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Rapid review of decision-making for place of care and death in older people: Lessons for COVID-19

Published online by Cambridge University Press:  13 August 2021

E. West ,
K. Moore ,
N. Kupeli ,
E. Sampson ,
P. Nair ,
N. Aker  and
N. Davies
E. West*
Affiliation:
Division Of Psychiatry, University College London, Marie Curie Palliative Care Research Society, London, United Kingdom
K. Moore
Affiliation:
Division Of Psychiatry, University College London, Marie Curie Palliative Care Research Society, London, United Kingdom
N. Kupeli
Affiliation:
Division Of Psychiatry, University College London, Marie Curie Palliative Care Research Society, London, United Kingdom
E. Sampson
Affiliation:
Division Of Psychiatry, University College London, Marie Curie Palliative Care Research Society, London, United Kingdom
P. Nair
Affiliation:
Research Department Of Primary Care And Population Health, Centre for ageing population Studies, London, United Kingdom
N. Aker
Affiliation:
Research Department Of Primary Care And Population Health, Centre for ageing population Studies, London, United Kingdom
N. Davies
Affiliation:
Research Department Of Primary Care And Population Health, Centre for ageing population Studies, London, United Kingdom
*
*Corresponding author.

Abstract

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Introduction

The coronavirus pandemic (COVID-19) has affected the functioning and capacity of healthcare systems worldwide. COVID-19 has also disproportionately affected older adults, including those living with dementia. In the context of COVID-19, decision-making surrounding place of care and place of death in this population involves significant new challenges.

Objectives

To explore key factors that influence place of care and place of death decisions in older adults. A secondary aim was to investigate key factors that influence the process and outcome of these decisions in older adults. To apply findings from current evidence to the context of COVID-19.

Methods

Rapid review of reviews, undertaken using WHO guidance for rapid reviews. Ten papers were included for full data extraction. These papers were published between 2005-2020. Data extracted was synthesised using narrative synthesis, with thematic analysis and tabulation.

Results

Papers included discussed actual place of death, as well as preferred. Results were divided into papers that explored the process of decision-making, and those that explored decision-making outcomes. Factors such as caregiver capacity, the availability of multidisciplinary teams, cultural appropriateness of care packages and advanced care planning were found to be key.

Conclusions

The process and outcomes of decision-making for older people are affected by many factors – all of which have the potential to influence both patients and caregivers experience of illness and dying. Within the context of COVID-19, such decisions may have to be made rapidly and be reflexive to changing needs of systems and of families and patients.

Keywords

Decision-makingCOVID-19Place of Care / Place of DeathAdvance Care Planning
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S273
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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