Annals of Long Term Care

From the Journal of the American Geriatrics Society

Physician Communication with Family Caregivers of Long-Term Care Residents at the End of Life
Holly Biola, MD, MPH, Philip D. Sloane, MD, MPH, Christianna S. Williams, PhD, Timothy P. Daaleman, DO, MPH, Sharon W. Williams, PhD, and Sheryl Zimmerman, PhD

OBJECTIVES: To assess family perceptions of communication between physicians and family caregivers of individuals who spent their last month of life in long-term care (LTC) and to identify associations between characteristics of the family caregiver, LTC resident, facility, and physician care with these perceptions.

DESIGN: Retrospective study of family caregivers of persons who died in LTC.

SETTING: Thirty-one nursing homes (NHs) and 94 residential care/assisted living (RC/AL) facilities.

PARTICIPANTS: One family caregiver for each of 440 LTC residents who died (response rate 66.0%) was interviewed 6 weeks to 6 months after the death.

MEASUREMENTS: Demographic and facility characteristics and seven items rating the perception of family caregivers regarding physician–family caregiver communication at the end of life, aggregated into a summary scale, Family Perception of Physician-Family caregiver Communication (FPPFC) (Cronbach alpha=0.96).

RESULTS: Almost half of respondents disagreed that they were kept informed (39.9%), received information about what to expect (49.8%), or understood the doctor (43.1%); the mean FPPFC score (1.73 on a scale from 0 to 3) was slightly above neutral. Linear mixed models showed that family caregivers reporting better FPPFC scores were more likely to have met the physician face to face and to have understood that death was imminent. Daughters and daughters-in-law tended to report poorer communication than other relatives, as did family caregivers of persons who died in NHs than of those who died in RC/AL facilities.

CONCLUSION: Efforts to improve physician communication with families of LTC residents may be promoted using face-to-face meetings between the physician and family caregivers, explanation of the patient's prognosis, and timely conveyance of information about health status changes, especially when a patient is actively dying. J Am Geriatr Soc 2007;55(6):846-856.

Emergence of Rimantadine-Resistant Virus Within 6 Days of Starting Rimantadine Prophylaxis with Oseltamivir Treatment of Symptomatic Cases
Paul J. Drinka, MD, CMD, and Tom Haupt, MS

OBJECTIVES: To report on the detection of rimantadine resistance within 6 days of starting rimantadine prophylaxis.

DESIGN: Observational prospective study.

SETTING: Fifty-bed nursing unit during the 2004/05 influenza season.

PARTICIPANTS: All residents.

INTERVENTION: Clinical monitoring for new onset of respiratory illness followed by collection of nasopharyngeal swabs for Directigen AB testing and influenza culture. After outbreak identification, rimantadine was administered as prophylaxis, whereas oseltamivir was used to treat symptomatic cases. Laboratory monitoring for the emergence of rimantadine resistance was reinitiated on the fifth day of rimantadine prophylaxis.

MEASUREMENTS: Tabulation of respiratory illnesses, rapid tests and cultures yielding influenza A, and rimantadine sensitivity determination in five index isolates.

RESULTS: A total of 15 symptomatic cases were identified over 8 days. Amantadine sensitivity was determined in five cases. Three initial cases were sensitive to rimantadine, whereas two cases identified after 6 days of rimantadine prophylaxis were resistant to rimantadine.

CONCLUSION: The Centers for Disease Control and Prevention reported that 91% of isolates collected early the following season (2005/06) were resistant to rimantadine. Rimantadine treatment is no longer recommended.