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Biomedical subjects

A Groth-Juncker

Publications and source records attributed to A Groth-Juncker.

8 recordsLinked to original sources
PubMed1994

Comfort care for terminally ill patients. The appropriate use of nutrition and hydration.

OBJECTIVE: To determine the frequency of symptoms of hunger and thirst in a group of terminally ill patients and determine whether these symptoms could be palliated without forced feeding, forced hydration, or parenteral alimentation. DESIGN: Prospective evaluation of consecutively admitted terminally ill patients treated in a comfort care unit. SETTING: Ten-bed comfort care unit in a 471-bed long-term care facility. PARTICIPANTS: Mentally aware, competent patients with terminal illnesses monitored from time of admission to time of death while residing in the comfort care unit. MAIN OUTCOME MEASURES: Symptoms of hunger, thirst, and dry mouth were recorded, and the amounts and types of food and fluids necessary to relieve these symptoms were documented. The subjective level of comfort was assessed longitudinally in all patients. RESULTS: Of the 32 patients monitored during the 12 months of study, 20 patients (63%) never experienced any hunger, while 11 patients (34%) had symptoms only initially. Similarly, 20 patients (62%) experienced either no thirst or thirst only initially during their terminal illness. In all patients, symptoms of hunger, thirst, and dry mouth could be alleviated, usually with small amounts of food, fluids, and/or by the application of ice chips and lubrication to the lips. Comfort care included use of narcotics for relief of pain or shortness of breath in 94% of patients. CONCLUSIONS: In this series, patients terminally ill with cancer generally did not experience hunger and those who did needed only small amounts of food for alleviation. Complaints of thirst and dry mouth were relieved with mouth care and sips of liquids far less than that needed to prevent dehydration. Food and fluid administration beyond the specific requests of patients may play a minimal role in providing comfort to terminally ill patients.

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PubMed1985

A randomized controlled study of a home health care team.

This report describes the findings of a randomized study of a new team approach to home care for homebound chronically or terminally ill elderly. The team includes a physician, nurse practitioner, and social worker delivering primary health care in the patient's home, including physician house calls. Weekly team conferences assure coordination of patient care. The team is available for emergency consultation through a 24-hour telephone service. The team physician attends to the patient during necessary hospitalizations. This approach was evaluated in a randomized experimental design study measuring its impact on health care utilization, functional changes in patients, and patient and caretaker satisfaction. The team patients had fewer hospitalizations, nursing home admissions, and outpatient visits than the controls. They were more often able to die at home, if this was their wish. As expected, they used more in-home services, measured in weighted cost figures; their overall cost was lower than their controls, but the difference was not statistically significant. Their functional abilities did not change differently from the controls, but they, and especially their informal caretakers in the home, expressed significantly higher satisfaction with the care received.

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PubMed1984

Effects of a physician-led home care team on terminal care.

Inconsistent results in studies of cost-effectiveness of home health care have led to the need for identification of target populations for whom cost-savings can be anticipated if expanded home care programs are introduced. This analysis of results of a randomized controlled study of efficacy of a physician/geriatric nurse practitioner/social worker home care team identifies such a potential target population. The team provides round-the-clock on-call medical services in the home when needed, in addition to usual nursing and other home care services, to home-bound chronically or terminally ill elderly patients. Overall health services utilization and estimated costs were not substantially different for the patients who did not die while in the study; however, for those who did die, team patients had considerably lower rates of hospitalization and overall cost than controls, and more frequently died at home. Of 21 team and 12 control patients who died but had at least two weeks of utilization experience in the study, team patients had about half the number of hospital days compared with controls during the terminal two weeks, and although they had more home care services, had only 69 per cent of the estimated total health care costs of the controls. Satisfaction with care received was significantly greater among the total group of team patients, and especially among their family caretakers, than among controls. This model is effective in providing appropriate medical care for seriously ill and terminal patients, and in enabling them to die at home if they so wish, while at the same time reducing costs of care during the terminal period.

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PubMed1983

Where do elderly patients prefer to die? Place of death and patient characteristics of 100 elderly patients under the care of a home health care team.

This report describes the places of death of 100 elderly home-bound patients served by a home health care team. It compares some medical and psychosocial characteristics of the patients who died at home and the patients who died in an institution, and examines the factors that lead to death in an institutional setting for patients who had planned to die at home. All patients at the time of admission to team care had wished to receive care at home. The preferred place of death or type of care when death became imminent were not discussed at that time. Of the 100 patients who died, 55 died in their own homes and 43 died either in a hospital (33 patients) or in a nursing home (ten patients). Two patients died unexpectedly, either at home or on their way to the hospital. Sociodemographic variables such as age, sexual gender, Medicaid status, living arrangements, diagnosis, and pain level did not appear to be related to place of death. The patient's expressed wish for one or the other option seemed the key factor. Failure to provide death at home to 19 patients was mostly due to a prolonged terminal phase leading to emotional and physical exhaustion in the patient or the family.

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PubMed1983

A time-motion study of patient care activities of a geriatric home care team.

A self-administered time-motion study of the activities of a home care team, consisting of physician, nurse practitioner and social worker is reported. The patients were home-bound, chronically or terminally ill and largely elderly, and the physician and nurse practitioner were available by telephone and for emergency visits on a 24-hour, 7 day per week basis. A systematic sample of 24 hour calendar days was studied; the average team patient census was 54 (the team had other clinical responsibilities in addition). Time spent on travel, home visits and on team conferencing and consultation was higher than in other practices, as might be expected. Full-time equivalent requirements for this type of care program were extrapolated to come to approximately one physician and social worker and one and one-half nurse practitioner per 100 patients. A truer estimate of actual costs of provision of team services to home-bound patients can be provided by this method than by the usual calculation of charges based only on actual home visits.

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PubMed1982

Off-hour telephone calls to a geriatric home care team.

This is a study of off-hour telephone calls to a physician/nurse practitioner/social worker team available on a round-the-clock basis to a population, averaging 54 in number, of chronically or terminally ill home-bound elderly patients. Most calls could reasonably be considered urgent and appropriate, and only about three per month necessitated immediate home visits: the off-hours time demand is not excessive and can be managed with appropriate practice organization and provider-patient understanding.

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