigorous physical activity to psychologic distress among adolescents.

This article examines the relationship between vigorous physical activity and psychologic distress (by using the General Health Questionnaire-12) among a sample of 2,104 adolescents. Multiple regression analysis revealed a differential relationship between physical activity and dimensions of the General Health Questionnaire-12. Specifically, vigorous physical activity was related significantly to problems with social functioning but not to depression or anxiety.

The Resident Assessment Instrument-Mental Health (RAI-MH): inter-rater reliability and convergent validity.

An important challenge facing behavioral health services is the lack of good quality, clinically relevant data at the individual level. The article describes a multinational research effort to develop a comprehensive, multidisciplinary mental health assessment system for use with adults in facilities providing acute, long-stay, forensic, and geriatric services. The Resident Assessment Instrument-Mental Health (RAI-MH) comprehensively assesses psychiatric, social, environmental, and medical issues at intake, emphasizing patient functioning.