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NIELSEN, Mette Kjaergaard

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Poor physical and mental health predicts prolonged grief disorder - a prospective, population-based cohort study on caregivers of patients at the end of life

LENGER, Maja Krarup ; NEERGAARD, Mette Asbjoern ; GULDIN, Mai-Britt ; NIELSEN, Mette Kjaergaard
PALLIATIVE MEDICINE, 23/08/2020, p. 1-9

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Thème : Soins. Cote : e00.07PAL

ETUDE PROSPECTIVE ; ETAT PSYCHOLOGIQUE ; FIN VIE ; AIDANT ; PERSONNE ENDEUILLEE ; DEUIL COMPLIQUE ; DANEMARK ; QUALITE VIE ; EVALUATION

Background: The health of caregivers can be affected during end-of-life caregiving. Previous cross-sectional studies have indicated an association between poor health status and prolonged grief disorder, but prospective studies are lacking.
Aim: To describe physical and mental health status in caregivers of patients at the end of life, and to investigate whether caregivers’ health status during caregiving predict prolonged grief disorder.
Design: A population-based prospective survey was conducted. Health status was measured in caregivers during caregiving (SF-36), and prolonged grief disorder was assessed 6 months after bereavement (Prolonged Grief-13). We calculated mean scores of health status and explored the association with prolonged grief disorder using logistic regression adjusted for age, gender and education.
Setting/participants: The health in caregivers of patients granted drug reimbursement due to terminal illness in Denmark in 2012 was assessed during caregiving and 6 months after bereavement (n = 2125).
Results: The SF-36 subscale ‘role-physical’ concerning role limitations due to physical health, the ‘mental health’ component score, and all ‘mental health’ subscales showed significantly worse health in the participants than in the general population. Both poor physical health (adjusted OR: 1.05 (95% CI: 1.04–1.07)) and poor mental health (adjusted OR: 1.09 (95% CI: 1.07–1.11)) predicted prolonged grief disorder.
Conclusion: Caregivers scored lower on one physical subscale and all mental health measures than the general population. Prolonged grief disorder was predicted by poor physical and mental health status before bereavement. Future research is needed on the use of health status in systematic assessment to identify caregivers in need of support.

Origine : PubMed

Mortality communication and post-bereavement depression among Danish family caregivers of terminal cancer patients

BACHNER, Yaacov G. ; GULDIN, Mai-Britt ; NIELSEN, Mette Kjærgaard
Supportive care in cancer, 20/08/2020, Pagination inconnue

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Thème : Soins.

DANEMARK ; AIDANT ; CANCER ; DEPRESSION ; COMMUNICATION ; MORT ; PERSONNE ENDEUILLEE ; DEUIL

PURPOSE: Depression is the most common negative reaction among family caregivers of terminal cancer patients, persisting to post-bereavement. A modifiable factor associated with depression is mortality communication (i.e., caregiver-relative communication about illness and impending death). The purpose of this study was to examine the impact that mortality communication has on family caregiver's depression after bereavement, and to translate into Danish and examine the construct validity of the caregiver communication with patients about illness and death scale (CCID; Bachner et al. Omega 57(4):381-397, 2008).
METHODS: A total of 1475 Danish family caregivers (partners and adult children) of terminal cancer patients, in both general and specialized palliative care settings, participated in the study. Respondents completed questionnaires twice: during caregiving and 6 months after the death of their relative.
RESULTS: Results of the hierarchical regression analyses showed that discussing illness and death with one's ill relative was associated with fewer depressive symptoms after bereavement, adjusted for depressive symptoms in the final year of caregiving and socio-demographic characteristics. For both partners and adult children, each of the five CCID items contributed significantly to measurement of a mortality communication latent construct. Moreover, the relative contribution of all five items was consistent across caregiver groups supporting the reliability of measurement.
CONCLUSION: As in Hebrew, Arabic, and English, the CCID can be used with confidence among Danish family caregivers. Mortality communication is a significant factor that may predict depressive symptoms while caregiving and also after the care recipient's death. This factor should be considered for inclusion in early family caregiver interventions.

Origine : PubMed

Predictors for place of death among children - a systematic review and meta-analyses of recent literature

WOLFF, Sanne Lausen ; CHRISTIANSEN, Christian Fynbo ; NIELSEN, Mette Kjaergaard ; JOHNSEN, Soeren Paaske ; SCHROEDER, Henrik ; NEERGAARD, Mette Asbjoern
European journal of pediatrics, 30/06/2020, Pagination inconnue

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Thème : Age de la vie, situations spécifiques liées à la fin de vie.

DEMARCHE PALLIATIVE ; ENFANT ; REVUE SYSTEMATIQUE ; LIEU DECES ; PREFERENCE ; DANEMARK ; META-ANALYSE

Through a systematic review and meta-analyses, we aimed to determine predictors for place of death among children. We searched online databases for studies published between 2008 and 2019 comprising original quantitative data on predictors for place of death among children. Data regarding study design, population characteristics and results were extracted from each study. Meta-analyses were conducted using generic inverse variance method with random effects. Fourteen cohort studies met the inclusion criteria, comprising data on 106,788 decedents. Proportions of home death varied between countries and regions from 7% to 45%. Lower age was associated with higher odds of hospital death in eight studies (meta-analysis was not possible). Children categorised as non-white were less likely to die at home compared to white (pooled OR 0.6; 95% CI 0.5-0.7) as were children of low socio-economic position versus high (pooled OR 0.7; 95% CI 0.6-0.9). Compared to patients with cancer, children with non-cancer diagnoses had lower odds of home death (pooled OR 0.5; 95% CI 0.5-0.5).
Conclusion: Country and region of residence, older age of the child, high socio-economic position, 'white' ethnicity and cancer diagnoses appear to be independent predictors of home death among children.
What is Known: ; Home is often considered an indicator of quality in end-of-life care. ; Most terminally ill children die in hospitals.
What is New: ; Through a systematic review and meta-analyses, this study examined predictors for place of death among children. ; Country and region of residence, older age of the child, high socio-economic position, white ethnicity and having a cancer diagnosis appear to be independent predictors of home death among terminally ill children.

Origine : PubMed

What socio-economic factors determine place of death for people with life-limiting illness? - a systematic review and appraisal of methodological rigour

NEERGAARD, Mette Asbjoern ; BRUNOE, Anne Hostrup ; SKORSTENGAARD, Marianne Hjorth ; NIELSEN, Mette Kjaergaard
PALLIATIVE MEDICINE, 09/2019, vol.33, n°8, p. 900-925

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Thème : Santé. Cote : 00.07PAL

FACTEUR ; LIEU DECES ; MALADIE LETALE ; DEMARCHE PALLIATIVE ; MORT ; ADULTE ; SOCIOLOGIE ; ECONOMIE SANTE ; SOCIODEMOGRAPHIE ; REVENU ; TRAVAIL ; MILIEU URBAIN ; REVUE SYSTEMATIQUE

BACKGROUND: Socio-economic factors play important roles in place of death. However, up-to-date knowledge on socio-economic determinants for place of death is warranted including analysis of collinearity between socio-economic determinants.
AIM: To examine associations between socio-economic determinants (social class, deprivation level in area of residence, income, education, occupation, urbanisation) and place of death among adult patients with life-limiting illnesses. Furthermore, to describe how these factors are operationalised and examined for collinearity.
DESIGN: A systematic review was performed (PROSPERO, record: CRD42018091218) and quality was assessed using the Newcastle-Ottawa Scale.
DATA SOURCES: A comprehensive search of PubMed, Embase, CINAHL, Scopus and PsycINFO was conducted for studies published from 1 January 2008 until the date of the search (23 March 2018) in English or Scandinavian languages.
RESULTS: Of the 1599 unique citations identified, 34 studies were eligible. Dying at home was to a high degree associated with better financial situation and living in rural areas. Furthermore, hospital death was associated with a high level of deprivation in the area of residence and being employed. Regarding educational level, we found mixed and inconclusive results.
CONCLUSION: Inequalities concerning place of death were found, and attention towards socio-economic inequality concerning place of death is necessary, especially in patients with a poor financial status, patients living in deprived and metropolitan areas and patients who are employed. Furthermore, we found a low degree of assessment for collinearity and adjustment of socio-economic variables. These issues should be considered in planning of future studies of socio-economic determinants for place of death.

Origine : PubMed

Socioeconomic inequality in drug reimbursement during end-of-life care - a nationwide study

DAUGAARD, Cecilie ; NEERGAARD, Mette Asbjoern ; VESTERGAARD, Anne Høy Seeman ; NIELSEN, Mette Kjærgaard ; JOHNSEN, Søren Paaske
Journal of epidemiology and community health, 02/02/2019, Pagination inconnue

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Thème : Santé.

FIN VIE ; DANEMARK ; PHASE TERMINALE ; COUVERTURE MALADIE ; ACCES SOIN

Background In Denmark, patients who are terminally ill have the right to drug reimbursement due to terminal illness (DRTI). DRTI, a proxy marker of planned end-of-life care, is intended to be equally accessible regardless of socioeconomic position. This study examined social and socioeconomic differences in DRTI among Danish patients who are terminally ill.
Methods This cross-sectional study based on individual-level nationwide data included all patients dying from cancer, dementia, ischaemic heart disease, chronic obstructive pulmonary disease, chronic liver disease, congestive heart failure, diabetes or stroke in 2006–2015 (n=307 188). We analysed associations between social and socioeconomic position (education, income, cohabiting status, migrant status and employment) and DRTI. Prevalence ratios (PR) and 95% CIs were estimated using log-linear models adjusted for age, gender, comorbidity, cause of death and residence.
Results Overall, 27.9% of patients received DRTI (n=85 616). A substantial difference in likelihood of receiving DRTI was observed among patients with a social and socioeconomic profile associated with the highest versus lowest probability of DRTI (adjusted PR 1.44, 95% CI 1.18 to 1.75). The probability of DRTI was higher among patients with high income compared with low income (adjusted PR 1.22, 95% CI 1.17 to 1.26). Also, living with a partner and being immigrant or descendant of such were associated with higher probability of DRTI compared with living alone and of Danish origin, whereas employment was associated with lower probability of DRTI compared with retirement.
Conclusion Social and socioeconomic position was associated with the likelihood of receiving DRTI, which indicates that planned end-of-life care is not equally accessible in Denmark.

Origine : PubMed

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ACCES SOIN ADULTE AIDANT CANCER COMMUNICATION COUVERTURE MALADIE DANEMARK DEMARCHE PALLIATIVE DEPRESSION DEUIL FIN VIE LIEU DECES MORT PERSONNE ENDEUILLEE REVUE SYSTEMATIQUE

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