Palliative Care Needs Assessment in NY Nursing Homes: Psychiatric Symptoms

TL;DR

This study assesses the need for psychiatric symptom management in palliative care for nursing home residents in New York.

Contribution

The study highlights the role of professional palliative care experience in identifying and managing psychiatric symptoms in nursing homes.

Findings

Over 60% of respondents reported psychiatric symptom management needs in at least half of their patients.

Nearly half of respondents treated psychiatric symptoms weekly and felt comfortable doing so.

Professional palliative care experience was linked to better recognition and management of psychiatric symptoms.

Abstract

Palliative care is specialized medical care aimed at improving quality of life for individuals with serious illnesses. Serious illness is prevalent among nursing home (NH) residents but integration of palliative care in NHs remains limited. Psychiatric comorbidities predict NH placement among older adults with serious illnesses, so the psychiatric domain of palliative care may be particularly critical in this setting. We conducted a palliative care needs assessment survey of 597 staff across seven NHs in New York. Our survey assessed staff experiences with specific domains of palliative care. Here, we present findings pertaining to the psychiatric components of palliative care: what proportion of respondents’ patients would benefit from psychiatric symptom management, the frequency with which respondents addressed psychiatric symptoms, and respondents’ comfort managing psychiatric symptoms. Over half of respondents (60.5%) identified psychiatric symptom management needs in at least half of their patients. Nearly half of respondents treated psychiatric symptoms at least weekly (49.2%) and felt comfortable treating psychiatric symptoms (48.7%). Staff with professional palliative care experience were likelier than those without to identify psychiatric needs in their patients (aOR 1.62 [1.07, 2.43]), treat psychiatric symptoms at least weekly (aOR 1.97 [1.29, 3.01]), and report comfort with treating psychiatric symptoms (aOR=1.54 [1.01, 2.35]). Professional experience in palliative care was was associated with increased recognition of psychiatric symptoms, and increased frequency and comfort in managing these symptoms. This suggests that workforce development in palliative care for NH staff may improve capacity in managing challenging psychiatric comorbidities.