Dying in a nursing home

Treatable medical symptoms linked to work environment in nursing homes, study shows.


(Edmonton) In their final year of life, many Canadian seniors living in nursing homes suffer from medical symptoms that could be treated but are not.

Carole Estabrooks, Canada Research Chair in Knowledge Translation and professor in the Faculty of Nursing at the University of Alberta, and her research team found that treatable medical symptoms are more frequent and increase strikingly over the final year of life.

The results, published in the Journal of the American Medical Directors Association, reveal that vulnerable Canadian seniors are experiencing unnecessary pain and suffering, and that there are higher health-care costs associated with looking after these patients.

The researchers, funded by the Canadian Institutes of Health Research and partners, looked at data collected on 3,647 residents and 1,381 front-line care staff in 36 nursing homes across Western Canada. Estabrooks and her team examined the typical and treatable symptoms that are experienced by nursing home residents, such as pain and delirium.

Her team's work, however, also yielded some encouraging findings that offer up insight into how this situation might be remedied.

They found a link between the work environment in nursing homes—like the amount of participation front-line staff have in care planning and decisions and available resources—and the level of treatable symptoms in the final year of life.

Based on Estabrooks’s results, nursing homes can direct their efforts to improving those specific features and reducing the treatable symptoms that cause unnecessary pain and suffering. These specific features should be a priority for quality improvement.

The need for quality improvement in nursing home care is high, notes Estabrooks. The number of Canadian seniors continues to increase sharply. By 2021, 19 per cent of Canadians will be over 65 years old. By 2041, 24 per cent of the population will be over 65, with seniors over 75 the most rapidly growing group.

Highly vulnerable seniors, such as those with dementia or frail elderly, have complex health needs and are highly dependent on their caregivers in nursing homes.

A new avenue for improving care

“The cornerstone of high-quality care in the final years of life is ensuring that nursing home residents are free of pain and other potentially burdensome symptoms,” says Estabrooks, whose study is the first is the first of its kind in Canada. “Many factors combine to influence how distressing medical symptoms are handled by nursing homes in the final year of life.”

The results of this research offer a new avenue for improving quality of patient care. Using measurement tools that Estabrooks and colleagues developed, researchers, nursing home operators and provincial health agencies can sharpen their focus on measurable and modifiable features of the work environment in nursing homes. 

“Change is clearly needed to ensure that Canadian seniors living and dying in nursing homes are able to do so with comfort and dignity,” says Estabrooks. “This research is an important step in identifying trends in residents’ experiences of troubling symptoms as they approach death, and in considering strategies for policies and practices in nursing homes.”

The study is part of the larger TREC research program (Translating Research in Elder Care).