Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-16T09:53:36.737Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  31 March 2010

Donna M. Wilson ,
Carolyn Ross ,
Donna Goodridge ,
Penny Davis ,
Alison Landreville  and
Kim Roebuck
Donna M. Wilson*
Affiliation:
University of Alberta
Carolyn Ross
Affiliation:
University of Alberta
Donna Goodridge
Affiliation:
University of Saskatchewan
Penny Davis
Affiliation:
University of Alberta
Alison Landreville
Affiliation:
University of Alberta
Kim Roebuck
Affiliation:
University of Alberta
*
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
Get access Rights & Permissions [Opens in a new window]

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.

Résumé

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.

Keywords

vieillissementsoins de santébesoinsethnographiecommunautépalliatifmaladie pulmonaire obstructive chroniqueaginghealth careneedsethnographycommunitypalliativechronic obstructive pulmonary disease
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 27 , Issue 4 , Winter/Hiver 2008 , pp. 347 - 357
Copyright
Copyright © Canadian Association on Gerontology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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), 133–139.CrossRefGoogle ScholarPubMed
Barnes, P.J., & Stockley, R.A. (2005). COPD: Current therapeutic interventions and future approaches. European Respiratory Journal, 25, 1084–1106.CrossRefGoogle ScholarPubMed
Blackler, L., Mooney, C., & Jones, C. (2004). Palliative care in the management of chronic obstructive pulmonary disease. British Journal of Nursing, 13(9), 518–521.CrossRefGoogle ScholarPubMed
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.Google Scholar
Canadian Thoracic Society (2003). Executive Summary. Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease—2003. Canadian Respiratory Journal, 10(Suppl. A), 4A–65A.Google Scholar
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.), S310–S313.CrossRefGoogle ScholarPubMed
Christakis, N., & Lamont, E. (2000). Extent and determinants of error in doctors' prognoses in terminally ill patients: Prospective cohort study. British Medical Journal, 329, 469–472.CrossRefGoogle Scholar
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. 123–131). London: Aesculapus Medical Press.Google Scholar
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, 287–295.CrossRefGoogle ScholarPubMed
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, 485–491.CrossRefGoogle ScholarPubMed
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, 439–445.CrossRefGoogle ScholarPubMed
Elkington, H., White, P., Higgs, R., & Johnson, P.C. (2001). GPs' views of discussions of prognosis in severe COPD. Family Practitioner, 18(4), 440–444.CrossRefGoogle ScholarPubMed
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, 69–76.CrossRefGoogle ScholarPubMed
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), 1638–1645.CrossRefGoogle ScholarPubMed
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.Google Scholar
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), 1000–1006.CrossRefGoogle ScholarPubMed
Kelly, B., & Long, A. (2001). Ethnography: A suitable course for nursing? All Ireland Journal of Nursing and Midwifery, 1(4), 135–140.Google Scholar
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), 819–823.CrossRefGoogle ScholarPubMed
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), 310–313.CrossRefGoogle ScholarPubMed
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), 399–403.CrossRefGoogle ScholarPubMed
Morse, J.M., & Field, P. (1995). Qualitative research methods for health professionals. (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
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, 1434–1440.CrossRefGoogle ScholarPubMed
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), 183–185.CrossRefGoogle ScholarPubMed
Price, B. (2004). Continuing professional development. Ethnographic research and older people. Nursing Older People, 15(10), 22–28.CrossRefGoogle Scholar
Rhodes, P. (1999). Palliative care: The situation of people with chronic respiratory disease. British Journal of Community Nursing, 4(3), 131–136.CrossRefGoogle Scholar
Shee, C. (2001). Respiratory disease. In Addington-Hall, J., & Higginson, I. (Eds.). Palliative care for non-cancer patients (pp. 20–27). Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
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, 245–254.CrossRefGoogle ScholarPubMed
Smith, I., & Newton, R. (2007). Systematic review of case management. Australian & New Zealand Journal of Psychiatry, 41(1), 2–9.CrossRefGoogle ScholarPubMed
Stokes, J., & Lindsay, J. (1996). Major causes of death and hospitalization in Canadian seniors. Chronic Diseases in Canada, 17(2), 63–73.Google ScholarPubMed
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), 167–173.CrossRefGoogle ScholarPubMed
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), 242–248.CrossRefGoogle ScholarPubMed
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), 81–86.CrossRefGoogle ScholarPubMed
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), 385–403.CrossRefGoogle Scholar