Anticipation des troubles respiratoires chez les personnes âgées en fin de vie en établissements d’hébergement pour personnes âgées dépendantes : étude qualitative par entretiens semi-directifs

Abstract : Introduction: the majority of patients that are transferred from residential establishments to the emergency room are due to respiratory disorders. The document « Anticiper les troubles respiratoires des personnes âgées en fin de vie » is meant to help with writing advance care planning (ACP). This study’s aim was to appreciate respiratory disorders anticipation in the elderly in symptomatic palliative and terminal state in nursing homes. Methods: qualitative study through semi-directive interviews with health professionals working in nursing homes. The results were analyzed according to the phenomenological method with the help of NVivo11® software. Results: ten professionals were interviewed from June 2017 to March 2018. The existence of these ACP reassured the family, the nurses of the nursing home and decreased transfers to emergencies. The document was reassuring for the different carers who could use it in nursing homes but suffers from a lack of diffusion. These ACP were therefore not used enough. The palliative culture spread by the coordinating physician allowed, after a dialogue between the various parties involved, to decide on adequate care for patients at the end of their life. The various actors’ collaboration (nursing home’s staff, teams specialized in palliative care and the general practitioner), associated with a satisfactory traceability and information to the families were essential to anticipate respiratory disorders in nursing homes. The lack of identification of palliative care leaded to interventionist cares and hospitalizations. The main obstacles to the use of ACP were the absence of: nurses in nursing homes at night, trained health professionals in palliative cares and general practitioners. Furthermore, there were difficulties in obtaining hospital-delivered products and many doctors and nurses apprehend the use of morphine. Conclusion: respiratory disorders anticipation at the end of life in nursing homes shows a benefit for the patient, his family and caregivers. However, it faces ethical, human and logistical obstacles. Promoting caregivers’ training and the use of ACP would help respect the quality of an ending life.
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Master Thesis
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Clément Spreng. Anticipation des troubles respiratoires chez les personnes âgées en fin de vie en établissements d’hébergement pour personnes âgées dépendantes : étude qualitative par entretiens semi-directifs. Médecine humaine et pathologie. 2018. ⟨dumas-02060752⟩

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