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The Care Needs of Community-Dwelling Seniors Suffering from Advanced Chronic Obstructive Pulmonary Disease

  • Donna M. Wilson (a1), Carolyn Ross (a1), Donna Goodridge (a2), Penny Davis (a1), Alison Landreville (a1) and Kim Roebuck (a1)...

Abstract

Aim: This study was undertaken to determine the care needs of Canadian seniors living at home with advanced chronic obstructive pulmonary disease (COPD).

Background: COPD is a leading cause of morbidity and mortality worldwide. Although hospitalizations for illness exacerbations and end-stage care may be common, most persons with COPD live out their lives in the community. Little is known about the care needs of this significant population.

Methods: This study was guided by the research question: “What are the care needs and care priorities of senior citizens with end-stage COPD?” An ethnographic qualitative approach was used to address this question. Twelve community-dwelling seniors living in a Canadian city and diagnosed with advanced COPD were interviewed three times in their homes over an eight-month period in 2006.

Findings: Three themes emerged, each with concrete care needs: (a) self-reliance and independence through adaptation, (b) stable health through maintenance, and (c) living with constraints. The predominant theme was that all participants wanted to maintain their independence. This required considerable adaptation, as well as assistance from others.

Conclusions: Ensuring and improving assistance is important to prevent additional suffering and reduce exacerbations requiring hospitalization, a particularly important aim given the high and rising incidence of advanced COPD. A number of other insightful findings reveal the significance of learning directly from the persons who live with chronic illnesses about their lives.

But: La présente étude visait à déterminer les besoins en matière de soins de santé des aînés du Canada vivant à domicile et souffrant de maladie pulmonaire obstructive chronique (MPOC) avancée.

Données générales: La MPOC est l'une des principales causes de morbidité et de mortalité dans le monde. Bien qu'il soit courant qu'une personne soit hospitalisée lors de l'exacerbation d'un processus morbide et qu'elle ait besoin de soins en phase terminale, la plupart des personnes souffrant de MPOC passent toute leur vie dan la communauté. On sait peu de choses sur les besoins en soins de santé de cette importante population.

Méthodes: La présente étude reposait sur le protocole de recherche: «Quels sont, en matière de soins de santé et de priorités, les besoins et les priorités des aînés souffrant de MPOC en phase terminale?» Nous avons utilisé une méthode ethnographique qualitative pour traiter cette question. Douze aînés vivant dans la communauté dans une ville canadienne et ayant reçu un diagnostic de MPOC avancée ont été interviewés trois fois chez eux au cours d'une période de huit mois en 2006.

Résultats: Trois thèmes ont été dégagés, chacun assorti de besoins concrets en soins de santé: a)autonomie et indépendance par l'adaptation, b) santé stable grâce à des soins intégrés, et c) vivre avec des contraintes. Le thème prédominant était que tous les participants souhaitaient conserver leur indépendance. Cette situation exigeait une adaptation considérable, ainsi que l'aide des autres.

Conclusions: Il est important d'assurer et d'améliorer l'aide si l'on veut éviter des souffrances supplémentaires et réduire les exacerbations exigeant l'hospitalisation, un but particulièrement important étant donné l'incidence élevée et croissante de MPOC avancée. D'autres résultats éclairants révèlent l'importance de l'apprentissage direct de personnes qui vivent presque toute leur vie affligées d'une maladie chronique.

Copyright

Corresponding author

Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à: Donna M. Wilson, R.N., Ph.D., Caritas Nurse Scientist and Professor, Faculty of Nursing, Third Floor Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3, donna.wilson@ualberta.ca

References

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Arvidsson, S.B., Petersson, A., Nilsson, I., Andersson, B., Arvidsson, B.I., Petersson, I.F., & Fridlund, B.B. (2006). A nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis: A qualitative study. Nursing and Health Sciences, 8(3), 133139.
Barnes, P.J., & Stockley, R.A. (2005). COPD: Current therapeutic interventions and future approaches. European Respiratory Journal, 25, 10841106.
Blackler, L., Mooney, C., & Jones, C. (2004). Palliative care in the management of chronic obstructive pulmonary disease. British Journal of Nursing, 13(9), 518521.
Canadian Hospice Palliative Care Association (2002). A model to guide hospice palliative care: Based on national principles and norms of practice. Retrieved 7 Jan. 2007 from http://www.chpca.net/marketplace/national_norms/national_norms_of_practice.htm.
Canadian Thoracic Society (2003). Executive Summary. Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease—2003. Canadian Respiratory Journal, 10(Suppl. A), 4A65A.
Carpenter, G.I. (2005). Aging in the United Kingdom and Europe – a snapshot of the future? Journal of the American Geriatrics Society, 53(9 Suppl.), S310S313.
Christakis, N., & Lamont, E. (2000). Extent and determinants of error in doctors' prognoses in terminally ill patients: Prospective cohort study. British Medical Journal, 329, 469472.
Davis, C. (2001). Organizing the provision of effective palliative care services for patients with advanced chronic obstructive pulmonary disease. In Wedzicha, J., Ind, P., & Miles, A.(Eds.), The effective management of chronic obstructive pulmonary disease. (pp. 123131). London: Aesculapus Medical Press.
Edmonds, P., Karlsen, S., Khan, S., & Addington-Hall, J. (2001). A comparison of the palliative care needs of patients dying with chronic respiratory disease and lung cancer. Palliative Medicine, 15, 287295.
Elkington, H., White, P., Addington-Hall, J., Higgs, R., & Edmonds, P. (2005). The healthcare needs of chronic obstructive pulmonary disease patients in the last year of life. Palliative Medicine, 19, 485491.
Elkington, H., White, P., Addington-Hall, J., Higgs, R., & Pettinari, (2004). The last year of life of COPD: A qualitative study of symptoms and services. Respiratory Medicine, 98, 439445.
Elkington, H., White, P., Higgs, R., & Johnson, P.C. (2001). GPs' views of discussions of prognosis in severe COPD. Family Practitioner, 18(4), 440444.
Engstrom, C., Persson, L., Larson, S., & Sullivan, M. (2001). Health-related quality of life in COPD. Why both disease-specific and generic measures should be used. European Respiratory Journal, 18, 6976.
Fox, E., Landrum-McNiff, K., Zhong, Z., Dawson, N.V., Wu, A.W., & Lynn, J. (1999). Evaluation of prognostic criteria for determining hospice eligibility in patients with advanced lung, heart, or liver disease. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Journal of the American Medication Association, 282(17), 16381645.
Global Initiative for Chronic Obstructive Lung Disease (2006). Global strategy for the diagnosis, management, and prevention of COPD. Retrieved 28 June from http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=996.
Gore, J.M., Brophy, C.J., & Greenstone, M.A. (2000). How well do we care for patients with end-stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax, 55(12), 10001006.
Kelly, B., & Long, A. (2001). Ethnography: A suitable course for nursing? All Ireland Journal of Nursing and Midwifery, 1(4), 135140.
Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324(7341), 819823.
Jones, I., Kirby, A., Ormiston, P., Loomba, Y., Chan, K., Rout, J., Nagle, J., Wardman, L., & Hamilton, S. (2004). The needs of patients dying of chronic obstructive pulmonary disease in the community. Family Practice, 21(3), 310313.
Maudlin, J., Keene, J., & Kobb, R. (2006). A road map for the last journey: Home telehealth for holistic end-of-life care. American Journal of Hospice & Palliative Care, 23(5), 399403.
Morse, J.M., & Field, P. (1995). Qualitative research methods for health professionals. (2nd ed.). Thousand Oaks, CA: Sage.
Nishimura, K., Izumi, T., Tsukino, M., & Oga, T. (2002). Dyspnoea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest, 121, 14341440.
O'Donnell, D.E., Hernandez, P., Aaron, S., Bourbeau, J., Marciniuk, D., Hodder, R., Balter, M., Ford, G., Gervais, A., Goldstein, R., Maltais, F., Road, J., McKay, V., & Schenkel, J. (2003). Canadian Thoracic Society Canadian Thoracic Society COPD guidelines: Summary of highlights for family doctors. Canadian Respiratory Journal, 10(4), 183185.
Price, B. (2004). Continuing professional development. Ethnographic research and older people. Nursing Older People, 15(10), 2228.
Rhodes, P. (1999). Palliative care: The situation of people with chronic respiratory disease. British Journal of Community Nursing, 4(3), 131136.
Shee, C. (2001). Respiratory disease. In Addington-Hall, J., & Higginson, I. (Eds.). Palliative care for non-cancer patients (pp. 2027). Oxford, UK: Oxford University Press.
Skilbeck, J., Mott, L., Page, H., Smith, D., Hjelmeland-Ahmedzai, S., & Clark, D. (1998). Palliative care in chronic obstructive airways disease: A needs assessment. Palliative Medicine, 12, 245254.
Smith, I., & Newton, R. (2007). Systematic review of case management. Australian & New Zealand Journal of Psychiatry, 41(1), 29.
Stokes, J., & Lindsay, J. (1996). Major causes of death and hospitalization in Canadian seniors. Chronic Diseases in Canada, 17(2), 6373.
Van Pelt, D.C., Milbrandt, E.B., Oin, L., Weissfeld, I.A., Rotondi, A.J., Schulz, R., Cherlluri, L., Angus, D.C., & Pinsky, M.R. (2007). Informal caregiver burden among survivors of prolonged mechanical ventilation. American Journal of Respiratory & Critical Care Medicine, 175(2), 167173.
Wagena, E.J., Arrindell, W.A., Wouters, E.F.M., & van Schayck, C.P. (2005). Are patients with COPD psychologically distressed? European Respiratory Journal, 26(2), 242248.
Wilson, D.M. (2002). The duration and degree of end-of-life dependency of home care clients and hospital inpatients. Applied Nursing Research, 15(2), 8186.
Wilson, D.M., Northcott, H.C., Truman, C.D., Smith, S.L., Anderson, M.C., Fainsinger, R.L., & Stingl, M.J. (2001). Location of death in Canada: A comparison of 20th-century hospital and nonhospital locations of death and corresponding population trends. Evaluation & the Health Professions, 24(4), 385403.
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Canadian Journal on Aging / La Revue canadienne du vieillissement
  • ISSN: 0714-9808
  • EISSN: 1710-1107
  • URL: /core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement
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